Even though this may be outdated by the time you read this, at the time of writing (Tuesday afternoon) it seems current. Over the last weekend, I have written 4 different versions, each outdated by the time they were proofread. This is just a brief summary: for more information contact me or info@southislandmsa.ca. We will be honest.
Physician Compensation.
Last week I wrote twice to the DoBC, to seek help for physicians who are having to divert from FFS work either to help the organization to prepare for COVID-19, or because of closures. There now has been the announcement of “surge funding” for CLINICAL services for previously contracted groups. There remains the question of whether this can be done retroactively (for March) and what about those groups who are non-contracted yet essential? Also, what about the non-direct-patient-care (yet essential) preparatory and organizational work?
Do the federal announcements have implications, at least for staff and office expense support?
The landscape seems to change daily. To all, please keep track of hours spent in this type of work, so if we can be successful in getting compensation, you can correctly account. I know it might seem silly to ask this on top of all that you are doing, but we will all eventually answer to the accountants.
Facility Engagement Funding.
We have received a wide variety of requests for FEI funds for COVID-19 planning. Although we have to follow the FEI rules, your Executive is interpreting them broadly: We support the use of funds for physician engagement with each other, or with the HA, to address organization of care problems. This general statement offers challenges in implementation, so we have identified some principles to make sure they make sense to us as clinicians now, again knowing that the landscape will be changing. There is no point in preserving engagement dollars when such engagement needs funding, providing the work fits under the engagement rubric. Not everything that we have been asked for does, even if it is “a good idea”, so the Executive has been brainstorming.
In looking at recent requests, we have adopted some priorities for the current situation: because of limited dollars, we may change these as we go along, but they seem to make sense and be fair.
- First, stuff necessary to keep docs safe.
- Secondly, stuff necessary to keep patients safe.
- Thirdly, some departments – or subgroups thereof – are more at risk than others: they get priority.
- Fourthly, priority is given to FFS / non-contract docs; some on APPs can flex their work with less income loss (and may be covered anyway through “surge” contract changes). We need to know if there is any other source of funding for what you do, although the answer may change tomorrow. If so, funds may have to be returned or declined, to avoid suggestions of double dipping. We have been blunt with administration that we are trying to help docs in a time of crisis, and expect that any such concerns will be quickly sorted.
- Fifthly, we will focus (at this time) on activities already done in March: who knows what April may bring? Our advice: again, wash your hands and keep track of your activities
Finally, there are grey areas, we have limited funds, and we will make value judgements as best as we can. Judgements will change as the landscape again changes and we thank you in advance for your understanding.
Things that we have declined include funding regular, recurrent or daily meetings; meeting attendance for the purposes of keeping yourself informed, including at multiple extra-ordinary department / divisional meetings or other rounds; individual literature review; individual training for tele-health. Most of what we reject makes medical sense, but doesn’t fall within our ambit. The same has been true with all FEI project requests: “a medically good idea” is not an adequate requirement for funding.
Keep track of your activities – if funding is available from any source, they will want some justification. Continue to let us know what you are doing; if we can fund it we will happily do so. If we can’t we will tell you, and no harm done.
Safety.
We all have worries, reflected in the questions all of us are asking in microbiology or administration. Without the actual data readily available, non-specific comments like “we have to conserve for next month” do not reduce anxiety. Clear knowledge, and a proposed plan, will defeat rumor; my impression is that some things may be improving – but again, that is said without clear knowledge. We all hear about the challenges of the world-wide competitions. Our administrative colleagues are aware of this too, and are working hard to address this issue. No-one anticipated this situation six months ago, and we are all now scrambling for answers. Doctors are all separately asking the same reasonable questions of the same people, who spend time giving the same answers. To reduce this, we are seeking straightforward to simple questions posted on the Medical Staff website. This should also include a listing of questions posed but which are not yet answered. Attempts to control information have never been helpful. We also must recognize that answers may change over time.
Future Planning.
This will happen again. I sincerely hope there is someone in Medical Affairs writing down, in real time, all the challenges and how we have to address them, so that for Covid-27, there can be a 3-ring binder pulled down so the chief medical administrator of the day can say these are the topics we have to address: this we tried, and it didn’t work, but this we tried and it did. This relatively small investment (in the scheme of things) could have enormous benefits for future administrators and clinicians: maybe a volunteer or patient partner with the necessary skills?