Things to think about before you start planning

Think about this as expanding in-person care, rather than returning to in-person care. For the foreseeable future, and maybe longer, many practices will be hybrid models providing both virtual and in-person care. Visualize them on a spectrum – virtual care on one end, and in-person care on the other.

Physicians decide where our future state lies within the parameters of safe and effective care.

Now and in the future, many of us will fall somewhere along this spectrum. Over time we will move further right along the spectrum based on our comfort levels. If a second wave flows in, we may revert back to more care delivered virtually.

Many factors will contribute to an individual physician’s position along the spectrum:

• your own health, risk factors, and personal circumstances;
• your specialty or focused practice area(s) (some are more amenable to virtual care than others);
• your supply of Personal Protective Equipment (PPE);
• whether your patients can travel, have access to wifi, cellular data, or have enough minutes on their phone plans;
• new information that may come from the Provincial Health Officer, the BCCDC, WorkSafeBC, and others. 

A key factor in where we sit on this spectrum is the availability of PPE. As per guidance from the College, if you do not have appropriate PPE, you are not expected to put yourself, your staff, your colleagues, and your patients at risk. Your ability to access PPE in your community office will vary from region to region and sometimes even from time-to-time owing to complex global factors. Therefore, the type of, number of, and method of how services are delivered either in-person or virtually will vary as well.

Adjusting practices to work for you and your patients

As we gradually expand in-person care, we have the opportunity to reflect and learn from our pre-COVID days and consider what we’d like to improve upon, and what should stay the same. Many physicians will want to maintain some level of virtual care—what will that level be for you? Will you continue to use telephone fees? Maybe even consider group visits?

There are some general concepts we should all keep in mind:

• How we deliver care will continue to evolve with every new learning and discovery related to COVID-19. 
• It will be a long time before we see any semblance of pre-COVID normalcy, if ever.
• Our whole lives have changed, as well as our work, providing us with options to adapt our work lives to better support our home and personal lives.

And there are some more specific thoughts to consider as in-person appointments are increased:

• Think about what has changed—and how you want to practice in the next few months, or years.
• Identify the community services you can leverage to help patients needing care—for example, physical examination clinics for lower COVID risk individuals, higher COVID risk assessment clinics, and COVID testing centres—depending on what is available in your region.
• Develop a rough timeline for the short, medium, and long term. And create a flexible plan that can be scaled up or down depending on the environment, and isn’t reactive. Look at the first 4 months and create a plan, then adapt for the next 12, 18 months, etc. as time goes on.

Consider this:

• It is important to ensure that practices are culturally safe for all British Columbians. The College of Family Physicians has developed Practicing Cultural Safety and Humility in the Response to COVID-19 to help guide physicians.

Related documents and resources:

Official guidelines for physicians to re-open clinics can be found below: 

• The Provincial Health Officer’s order from May 15th; 
• The College’s Guidance on providing in-person care during COVID-19;
• The BCCDC’s COVID-19: Infection Prevention and Control Guidance for Community Based Physicians, Nursing Professionals and Midwives in Clinic Settings;
• WorkSafeBC’s Health Professionals: protocols for returning to operation