Issue: BCMJ, Vol. 59,
page(s) 123-124 Premise
Kevin Wade, CD, MD, CCFP
As a recent UBC graduate and new-in-practice family physician, I read with interest the 2014 articles on changes to medical staff privileging by Dr Slater and Ms Bloch-Hansen, and Dr Avery and colleagues.[1-3]
Given that 2 years have passed since these articles were published, a recapitulation of the privileging process may be in order. The process described in those articles is, in essence, iterative, with the suggestion that the dictionaries will not be perfect and will be improved over time. The experiences of new practitioners in family medicine, especially those of us working as locums in rural family medicine, unfortunately, do not bear out this early promise.
The privileging process itself is burdensome, bound by red tape and requirements for exhaustive resubmission of documentation to multiple health authorities and, separately, to the College. There is no recognition of previously submitted forms and, despite the provincial mandate of privileging, communication between health authorities is apparently nonexistent. Woe betide the locum who would choose to work in both Merritt (Interior Health) and Hope (Fraser Health), for this necessitates duplication of hours of paperwork, and seeking documents that were already provided when obtaining College registration.
Recent criticism of the privileging project focused on the inherent flaws of minimum-volume credentialing, particularly in a rural setting. To these concerns I would add my own about the additional administrative burdens placed on physicians by the privileging project. This concern is particularly acute for new physicians working as locums. In the 4 months since I completed residency, I have received more than 100 e-mails from the privileging assistants at various hospitals where I will work and live. I have sent an equal number. The time and burden has been quite shocking.
Each new locum seems to generate a new request, each with its own peculiarities. At one hospital I needed to provide all of the licensing information that I had just submitted to the College as a graduating resident. At another within the same health authority I was given a privileging dictionary, submitted it, only to have it denied because the physician I am covering does not have those privileges. Now, as I participate in the rural locum program further afield, a completely new application with new documentation is required by two other health authorities. Administrative burdens were identified as “the most consistent and vexing concerns we heard about the business of being a family doctor,” by the Institute for Health System Transformation and Sustainability, and the privileging project represents a dramatic increase in that burden for many new family physicians.
In their provincial review of licensure, credentialing, and privileging that forms the basis of the Provincial Privileging Project, KPMG specifically identified concerns that the BC locum program “has potential to be used inappropriately as some physicians could view it as a licence to practise without formally obtaining privileges.” While this may be a concern, it also provides locums and medical care to rural British Columbians. These services are being subsumed by the bureaucracy of privileging on the assumption that the best way to avoid substandard care is not to deliver care at all.
I propose that something closer to the original ideal would be a set of portable privileges that can be transferred from hospital to hospital, lasting for at least 1 year to minimize the administrative burden of repeat privileging applications. Fortunately, a framework for such a system already exists. It is called a medical licence.