Update on Reopening of Clinic Offices

May 15, 2020

Dear Colleagues,

As we head into this May long weekend, we are marking a milestone in the provincial response to COVID-19. By now, you should have received guidance on how to provide in-person care in your clinics from the College of Physicians and Surgeons, including guidelines developed by the PHO, Ministry of Health, BCCDC and WorkSafeBC. The documents are also available on our COVID-19 resource page.

This is part of a gradual lifting of restrictions that is taking place more broadly in BC. Doctors of BC and the Ministry of Health advise that there is no expectation that Family Physicians and Specialists with community offices must reopen the doors to their clinics on the morning of May 19th. It will take time to ensure the necessary precautions are in place for patients, physicians, and other medical staff to remain safe, while at the same time continuing to provide care to patients. We encourage physicians to continue to use virtual care as appropriate while making changes to their workflow. 

The Big Picture

Our experience during this pandemic will mean long-term changes in how patient care is delivered, given that the pandemic risk will continue for the foreseeable future. As a profession, we need to envision how we can safely and effectively provide access to care for our patients while maintaining sustainable practices. This presents an opportunity for all our members to be part of a significant shift in the way care will be delivered. Doctors of BC will play an active role in engaging with you on this work over the next several months.

With virtual care likely to be an integral part of the way we work over the longer term, we encourage you to refer to some new resources provided by the Doctors Technology Office on best practices to providing virtual care. The Getting Patients Back to Practice Guide provides workflow recommendations, sample communications templates, and tips on how to rebuild patient volume. You can also view the recording of a recent online session Getting Patients Back to Practice and Navigating the New Norm.

There remain many uncertainties and challenges associated with this novel coronavirus, particularly as we see infection rates recurring in some countries where people are returning to work. As we move toward our new reality, we recognize that there are immediate challenges for physicians that need to be addressed. Access to personal protective equipment is problematic worldwide. Supply chains normally afforded to community physicians are no longer reliably able to deliver these important resources. While we are seeing some successes at the community level with PPE distribution to community offices, this continues to be a source of considerable stress for physicians. 

Providing Care to All Patients

Doctors of BC has heard from members who are concerned they are not able to meet the needs of all their patients. For some physicians, the pandemic has significantly affected your ability to safely provide services to them. One of the hard realities of COVID-19 is that a number of you will continue to see patient volumes that are lower than usual for the foreseeable future. This is concerning to all of us as we know not all patients are receiving the care they need.

As a profession, we must continue to rise to this challenge and design innovative ways to bring our practice capacity high enough to meet patient demand. Government must also rise to the occasion. The temporary fee codes for telehealth have enabled fee-for-service work to continue virtually, however this payment model does not address the needs of all physicians. 

Doctors of BC and the provincial government are working on a process to provide optional contracts to remunerate physicians who anticipate continued lower volumes. These contracts should enable physicians to sustain their practices while they adjust their workflow to treat increasing numbers of patients in the pandemic environment.  These contracts will be a temporary, optional payment method for physician during the pandemic. They will not replace all of your lost income, but rather provide a stable income.

As you are aware, government can offer contracts under the current Physician Master Agreement (PMA) without the agreement of Doctors of BC. However, government is consulting with us on the terms of these contracts. Once these contracts are offered, it will be up to individual physicians to determine whether to enter into such an arrangement, stay with FFS, or enter into a longer-term Alternative Payment Subsidiary Agreements (APSA) where available. Government has indicated support for the greater use of longer-term APSA contracts, including offering such contracts to family practitioners in certain circumstances.

More information on these options should be forthcoming in the next few weeks. As you can imagine, government has been dealing with an overwhelming number of issues during the emergency limiting its ability to engage with us. I hope that you can continue to have patience on this front. 

I want to acknowledge the commitment and professionalism of so many physicians who are working through this difficult time to serve patients and the health care system. Our success to date has only been possible with your tremendous dedication. We are truly all in this together and together we will prevail. 

Kathleen Ross, MD
President, Doctors of BC – 2019/2020