Thread by @DrRitaMc

I am on call for my primary care clinic this week...

What does that mean?

A 🧵 about how
our fee for service (soon to be "group contract") clinic
of 16 clinicians, ~15,000 patients
delivers afterhours #BCPrimaryCare

@BCFamilyDoctors

Our MDs and NPs are on call for one week at a time.

Between 5pm-8am weekdays and all weekend,
we need to be ready to
support patients for
URGENT, not emergency issues
that cannot wait until the next business day

that means phone close by at all times

People call appropriately for:

e.g. sick baby with fever, to figure out does she need to go to emergency or can stay home

or

e.g. strained back shoveling snow and want to know what can do to alleviate pain

I can bill a "telehealth visit: 14x37"
~32$ for call + documentation

Sometimes people call hoping for:
✖️an appointment the next day, or
✖️something in their chart or
✖️renew a medication that is coming due in the next few weeks.

This is not what the service is for & this kind of request is why we have our fabulous admin staff.

I ask people to leave a voicemail with their name, contact and brief description of their issue.

I get to my computer, open up their chart and get a bit of background info about who they are, before I call them.

Emergencies should be calling 911, not me!

After I speak to the person & give advice
I write a detailed note
often with a direct message back to their usual MD
I might also need to print a prescription
find the pharmacy fax number
fax a prescription to the pharmacy &
make sure it gets there

Each call takes me ~30-60 min

I usually get 1-6 calls per day, a total of ~20 in a week.

This week is much busier

People are frantic, burnt out from the pandemic. Unsure about how to handle return to school, "typical cold symptoms", etc.

Myself,
I find the anticipation
of being called at any time
very taxing

while I only have to do it
3-5 weeks a year,
it adds a significant layer of stress to my work.

I wish that we could plan for those weeks and reduce or stop all other work, but that is not feasible

In our current #BCPrimaryCare setup,
we are all working flat out
doing the patient visits, virtual and in person

then we add on:
-pandemic response
-IT support
-HR/Lease mgt of office space and employees
-staying up to date on medical treatments
-being peer-reviewed by @CPSBC

Ideally, we would be able to describe all the necessary work to plan, deliver and improve #BCPrimaryCare, hire the best-qualified people, and ensure everyone has a sustainable, healthy work environment.

This would require clinic-based funding (instead of paying for everything via paid to MD fees).

Like how a school gets funds for its building, and operations and then based on the community needs, the teachers and support staff are hired.

The lack of this infrastructure is one reason for the persistent "family doctor shortage".

Imagine we graduated new teachers
& said, please go organize yourself
with other teachers
& start a school.
We will pay you per lesson delivered/child.

Bananas, right?
@BCFamilyDoctors

Providing after-hours care is a requirement of licensure to practice medicine in BC.

Some types of care, by some types of doctors have time paid for (plus billing per visit).

This is called "MOCAP", but it is not available to family doctors. www2.gov.bc.ca/gov/content/he…

I'm glad to speak to the patients
& when possible reassure them,
or avoid a trip to Emerg.

But I am not sure this model of care is sustainable, healthcare workers are getting BURNT OUT.
Real rest and breaks,
v. layering on more work is needed.

Maybe UPCCs are the answer.

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