FAQ

Currently, family doctors are either contracted through Island Health or individual physicians in private practice. This model will be a community-led initiative, governed and operated by the Cowichan Valley Primary Care Society, an entity which will be more effective in responding to healthcare priorities of the Cowichan Valley as well as to the challenges that family doctors face in this stressful and changing landscape of community Family Medicine. The Society would be accountable, therefore, not only to residents of the Cowichan Valley but also to ensuring a better quality of life and practice environment for Cowichan Valley family physicians.

A community governed Board which fosters strong partnerships and has diverse representation will help us to prioritize and plan health care services that address the unique needs of various populations in our community in a culturally sensitive way. The Society has already formed partnerships with key stakeholders in our community within the health care and business sectors, as well as with local government and other non-profit organizations. These partnerships will foster collaboration on healthcare initiatives that will benefit Cowichan Valley residents and will also enable the Society to access resources, funding and other opportunities that will help us achieve our goals.

A not-for-profit model will also ensure that the initiative will remain true to the Society’s Mission and Values, promoting the Community’s best interests and responding to the needs of our family doctors by channeling any added resources or ‘profit’ back into further expanding our vision.

The Cowichan Valley Primary Care Society is incorporated and governed by the Societies Act of British Columbia. It is a separate not-for-profit organization solely focused on improving primary care for the residents of the Cowichan Valley and improving the practices and lives of the providers who deliver that care. The Society is governed by a board of directors (the Board) that is currently made up of a cross-section of family physicians who practice in the Valley. The Society is also supported by an Advisory Group of community leaders who provide advice and feedback to the Society on its development. During Phase 1, the plan will be to expand the Board of Directors to include community representatives/leaders drawn from the Advisory Group. The Board will institute and oversee a hiring process for an executive director, who will be responsible for the day-to-day operations of the Society and its clinics.

The Board will be a cross-section of community and physician leaders, selected for their commitment to the mission of the Society. Board members will include primary care providers, initially from the “start-up clinics”, as well as community representatives/leaders drawn from the Advisory Group. The Board will establish a governance sub-committee which will be responsible for the on-going recruitment of new board members as well as the evaluation of the performance of the board and how to continually improve its functioning. There will be term-limits for directors and on-going renewal of the board to help ensure that it operates effectively, with fair representation of primary care providers and clinics in the Cowichan Valley.

The Society will assume administrative operations of each of its clinics, lifting this burden from primary care providers and allowing them to focus on their professional practices and delivering care to their patients. The Society Executive Director will have responsibility for ensuring the effective operation of each clinic and will work with on-site Clinic Managers and/or Medical Directors to ensure that there are opportunities for clinics to have input and provide feedback to the Society and that unique clinic needs are addressed. Examples of some of the functions/roles that the Society could assume are as follows:

• Recruiting and retention of medical office assistants (MOAs) and other staff

• Creating and reviewing contracts with new hires (staff or PCP's)

• Providing IT support and oversight and enabling bulk purchases of equipment and supplies, taking full advantage of economies of scale

• Negotiating and managing EMR contracts and fees

• Negotiating leases, managing lease responsibilities and communicating with landlords

• Managing and paying staff payroll and benefits

• Ordering supplies

• Defining and managing Privacy Officer protocols

• Managing and renewing clinic insurance

• Hiring and managing cleaners

• Disposing of files/charts securely

• Overseeing accounting and bookkeeping

The current primary care model of private, fee-for-service group or solo practices - each clinic running as its own small business with family doctors having to be lease-holders and managers -is not appealing to new grads for a number of reasons. Many of these doctors do not want to take on the enormous administrative burdens of owning and running a business, especially in these uncertain times, opting to do other work rather than committing to looking after a panel of patients.

One of the Society’s key roles will be to remove the burden of practice management, business ownership and lease-holding from family physicians, while offering flexible contracts that respect the unique needs of each primary care provider and that support PCPs to work in other sub-specialty areas of interest, while also working in longitudinal primary care.

The creation of an organizational model that supports a large group of family physicians, working in a number of clinics within the community, will result in an expanded base of income from a diverse range of practitioners and allied health professionals, while also increasing efficiencies through economies of scale (ie. bulk purchasing of supplies and equipment). In addition to providing greater stability to primary care in the Cowichan valley, this type of organizational structure will have built-in resilience because it will be more easily able to adapt to a primary care system that is everchanging.

Within the proposed model of primary care, family physicians would have the option to practice within “Pods of Primary Care”, in which 5 to 7 Primary Care Providers would share the care of their joint patient panels which would vary in size according to the unique needs and specialized interests of each PCP. Members of a pod would provide coverage for each others’ out-of-clinic time, whether for work or other reasons. Each PCP Pod would be supported by and support a team of allied health professionals which would include but not be limited to a RN, MOA, panel manager, social worker, clinical pharmacist and others. Team Based Care will help to address the ever-expanding role of the family doctor by divesting them of many tasks that are more appropriately and efficiently done by other team members.

The Board will work with physicians in the Start-Up Clinics to appoint a Medical Director or lead physician for each clinic that it operates. Each clinic would also have an on-site Clinic Manager who would work with the Medical Director and with individual primary care providers in their clinic to ensure that practice requirements and administrative needs are being met effectively and that the clinic is running smoothly. The on-site Clinic Manager and Medical Director would respond to issues as they arise that are specific to their clinic, thus preserving clinic autonomy and culture. The Medical Director and on-site Clinic Manager roles under the Society would not differ very much from how they currently function within individual clinics except that, from time to time, they would also communicate with Medical Directors and Clinic Managers from other clinics, as well as with the Executive Director who would oversee higher level operations of all the clinics, working closely with Clinic Managers.

Family Physicians will experience reductions in administrative time and better quality of life as a result of this initiative. This work will lead to a more joyful and sustainable primary care provider workforce. It is expected that new-to-practice Family Physicians will see this model as a desirable way to enter into longitudinal family practice. By reducing administrative and lease-holding burdens and working within Pods of Care, it is hoped that physicians will have greater capacity to support one another to continue to care for their patients in hospital. Near retirement-age physicians will also find this model to be attractive, allowing them to work longer in a supportive, part time way. This initiative will also allow the expansion of team-based care which will introduce physicians to the strengths of other team members including nurse practitioners.

The overall desired outcome of this initiative is the stabilization of primary care in the Cowichan Valley. It is hoped that this initiative will maintain and grow existing family practices and allow innovative new models of care to emerge that will be attractive to new grads and to current family physicians who have not wanted to enter longitudinal practice. Over time, this will result in a reduction in the number of “unattached” patients in the Cowichan Valley which will result in a reduction of unnecessary emergency department visits and hospital admissions and readmissions.

One of the most concerning impacts that is being observed as a result of increasing administrative burdens and physician-burnout, is an increasing number of family doctors giving up their roles as Most Responsible Physician (MRP), looking after their own hospital in-patients, leaving an increasing number of patients admitted to hospital without a MRP to look after them. The MRP role has had to be delegated to other family doctors and at times, specialists, in order for the patient to receive care. A strongly desired outcome of this initiative is that it will not only increase the number of family doctors taking on panels of patients in the community, it will also increase the capacity of physicians to continue to care for their patients in hospital.