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



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



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



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).



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.



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



Appendix A

Audience Response

System Results

Please note:

Data in RED font = lost data with estimated responses

Data in BLUE font = actual responses



On a scale of 1-10 rate your satisfaction with the experience of providing in hospital care for your patients

(1=low, 10= high)



Do you provide obstetrics care?

1. Yes 60% 2. No 40%



I plan on retiring or leaving family practice in next?



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%



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%



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%



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%



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%



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%



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%



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%



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%



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%



Compensation Office work is better paid than hospital work on an hourly basis.

1. True 96% 2. False 4%



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%



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%



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%



Please indicate which of the themes related to provision of In-patients care is most important to you:



Please indicate which of the themes related to provision of In-patients care is are secondly most important to you:



Please indicate which of the themes related to provision of In-patients care are thirdly most important to you:



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



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



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



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



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



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.



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.



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



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!



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.



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



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.



Report prepared for Dr Jeanne Mace by:

Tristan Smith

Executive Director




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



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?

_______________________________________________________________________________

_______________________________________________________________________________



_______________________________________________________________________________

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?

_______________________________________________________________________________

_______________________________________________________________________________

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Thanks again for your help,

Dr Jeanne Mace



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



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



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



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

central okanagan division of family practice. 2010 annual report

Documents

local family physicians

care of patients

provision of inpatient

provision of inpatient

exit survey results

active privileges

appendix c

hospitalist members