Central Okanagan Division of Family Practice. 2010 annual report
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Transcript of Central Okanagan Division of Family Practice. 2010 annual report
Summary Report
Family Physicians and
Inpatient Care
April 2011
Prepared by:
Tristan Smith Executive Director Central Okanagan Division of Family Practice
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 2 www.divisionsbc.ca/cod
Table of Contents
1 Summary Report …………………………………………………………….. 3-6
1.1 Introduction …………………………………………………………… 3
1.2 Objective ………………………………………………………………… 3
1.3 Process …………………………………………………………………… 3-4
1.4 Results ……………………………………………………………………. 4
1.4.1 Challenges ……………………………………………………… 4-5
1.4.2 Benefits …………………………………………………………. 5
1.4.3 Ideal work environment ………………………………… 6
1.5 Conclusion ………………………………………………………………. 6
2 Appendices ………………………………………………………………………. 8-48
2.1 Appendix A- Audience Response System Results … 8-28
2.2 Appendix B- Facilitators Summary Report ........... 29-35
2.3 Appendix C- March 8th Meeting Evaluations ...…….. 36-37
2.4 Appendix D- Summary Report KGH Exit Survey ….. 38-48
2.4.1 Summary Report …………………………………………… 38-41
2.4.2 Exit Survey …………………………………………………….. 42-44
2.4.3 Exit Survey Results ……………………………………….. 45-48
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 3 www.divisionsbc.ca/cod
Introduction
The Central Okanagan Division of Family Practice (COD) is a non-profit society governed by local
family physicians who identify areas to improve care of patients with its members and work with
partners towards solutions and results.
Following membership engagement and strategic planning, our board supported initiating a
conversation regarding provision of inpatient care by family physicians.
At Kelowna General Hospital (KGH) the majority of general practice care is provided through
Hospitalists and Family Physicians with active privileges. Both Hospitalists and Family Physicians
are members of our Division.
After consultation with our board and discussions with one of our hospitalist members, it was
decided to begin the conversation with family physicians who have active privileges and then
extend the conversation to our other members and stakeholders.
Objective
Summarize discussions to date related to identifying and validating challenges and benefits to
family physicians that provide inpatient care for their patients.
Process
The COD developed a steering committee to lead this process including: Dr Rob Williams (board
executive), Dr Jeanne Mace (board member), Tristan Smith (COD Executive Director) and Anita
Bakker (facilitator).
Documentation was attained from the Ministry of Health Services titled “A Review of BC Models of
In-Patient Care” dated February 23, 2011. From this document, common themes of challenges,
barriers and benefits were identified.
Meeting date of March 8th was set and invitations went out to all family physicians that had active
privileges at the time, which numbered 59.
The meeting was organized into four components:
1. General introductory questions
2. Identify and validate challenges to providing inpatient care using PowerPoint
questions and an Audience Response System (ARS).
3. Identify and validate benefits to physicians to provide inpatient care for their patients
4. Describe the ideal scenario for provision of inpatient care
In the past, physician meetings regarding challenges to provision of in-patient care seemed to
result in low morale, decreased satisfaction and commitment to working in the hospital. To avoid
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 4 www.divisionsbc.ca/cod
this outcome, it was decided to use ARS and vote on the most common challenges as presented in
the Ministry of Health Services document “A Review of the BC Models of Inpatient Care.”
The remainder of our meeting was a facilitated discussion regarding the benefits of family practice
providing inpatient care and describing an ideal working environment.
Physicians also had the opportunity to provide written feedback individually.
SW Audio was hired to manage the ARS, however due to their computer problems, the majority of
our data was lost after the meeting. The COD board met after learning about the loss of data,
reviewed each question and provided estimates to the answers to each question. Please refer to
appendix A where collected data and estimated data are separated and identified.
Results
Attendance for the meeting included 47 out of a total of 59 physicians who had active privileges at
KGH.
Introductory Questions
General Gauge of the audience (appendix A):
Majority of physicians felt they were satisfied with the experience by providing inpatient
care (estimated majority of answers 7 out of 10).
Slightly more than half of the participants also covered obstetrics.
The majority of the audience plans to retire in more than 5 years.
Challenges
The main issues facing family physicians providing inpatient care are (appendix A):
Impact on lifestyle: call group functionality, evenings
Compensation: comparatively poorer rate of pay, no on call pay
Disruptions at the office: non urgent, inappropriate or misguided calls
Effective/efficient communication: on ward staff, access to clinical data, and access to
equipment.
Parking
When asked what makes KGH different from other hospitals, the three themes within the answers
were: 1) high rate of change in the hospital and area (IH reorganizations, Construction), 2)
disjointed mapping of hospital (4A to 4E to ER to rehab to Psyc), 3) lack of Residents for a more
robust coverage of patient needs (appendix B).
In general, a visit to the hospital that starts with difficulty finding parking, traversing through a
disjointed hospital to visit multiple wards, having difficulty finding necessary clinical information
and knowledgeable staff for questions, gives the impression that family physicians work in an
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 5 www.divisionsbc.ca/cod
environment that is unorganized, unsupportive and leaves them at times feeling not respected and
poorly remunerated.
These findings are supported by a parallel process initiated by Dr Jeanne Mace (KGH Medical
Advisory Committee and COD Board Member) who collected an exit survey of physicians that
recently gave up privileges (appendix D). The major findings from the exit survey are:
Remuneration (equity with MOCAP, time for rounds, rejected billings), Quality of Life (morale, job
satisfaction, respect) and Efficiency (access to patients/ knowledgeable staff/ charts).
March 8th meeting evaluations showed that when asked if challenges for providing in hospital care
were accurately summarized, 96% (28/30) of physicians either agreed or strongly agreed
(appendix C).
Benefits
Physicians agreed there were mutual benefits to their patients and themselves to providing
inpatient care. Three key themes that emerged from the discussion were: 1) maintaining and
building clinical skills, 2) improved patient care and 3) sense of purpose (appendix B).
The majority of physicians felt that maintaining privileges offered an opportunity to maintain
clinical skills by involvement with complicated cases, opportunities to work closely with specialists
and attend educational events.
There was a strong sense that patients cared for by their family physicians received better care due
to the trust established between themselves and their patients. Family physicians have knowledge
of patient’s history, family history and environmental/social circumstances, which can lead to
avoidance of redundant or unnecessary tests, procedures, medications and can support appropriate
discharge planning.
One physician offered his story:
Dr B had a heart failure patient whom he visited one morning at the hospital. His patient said she
had a cardiac catheter procedure and the cardiologist mentioned to her she was leaving the
hospital. She was planning for home. In fact she was being transferred to a coastal hospital for
urgent bypass surgery. The minimum time spent explaining this to the patient by the cardiologist
and the complexity of language he used left the patient unaware and confused. Through an
established relationship, Dr B was able to explain the circumstance to his patient, which resulted in
an informed, less anxious patient being prepared for cardiac surgery.
Finally, the majority of physicians felt a sense of belonging, purpose and loyalty to patients when
providing inpatient care. One quote seemed to resonate with the group “I feel like I belong to a
community.”
March 8th evaluation summary showed that when asked if the benefits for providing in hospital care
were accurately summarized during table conversations 93% (28/30) either agreed or strongly
agreed (appendix C).
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 6 www.divisionsbc.ca/cod
An Ideal Work Environment
We provided an opportunity for physicians to describe an ideal situation when visiting their patients
in the hospital. Themes that evolved from the discussion (appendix B) were:
Effective Communication - hospital staff, consultants, clinical data
Respect – hospital staff, consultants, remuneration that is fair
Access – patients, privacy, charts, charge nurses and parking
A sample visit to the hospital may look like this according to our discussion:
Dr Smith drives to the hospital in good weather experiencing little traffic and finds a parking spot
without trouble. The patient census provided is correct and complete. All inpatients are in the
same building, in their beds, comfortably. The charge nurse is available and informed. Clinical
data is updated and easy to find; chart is available and intact. Nurse for rounds is available and
informed. Consultant’s notes are accessible, legible, and identifiable and provide required
information. Exam equipment is available and easy to find. Computers are available when required
for ordering and updating. Leave the hospital before office hours start, finding car in convenient
parking space knowing that hospital staff will contact the office only for necessary advice. Fees
submitted and paid without hassles (no billing rejections due to specialists or others billing MRP
status). On call coverage and remuneration is appropriate and allows quality of life with my family.
Conclusion
Family Physicians who maintain active privileges at Kelowna General Hospital feel they provide a
valuable service to their patients. Most also feel a strong sense of community and purpose by
providing inpatient care. Physicians also feel they maintain clinical skills working at KGH through
closer relationships with specialists and attending continuing medical education events.
The physicians at our meeting collectively described the challenges to providing care to their
patients when admitted at KGH. Three key themes identified were:
Access: patients, privacy, charts, computers, clinical data, parking,
Efficiency: disjointed hospital, incorrect inpatient census, on-call functionality,
knowledgeable and accessible charge nurse, in office disruptions (call-ins, phone calls,
returned pages),
Respect: staff communications, adequate compensation.
The majority of physicians who attended the meeting plan to continue providing inpatient care for
their patients despite challenges. The evaluation summary from March 8th showed that when
asked if interested in meeting again about this topic, 74% (20/27) either agreed or strongly agreed
(appendix C).
The COD is looking forward to collaborating with our partners and hospitalist members in efforts to
better patient care and increase work satisfaction with respect to provision of care at KGH.
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 7 www.divisionsbc.ca/cod
Appendices
A. Central Okanagan Division of Family Practice - challenges to providing inpatient care Audience
Response System
B. Facilitators report- Summary Document of Discussions
C. March 8th 2011 Meeting Evaluation Summary
D. Summary Report: Family Physician Exit Survey
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 8 www.divisionsbc.ca/cod
Appendix A
Audience Response
System Results
Please note:
Data in RED font = lost data with estimated responses
Data in BLUE font = actual responses
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 9 www.divisionsbc.ca/cod
On a scale of 1-10 rate your satisfaction with the experience of providing in hospital care for your patients
(1=low, 10= high)
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 10 www.divisionsbc.ca/cod
Do you provide obstetrics care?
1. Yes 60% 2. No 40%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 11 www.divisionsbc.ca/cod
I plan on retiring or leaving family practice in next?
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 12 www.divisionsbc.ca/cod
Validation of challenges to provision of in-patient care for family practice physicians
Specialists co-managing care with family physicians
Do you feel that specialists adequately communicate with you regarding management of your patient? (discharge, Rx changes, transfer of MRP status)
1. Yes 60% 2. No 40%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 13 www.divisionsbc.ca/cod
Specialists co-managing care with family physicians
Do you feel adequately supported by specialists in the management of complex patients?
1. Yes 70% 2. No 30%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 14 www.divisionsbc.ca/cod
Office Disruptions
The Most Responsible Physician (MRP) also maintains an office practice and is frequently interrupted for phone calls from the wards, and occasionally the urgent need to leave in order to attend a sick inpatient.
1. True 90% 2. False 10%
True False
10%
90%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 15 www.divisionsbc.ca/cod
Office Disruptions
Effective phone communication with hospital staff can be very difficult, when a FP calls the ward or returns a page it is often the case that: no-one answers the phone.
1. True 20% 2. False 80%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 16 www.divisionsbc.ca/cod
Office Disruptions
Effective phone communication with hospital staff can be very difficult, when a FP calls the ward or returns a page it is often the case that: no-one knows who paged
1. True 30% 2. False 70%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 17 www.divisionsbc.ca/cod
Office Disruptions
Effective phone communication with hospital staff can be very difficult, when a FP calls the ward or returns a page it is often the case that: the person who paged is not available, and no-one else can speak to the issue
1. True 40% 2. False 60%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 18 www.divisionsbc.ca/cod
Office Disruptions
Effective phone communication with hospital staff can be very difficult, when a FP calls the ward or returns a page it is often the case that: the person who paged is available but unable to answer any questions about the; time is wasted gathering information that staff should have on hand before paging the physician
1. True 80% 2. False 20%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 19 www.divisionsbc.ca/cod
On Ward Communications
When you get to the ward and you need information: the patient’s nurse is away on break, busy, or has just assumed care of the patient and claims no knowledge of the case or the patient’s clinical trends; there is no identified charge nurse who is up to date on the patients problems and plans and is available to speak with the MRP during morning patient rounds.
1. Yes 80% 2. No 20%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 20 www.divisionsbc.ca/cod
Impact & Lifestyle
The demands of being on call for one’s own inpatients and for those of one’s group on a call weekend are considerable, especially with no remuneration for time on-call?
1. Yes 90% 2. No 10%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 21 www.divisionsbc.ca/cod
Impact & Lifestyle
The impact on sleep, family and social life, and one’s peace of mind are considerable. Being woken up nightly to address patient issues can further exacerbate the issue: “Did I deal with that phone call appropriately - am I missing something?”
1. True 80% 2. False 20%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 22 www.divisionsbc.ca/cod
Compensation Office work is better paid than hospital work on an hourly basis.
1. True 96% 2. False 4%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 23 www.divisionsbc.ca/cod
Compensation
Fee-for-service remuneration for a call weekend is unpredictable; not all the billings are accepted; some patients are over the MSP limits; frequent billing rejections for patients who have had a procedure and then MRP transferred to family doc or for patients with nephrology involvement.
1. True 90% 2. False 10%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 24 www.divisionsbc.ca/cod
Compensation
Much of the work is not remunerated. For example, there is no payment for the numerous phone calls/faxes that take place or for discussions with family members.
1. True 90% 2. False 10%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 25 www.divisionsbc.ca/cod
Other Related Issues
Simply getting a parking spot at the hospital can be a major challenge. Given the time pressure under which physicians operate, this alone can be a major disincentive to maintaining hospital privileges.
1. True 73% 2. False 27%
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 26 www.divisionsbc.ca/cod
Please indicate which of the themes related to provision of In-patients care is most important to you:
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 27 www.divisionsbc.ca/cod
Please indicate which of the themes related to provision of In-patients care is are secondly most important to you:
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 28 www.divisionsbc.ca/cod
Please indicate which of the themes related to provision of In-patients care are thirdly most important to you:
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 29 www.divisionsbc.ca/cod
Appendix B
Facilitator’s Summary Report
March 8th, 2011
Purpose:
Start the conversation to keep and attract active physicians with hospital privileges at KGH.
Desired Outcomes:
Work collaboratively to...
Bring issues to the table
Engage members – we need all voices, all perspectives
Validate what is known and hear what is unique
Issues Unique to Kelowna
The question asked:
What are the issues that haven’t been touched on that are unique to Kelowna?
Rate of change
Large hospital but no med students/Residents
“scut work”, ie phone calls
$ “undervalued” (ie orphaned pts $300) ...This response received spontaneous applause
Hallway assessments
Privacy/dignity...This response received spontaneous applause
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 30 www.divisionsbc.ca/cod
Lifestyle/work hours
Better use of resident for after-hours call (care)
Disjointed hospital, patients all over
Consultants don’t take referrals directly from GPs but send patient to ER
Construction problems barriers for our patients
Perfect Hospital Visit
The question asked:
How would you define the “perfect” hospital visit/experience?
Traffic okay
Parking spot close – good parking spot
Coffee, Welcome – personal greeting with information boards
Charge nurse available and informed
No memos on chart
Patient comfortable in appropriate bed
Head nurse/assigned to GP
BS and VS data easily accessible
Chart together and accessible – no students borrowing
Legible consult note written or available
Latest lab available
Helpful ward clerk
Easy access to computer
Sinks available
Patients close together on dedicated wards
Less crowded ward for student teaching done in appropriate area
Attentive nurse for rounds
Adequate exam equipment
Rapid order processing and reporting
Helpful ward clerk
No telephone tag with consultant
Payment of all billings
Be notified before visits
Availability of patient (patient in bed), staff, vitals, results, place to examine
Chart available
Accompanied by nurse
Tests get done
Patients should be in ward between 8 & 9
Privacy – appropriate place to examine
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 31 www.divisionsbc.ca/cod
Respect for GP as MRP
Knowing RNs or which RN is looking after your patient
All patients [on ward] where nurse manager greets doc by name and knows the patient and
care issues
Pt chart, bedside chart and blood sugars in consistent place
Updated ER computer board so that we can find our patients
Discussion with specialist done with first phone call in a timely fashion (no telephone tag)
Patients on my list are my patients and all my patients in hospital are on my list
I get appropriate calls for my patients, with no call schedule errors or overdone pages
When paged, all relevant info has been gathered and the correct nurse is available
One ward to visit
Privacy to examine and talk to patients
Results and consults on chart, chart in spot, charts organized the same on all floors, blood
glucose on chart.
Labs available at 8am
Communication or ongoing plan from consultants
Consultants identifying themselves in notes
Consultants follow-up on their results
Reply from consultant as to when they will see our patient
Locate patient and chart
Current VS
In room (not hallway)
Head nurse - “Carrie” [representing exemplary professional]
Labs available
Ward clerk helpful consistent location
Computers available
Telephone conversation
List of patients MRP correct
Patients on one ward
Labs available at 8:00
BS available
Parking spot
Students not with charts and in way
Sinks in rooms
Appropriate MRP
ER admissions – find/chart
Patient privacy
Control over patient’s admission (or not)
I leave the hospital for my convenient parking spot!
*Get paid for the visit *without hassles
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 32 www.divisionsbc.ca/cod
Model of What Is Working Well
(Elements from “Perfect Hospital Visit”)
Communication
Charge RN
Information available
Direct idea of plan
Collateral
Suggestions ie PT/OT
Consistent
Know the patient
Well written notes
Charge nurse/PCC knows patients
Each patient in room, same gender
Specialists available on phone
Convenient parking days billings paid
Charts organized the same
Spec. FUP on results, see patients in timely fashion
Room/Terminals available
Notified of admissions, unstable patients
Respect for GP as MRP in tests ordered get same priority as specialist orders
On ward communication varies per ward – [some] are smaller and communication is better
Issues & Challenges
Switchboard errors in paging need to be addressed
Inappropriate discharge requests ie in code purple
Need direct admit to resume
Trend: calls from LPNs increasing
Different patient info kept in different places on charts etc. (eg vitals, glucometers, etc.)
Lack of charge nurses on some wards
Book with photos of medical staff with names would help us all know who to look for
We never know if specialist bills MRP care (may be listed as MRP with GP) – specialist bill
always takes precedent
Frustration with how powerless we often feel when trying to get patients admitted or
procedures done.
ER physicians/specialists have far more power to make decisions when we are often in the
better position to make decisions regarding our patients. Often decisions are made on our
patients and we are the last to find out or our patients tell us.
Fix the parking by making the Royal St. Parking 2 Hr. only
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 33 www.divisionsbc.ca/cod
If I am late answering a call to 862-4009, I call and the switchboard has no idea where the
call came from ie. What ward called me.
Inappropriate pressure from TN to discharge patients when not medically appropriate.
No stethoscopes on ward for E.M
Why Do We Stay?
The question asked:
What is drawing you, in your practice to provide in-hospital care for your patients?
Continuity of care
Positive feedback
In touch with colleagues
Education and learning
Patients avoid unnecessary care
Feels good
Sense of responsibility
Able to explain t patient better
Skills not available in office
Personal mental health
Camaraderie
Better patient care
Challenging and interesting
Feel part of community
Contribution – add to care
Facilitate conversations with specialists, etc.
Keep in touch with specialists and colleagues
Altruism
Because I deliver babies
Loyalty to patient
What could keep me there...parking – close and free!
Patients know us and trust us – we feel good providing continuity of care
Help facilitate communication/understanding between specialists and patients
Maintain skills
Keep relationships with specialists/colleagues
Important part of total patient care
Part of the continuity of care
Role modelling – part of our training
Helps to maintain certain skill sets
Supportive camaraderie of your colleagues – mental health
Maintain and support acquaintance with specialists which pays dividends
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 34 www.divisionsbc.ca/cod
Brings a long term knowledge to aging and palliative patients
Altruism – knowing the system will crumble without us
Believing that eventually we are going to be recognized for our efforts
Better patient care
Feedback from patients – increased respect
Challenging and interesting work
In touch with colleagues and specialists
Feel more a part of the medical community/team
Educational opportunities
Change from office drudgery
Helping patients avoid unnecessary care – direct their care appropriately eg to palliative
care
We have a lot to add – long term knowledge of patient and family
Patient satisfaction and appreciation
Change of scenery
Ongoing learning
Collegiality with family docs/specialists – more personal relationships/familiarity gets better
care for patients
CME rounds for those of us who can go
Additional Feedback - General
Why Would I Quit?
Because I’m poorly remunerated
Because I’m disrespected
o By nurses
o By consultants
o By IHA
So far, the $ doesn’t matter to me
I find enough respect in the people I work with
It’s IHA’s attitude to Full Service FPs that’s the problem. Eventually will be too much despite the
value I may bring.
Most specialists work well with FPs. Some you have to chase. Not a big problem.
Most wards function well if you avoid the staff breaks. Staff need to prepare prior to phone calls
– 50% do!
I hear that (vascular? 5X?) team has done nurse education sessions to prevent “unhelpful”
pages, teaching nurses how to solve common problems and the info the doc will need at the
time of the call.
Would there be a future stipend for GPs with privileges, similar to the GP-OB quarterly stipend
for being part of call group?
Regarding on ward communication – ++ variability dependent on floor -
Call backs – [some] staff exemplary in being informed and helpful with patient care and
problems. [Some] staff very prepared/helpful.
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 35 www.divisionsbc.ca/cod
Hospital experience remains quite collegial in the face of all the changes in infrastructure.
It remains a great privilege to provide care to my patients in hospital – people I know and care
for, and who are grateful for my care. A key factor for patient care going forward is continuity.
DOD: patients sent to GP be suitable for GP care out of hospital for the day (my last DOD
wound up as a direct to ICU after I talked to specialist)
Do we need a call group for DOD?
On KGH in patient list: MRP needs to follow up with billings such that doc billing MRP can
have the late night calls etc.
Note:
* Any references to “Model Wards” and noted “Best Experiences” must be taken in the context of
this discussion. There is no disrespect for areas not mentioned; those noted were simply identified
as areas that are examples to look at for what is working well in relation to the experiences of this
participant group. There may be many factors that create this experience that might be respectfully
examined.
This was articulated by a participant physician and was supported through spontaneous applause
by the group.
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 36 www.divisionsbc.ca/cod
Appendix C
Evaluation of Meeting: March 8th, 2011
1. This meeting time and location was suitable 28 yes no 2
2. Division of Family Practice Activities Update, I found this information worthwhile
30 yes no
For the next meeting, I would like more information on:
low risk obstetrics (x2), radiology (x2), billing (x2), in hospital billings being
rejected.
3. Did you find the clicker questions summarized challenges on providing inpatient care for your
patients?
28 yes 2 no If no, did you provide written feedback for us? yes
1) most important issue was lack of patient privacy and lack to availability of patient
between 8-9am
2) questions were a bit too general/simplistic
3) organisation of charts critical
Please circle the appropriate response Strongly
agree Agree Disagree
Strongly
disagree
4. Challenges for providing in hospital care
were summarized 17 12 1
5. Benefits for providing in hospital care
were summarized during table
conversations
14 14 2
6. We had enough time for
discussion/questions 12 15 2
7. I would be interested in meeting again
about this topic 7 13 5 2
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 37 www.divisionsbc.ca/cod
8. For my needs, the length of today’s session was:
1) 30 Appropriate 2) Excessive 3) Insufficient
9. For the next members meeting I would like to learn more about? (specific CME, billing tutorials,
other)
CME, need more beds for our patients in the community to drain off the hospital beds,
keep focused topics relevant.
Additional Comments/Questions/Feedback (please use back of page)
Good venue, good food, great turnout - good for morale!
Meeting closer to Westside please
Plenty of time given for positive comments, time needed to be given to raise
concerns too!
Accessing Mental Health Services in Kelowna (?) and getting contact #s from
community care given when they write to us about our patients and say “if you
have any questions just call me” without a phone number!
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 38 www.divisionsbc.ca/cod
Appendix D
Summary Report
Family Physician Exit Survey
Kelowna General Hospital
April 2011
Introduction
Over the past 18 months approximately 30 family physicians have given up Active Privileges at
Kelowna General Hospital (KGH). Currently there are approximately 62 physicians with Active
Privileges out of an estimated 160 physicians in the community.
In the fall of 2010, Dr Jeanne Mace, through discussions at the KGH Medical Advisory Committee
and the Central Okanagan Division of Family Practice, felt it would be useful to gather information
from family physicians that have recently given up Active Privileges. Dr Mace developed an “Exit
Survey” (appendix A) and in January 2011 sent the survey to approximately 30 physicians.
The survey is divided into two sections. The first section is a table where respondents were able to
rate how the listed issues influenced their decision to give up hospital privileges. This section is
followed by an open-ended question asking what issues were missed and gave an opportunity to
expand answers. The second section included 6 open-ended questions (see appendix A).
Objective
To better understand why family physicians have given up Active Privileges at Kelowna General
Hospital.
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 39 www.divisionsbc.ca/cod
Results
The Exit Survey was sent to approximately 30 physicians; 16 returned their surveys (results
summary Appendix B). Out of the 16 respondents, 11/16 completed and returned both sides to
the survey, only 6/16 answered every question.
Section 1:
Three major issues that influenced a physician to give up active privileges were:
Financial (not worth your time)
Lack of Job Satisfaction
Poor Morale
Issues that did not or somewhat effected decisions to give up privileges included:
Too much call
Not able to maintain call group
Cut backs
Organizational climate of IH (politics)
When asked, “Please list other reasons you can think of, or expand on, any of the above (table
questions),” the challenges to providing inpatient coverage included:
MOCAP On call Inequity (not respectful)
Time it takes to cover patients in hospital, feeling rushed
On Call Coverage
Office Interruptions
Billings “scooped” by specialists
Section 2 - Open-Ended Questions
Specific challenges to ward rounds include:
Lack of charge nurse
RN unable to answer questions regarding patients
Difficulty finding patients and charts in the morning
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 40 www.divisionsbc.ca/cod
What physicians missed about maintaining active privileges:
Collegiality
Working with specialists and nurses
Caring for patients when they are most seriously ill
Three questions asked for clarity regarding measures that could attract physicians back
to working in the hospital. The major themes to the answers included:
Improved afterhours call system
Efficient ward rounds/Respect
Remuneration (Finances)
Survey respondents who plan on retiring in the next 5 years were:
No 6
Probably 3
Yes 2
The 6 physicians who responded NO to retiring in the next 5 years also indicated interest in
returning to KGH.
Conclusion
Over the past 18 months, a significant number of family physicians have given up Active Privileges
at KGH.
Exit Survey results reflect some of the challenges to providing inpatient care. The major themes
found in this survey are:
Remuneration (time for rounds, MOCAP inequity and rejected billings)
Quality of work life (morale, job satisfaction, respect)
Efficiency (access to patients/knowledgeable staff /charts)
These findings are similar to the themes from the Central Okanagan Division of Family Practice
meeting held with physicians who maintain Active Privileges on March 8th, 2011.
Physicians who do not plan on retiring in the next five years indicated a willingness to consider
returning to KGH with Active Privileges. The findings from this survey may be helpful to the KGH
Medical Advisory Committee or the Central Okanagan Division of Family Practice when considering
how to support family physicians that choose to care for their patients admitted at KGH.
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 41 www.divisionsbc.ca/cod
Report prepared for Dr Jeanne Mace by:
Tristan Smith
Executive Director
Central Okanagan Division of Family Practice
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 42 www.divisionsbc.ca/cod
Physician to Physician
“Exit Survey”
Many Family Physicians have given up their Active Privileges at KGH in the last few years for a
variety of reasons. As a member of the MAC and a board member of the Divisions of Family
Practice I would like to better understand these reasons. After gathering your responses I will
generate a report and present it to the Central Okanagan Division of Family Practice and the
Kelowna General Hospital Medical Advisory Committee.
I thank you in advance for your time and interest. Please if you have any questions, do not
hesitate to contact me. If you would like a copy of the final report please provide your email or fax
number.
Once you have completed the attached questionnaire please fax it to my residential fax number
xxxxxxx.
Or leave it in my hospital mailbox.
Sincerely,
Dr Jeanne Mace
1. There are usually multiple reasons why a physician chooses to give up full hospital privileges.
Please mark the following as they influenced your decision:
Not at all Somewhat Very much so One of the main
reasons
Too much call
Not able to maintain call group
Unable to get locum coverage for
holidays
Parking problems
Financial (not worth your time)
Part of retirement
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 43 www.divisionsbc.ca/cod
Personal reasons
Workload demands
Concerns about handling
complex patients w/o support
Hospitalists provide good inpt
care (good alternative)
Lack of control over pt care
Lack of job satisfaction
Lack of collegiality
Poor morale
Cost containment efforts by IH
Organizational climate of IH
(politics)
Please list any other reasons you can think of or expand on any of the above:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Did you find the ward rounds frustrating for any specific reasons? Ie no charge nurse or floor
pharmacist
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
What do you miss about no longer having Active Privileges?
_______________________________________________________________________________
_______________________________________________________________________________
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 44 www.divisionsbc.ca/cod
_______________________________________________________________________________
What, if anything, would bring you back to carrying full Active Privileges?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Would having an on-call service to sign out to for weekend or holiday coverage help to bring you
back?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Would being paid more for hospital rounds bring you back?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Do you plan to retire in the next 5 years?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Thanks again for your help,
Dr Jeanne Mace
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 45 www.divisionsbc.ca/cod
Exit Survey Results
1. There are usually multiple reasons why a physician chooses to give up full hospital privileges.
Please mark the following as they influenced your decision:
Not at all Somewhat Very much so One of the
main reasons
Too much call 8 3 1
Not able to maintain call group 7 2 2 2
Unable to get locum coverage for
holidays 4 6 1 4
Parking problems 6 3 4 2
Financial (not worth your time) 1 3 7 4
Part of retirement 9 6
Personal reasons 6 3 1 2
Workload demands 4 2 5 3
Concerns about handling
complex patients w/o support 5 2 5 3
Hospitalists provide good in-
patient care (good alternative) 4 3 7 2
Lack of control over pt care 5 4 6
Lack of job satisfaction 4 6 5
Lack of collegiality 3 4 3 4
Poor morale 5 1 7 3
Cost containment efforts by IH 11 2 1
Organizational climate of IH
(politics) 7 4 2 2
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 46 www.divisionsbc.ca/cod
Please list any other reasons you can think of or expand on any of the above:
2 tiered system for on call, specialists get on call pay but not GPs- insulting
My office is 30 minutes from hospital, not working in hospital saves me over 1 hour per day
(same pay)
Frustration in delay with unavailable specialists or specialists who don’t see complex
patients daily
MOCAP- since when is specialists’ time more valuable than GPs time. The specialists will get
paid more than GPs but we are not anywhere near that now. It was frustrating being called
after midnight about a specialist issue when they are being paid to be on call and I am not
As a solo practitioner it is difficult to get a locum to cover with hospital privileges
No financial assistance when being on call
Instances where patients admitted via ER to ward without notification. Patient deteriorated
through the night and subsequently difficult to manage the next morning when you are
designated as MRP.
Having to round on patients from one end of the hospital to the other.
Complex cases, lots of interruptions in my office (calls), the weight of 35 years of being on-
call, no remuneration or respect in the face of every specialists receiving at least some
MOCAP for on call, we GPs do a really good job that is not really valued. Wear and tear
effect.
Called for trivial things often at late hours
Called for other groups patients sometimes!
Being MRP for patients who should be the responsibility of a specialist
No call pay for grueling call weekend. Being treated like a resident to do scut work for all
internal medicine services except cardiology. Fighting with MSP for billings scooped by
specialists.
Did you find the ward rounds frustrating for any specific reasons? I.e. no charge nurse or
floor pharmacist?
Generally wasn’t a problem when I was still in hospital
Yes, nursing often indicates that they don’t know the patient when asked a question specific
to the patient.
Yes, at times RN just started shift, no knowledge of patient, they want to send pt home
from ward that specialist was covering
No charge nurse is frustrating, often no one on ward seems to know who you are or why
you are there
Travel time to office was approaching 30-45 minutes. Needed to do rounds at 0630-0800 in
order to be in office at 0830. Patients sleeping, away for tests, nursing shift change over
etc made it difficult to access patients. Then at 0900-1200 hours office being interrupted by
wards re: orders, test results, discharge etc…
Difficulty finding patient charts and bedside charts, lack of charting by RNs
No charge nurse
Felt rushed because had to get to the office
Yes, struggle to find a nurse who knows condition of patient
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 47 www.divisionsbc.ca/cod
Little help from head nurses on many wards
The hospital staff would continually call the wrong person. They could not figure out- call
the GP during weekdays 24-7 and then call the call guy on weekends. They continually
called the wrong person. I think this is because GPs and Specialists set up call differently
What do you miss about no longer having Active Privileges?
I miss the headaches and long rives in the morning- NOT
Interaction with specialists and nursing staff
Very little
Nothing
Less contact with other docs
Nothing: maybe interaction with colleagues
Interaction with colleagues
Ability to admit an unwell patient (rarely happened anyway, but twice in 10 years there
was actually beds and I could bypass ER)
Hospital care
Nothing
Being involved with my patients when they are the most seriously ill
What, if anything, would bring you back to carrying full Active Privileges?
Nothing will bring me back to the full time hospital privileges at this point
I have found the “new arrangement” great, with a marked reduction in after
hours/weekend call (by 80%)
Nothing
Nothing
Nothing at this stage
n/a
Not sure if its possible
More beds so easier to admit, (billing) codes to allow rounding twice daily
Parking, collegiality
Finances, being MRP for patients with a general family medicine problem
Nothing
Would having an on-call service to sign out to for weekend or holiday coverage help to
bring you back?
No, we had a functioning call group before our whole office withdrew from the hospital
I would consider this
No
Central Okanagan Division of Family Practice
An initiative of the GPSC June 13, 2011 48 www.divisionsbc.ca/cod
No
Possibly
n/a
Would be a start
May help
Yes
No
Not likely
Would being paid more for hospital rounds bring you back?
No
No
No
No
Possibly
Wouldn’t hurt. Time spent managing hospital patients was the least cost effective part of
my career
Recognizing that GPs invest their time being on call just like all call groups. I’m not sure
I agree with on call stipends in general but once you’ve done it for some, you have to do
it for all. We’re doormats to accept anything but equality with all groups
For second visits routinely
Yes
Possibly
Not likely, although a good idea - long overdue
Do you plan to retire in the next 5 years?
No 6
Probably 3
Yes 2