We have read the commentary from Drs Avery, Boyd, Iglesias, Johnston, Klein, Ruddiman, and Woollard [BCMJ 2014;56:326-327 [4]] with some concern. We accept that change engenders fear, but we disagree with the assertions made. The privileging dictionary project is only one of a larger suite of projects to address credentialing and privileging activities across the health system. In responding to the concerns raised we appeal to hope and to a better future for the physicians of this province. We anticipate, once implemented, the privileging dictionary project will grant physicians the opportunity to enter into conversations regarding the supports they need to maintain and exercise the skills employed in clinical practice. In undertaking this work (56 expert panels participating), we have consulted widely with practitioners from all disciplines, with boards of governance, and with administrators across the province, and we are using what we have learned to articulate the guiding principles below. While these guiding principles are not the reason this project was initiated, they are a beneficial by-product.

First, all practitioners in the province should feel supported in clinical practice. While a certain skill set is required for each medical staff position in the province, many physicians are reluctant to discuss their level of comfort performing these skills. This project creates a safe environment and context for this to occur and for discussions on how comfort may be maintained or restored.

Second, we must not confuse currency with competency. The training colleges are only now beginning to address the challenge of defining competence for the practising physician. We are interested in this issue, but it is beyond the scope of our project. Other initiatives will address competency.

Third, currency is an estimate of the level of activity below which a collegial discussion about support should be triggered. It is not a disqualifier. This discussion should be guided not only by the expectations and standards outlined in the dictionary but also by the risks inherent in the privilege being discussed and by similar activities that contribute to the skill under consideration. This is an opportunity to reflect with a respected colleague on one's professional practice and to deliberately plan an approach to skills maintenance.

Lastly, we do understand that the dictionaries being developed will need maintenance and improvement. This is an iterative process; its implementation will be closely monitored by the province, the colleges, and the health authorities. Any unintended consequences will be addressed quickly.

In the absence of a comprehensive strategy of support, rural health care has continued to face difficulties. Some may assert that our approach will lead to physicians leaving rural health. We point out that this is already happening and we believe that a planned and collaborative approach to maintaining skills may be part of the solution.

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This article has been peer reviewed.