PROVINCE UNVEILS PROGRAM MEANT TO KEEP DOCTORS IN ER
OSOYOOS TIMES-July 20, 2011
By Paul Everest – Osoyoos Times
Oliver’s South Okanagan General Hospital can now apply for up to $200,000 per year in provincial cash to help keep doctors in its emergency room under a new $10 million government program aimed at helping rural communities.
The province announced on July 18 that groups of “rural, fee-for-service physicians who commit to work as a team to ensure reliable public access to emergency services at their rural community hospital” can apply for the $200,000.
The announcement comes after local doctors, Boundary-Similkameen MLA John Slater and the mayors of Osoyoos, Oliver and Keremeos approached B.C. Health Minister Michael de Jong to discuss ways to keep doctors working in regional emergency rooms.
This spring, doctors who staff the Oliver hospital’s emergency room sent a request to the province asking for a new program for paying emergency room physicians.
Doctors taking shifts in the emergency room have been paid under a fee-for-service system where they receive a fee for each patient they see.
But since doctors from other areas such as Penticton receive a flat fee or salary for the time they work in an emergency room, it’s difficult for the hospital to attract out-of-area doctors to cover shifts at the hospital or to recruit new doctors to the Osoyoos-Oliver area.
It’s also often uneconomical for local doctors to work in the emergency room since at certain times of the year such as the winter, the volume of patients at the hospital would not provide adequate compensation for a doctor compared to the amount of money he or she would make at their practice.
The doctors’ request was turned down and last month the hospital’s emergency room physicians created a contingency plan for the provision of emergency services this summer.
Because of understaffing problems in the emergency room, part of the plan included having no doctor working the emergency department on certain Tuesdays and Thursdays in August and September between 8 a.m. and 6 p.m.
Under the plan, a doctor would be called in on those days to provide treatment to people at risk of dying, but all other people suffering non-life-threatening illnesses and injuries would have been seen by a nurse and then taken by ambulance to Penticton or referred to their local family doctor.
Slater said he is certain that the funding announcement from the province means there will be no days when the hospital’s emergency room doesn’t have a doctor.
With this provincial cash, he added, the hospital will be able to offer doctors a set rate that is similar to a salary for working an emergency room shift instead of the fee-for-service system.
This way, the Osoyoos-Oliver area will be able to offer a better incentive to doctors to move to this area, doctors already living here will have more incentive to cover an emergency room shift and the hospital will have an easier time attracting a doctor from another area such as Penticton to cover a shift at the hospital, Slater said.
Part of the reason behind the funding announcement, he said, is the ministry’s aim to equalize payment programs for emergency room doctors across the province in order to improve patient access to rural emergency services.
But, he added, the $10 million pledge from the government is only a short-term fix.
Last month, a ministry spokesman said the ministry and the BC Medical Association had committed $20 million to expand access to physician services in rural and remote communities, with a particular emphasis on emergency care.
Slater said that commitment was cut in half because the ministry and the association will monitor how this new program works and decide whether to expand or alter it in the future.
The new program was created by the Joint Standing Committee on Rural (JSC) issues, a body made up of representatives of the provincial government and the association.
The committee will begin accepting applications for the money immediately and the cash will be distributed to successful applicants through the regional health authority.
Ministry spokesman Ryan Jabs said it would be up to the hospital and Interior Health to determine how the cash would be best allocated here.
According to a ministry media release, examples of how the cash might be used include the hiring of additional full-time or part-time doctors, bringing in more locums, offering more incentives for weekend, holiday or night shift coverage of the emergency room, hiring other health-care service providers such as nurses or buying equipment.
Dr. Steven Evans, president of the hospital’s medical staff, said that while he sees the program as a positive step forward, he’s concerned about some of the “strings attached.”
For example, he said, one of the criteria for receiving cash through the program is a condition that an emergency room is staffed by a doctor 24 hours a day, seven days a week and 365 days a year despite illness or doctors taking holidays.
According to documents from the British Columbia Medical Association, should a hospital’s emergency room doctors “be unable to provide reliable public access to hospital ER services throughout the calendar year, the payments under this program are forfeited.”
“I suspect this is unlikely to fly very far or provide the benefits intended because of the restrictive nature of the funds,” Evans said. “For example, you have four physicians in a small community and one leaves so the others must continue to work every day and then another becomes ill and so the remaining two work half-days on call or lose all the funds previously paid within the last year?
“How will this work?”
The association documents do state, however, that the joint committee “recognizes that there may be situations of, for example, unexpected illness of a physician, where the (emergency department) Group is unable to complete 24/7/365 public access. The JSC may consider exceptions in these situations on an individual, case-by-case basis.”
Evans also expressed doubt that the program would allow the hospital to bring in doctors from other areas since they would still be making less money here.
“I do not know if this money will be sufficient to induce the physicians in Penticton to provide additional support as the difference between their income and this supplement when combined with our average still leaves us short.”