Re: Stop, collaborate, and listen

Thank you, Dr Chahal, for your editorial “Stop, collaborate, and listen” [BCMJ 2024;66:5]. I would suggest that many of us in family medicine and beyond have been doing this for many years, and now that we have the Longitudinal Family Physician Payment Model, we can dust off some of the projects we’ve dreamed about for years that stalled and failed due to inadequate remuneration.

Here in Victoria, we have been collaborating and listening since the formation of the Victoria Division of Family Practice 13 years ago. We started with great excitement and ambition, and our community benefited enormously from the new collegiality. How many meetings did I attend in which family physicians were paid by the Ministry of Health to sit down to collaborate with each other, our specialist colleagues, and our health authority? Unfortunately, as the years rolled by, it became apparent that many of the wonderful ideas and projects that we created could not be sustained. The basic element of remuneration to sustain the time to communicate was missing, even if we painstakingly (and expensively) managed to make changes to the system to enable this communication. There was no investment in sustainable action.

For example, my colleagues and I created a care transitions committee 13 years ago to address the communication gaps our patients experience as they transition into and out of acute care. For the last 8 years we have worked with our health authority and EMR vendors to create the primary care provider patient summary, a document created by primary care physicians and uploaded into the hospital EMR. To incentivize the work, our Shared Care Committee funder paid family physicians a modest fee to create these thoughtful documents. The summaries flowed for three iterations over 7 years, and we collected good data, which showed their value to patient care.

The bad news is that, despite our best efforts, we could not find a way to sustain remuneration of this work under the fee-for-service model. When the money dried up, the summaries stopped flowing, and they currently remain at a trickle. The new Longitudinal Family Physician Payment Model has given us hope, and my colleagues and I are working with BC’s Digital Health Strategy to create a provincial system that will allow this sort of information exchange for everyone.

I imagine there are many collaborative projects around BC that can now be dusted off, revitalized, and hopefully sustained. I look forward to hearing what they may be!
—Lisa Veres, MD
Victoria

This letter was submitted in response to “Stop, collaborate, and listen.”

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