September 2009 - President's Letter

President's Letters | Sep 08, 2009

Tuesday, 08 September 2009

Update and Plans for the Coming Year (Sept 2009-May 2010)

Dear Colleagues,

I am sending all members a very much-shortened letter now; and will follow this over the next 2 months with more detailed letters on each of the topics covered succinctly here. This letter is to alert you to the issues we will be addressing at the Executive this year, and invite your Heads and/or Representatives to our open meeting Tuesday, September 22^nd, 0930-1230hrs at the BCMA – please see the attached agenda for details.

Introduction: personal meditations on our interface with Government 2007-09:

Over the last two years we have been working with the Ministry of Health on many fronts, thus aligning ourselves with a larger BCMA strategy of engagement between physicians and government. I am of two minds about the success of this effort. On the one hand we have made progress; progress that those with more years of experience say is remarkably smooth and rapid:

• We have developed working relationships and created trust with the Ministry: members of government are listening to us, trusting our motives, understanding our arguments, and incorporating our recommendations in their policies and documents.

• Our collaboration on overcrowding resulted in a nine-point plan that, if implemented, would do much to address that problem.

• The ED Expert Panel created a report that reinforced and amplified the message of the Overcrowding Collaboration report: the urgent need to solve overcrowding in Emergency Departments.

• Our meetings with Health Minister Abbott and other MoH and Health Authority officials anticipate in content and openness the kind of working relationship we foresee with the establishment of an ED Roundtable (PESAC).

• We can point to many other signs of hope and progress: the P4P program expansion, decreased admitted-patient times in some ED’s (Richmond, LGH), and a determined emphasis in some Health Authorities on unblocking beds.

On the other hand I am frustrated, as many of you are, by the slow pace of change. Regardless: we are where we are. We must build a relationship of trust and mutual respect with a new Health Minister during a period of grim budgetary reality.

Executive: 2009-2010 Let me introduce your SEM executive for this year:

* designates new members

David Haughton (Children’s - BCCH) President & Secretary

Krystaleah Lindsay (St Paul’s - SPH) Treasurer

William Cunningham (Duncan - CDH) Financial Representative

Members-at-Large - with committee responsibilities:

• Andrew Macpherson (Victoria) Overcrowding Task Force (OTF) & VIHA

• Rob Street (Royal Columbian–RCH) Overcrowding Task Force (OTF) & Fraser HA

• Eric Grafstein* (SPH) Overcrowding Task Force (OTF) & Orphaned Patients 

• Michael Ertel (Kelowna–KGH) Chair–FFS Issues/SSPS Representative

• Kris Weibe (Chilliwack ) FFS Issues

• Nick Szpakowitz (Surrey–SGH) Membership & FFS issues

• Patrick Rowe (Prince George) Northern HA & Northern University

• Adam Lund (Royal Columbian–RCH) Website

• Quynh Doan (BCCH) Physician Extenders & Academic Issues

• Riyad Abu-Laban (VGH) Dept of Emergency Medicine, Academic Issues

SEM Executive meeting dates: (all Tuesdays; 0930-1230hrs @ BCMA)

September 22^nd, 2009 & November 24^th, 2009

January 26^th, 2010 & March 23^rd, 2010

Meetings of the executive will remain open to all interested members.

Proposed date of AGM: please pencil this date in to your calendars now.

Monday, May 17^th, 2010:  Conference in a.m.; AGM in afternoon

SEM Budget & remuneration for Executive:

Our membership numbers have grown the last two years.  Last year we increased our membership dues substantially; this increase was reaffirmed by the membership at our April AGM. We will remain prudent, husbanding an adequate war-chest of funds to address sudden legal, negotiation or other crises.  Having said that, the increased funds were agreed to by the membership to allow us to do more work more effectively, and so we plan to.

 The next SEM President: I will serve as President through August 2010, and as past-President for the year following.  Ideally candidates nominated for the May 2010 election should be individuals who have attended SEM executive meetings over the last two years and are versed in the issues facing the Section. 

 Meetings with the Minister & the Emergency Roundtable (PESAC): solving overcrowding & other problems

• I have written a letter asking for an early meeting with Minister Falcon.

• I would suggest that the members of the Overcrowding Task Force (now William Cunningham, Rob Street, Andrew MacPherson, & Eric Grafstein) accompany me, to build on the present process. 

• The ED Overcrowding reports prepared by the MoH (and BCMA for the Collaboration Report and with a BCMA appointee in the case of the ED Expert Panel) are finished. We will ask that these be rolled out/released/acted upon, including initiation of the “pilot projects” on ED Overcrowding.

• Key to many of our endeavors will be the creation of an “Emergency Roundtable” – proposed as the Provincial Emergency Services Advisory Committee (PESAC) in both ED overcrowding reports. We are arguing that we should have a significant involvement with health care transformation; that we can help the Ministry protect clinical services and make their delivery more effective. PESAC could serve, as GPAC does with Family Medicine/General Practice, to plan future directions in provincial emergency care and systems through a collaborative effort, and, by solving problems for government, set the scene for the resolution of all our other issues, including future negotiations.

FFS  issues

Audits: I have written to the BCMA, to ask them to engage with us in addressing with government our several concerns.

Consensus on billing practice: We need to avoid complacency: only meticulous documentation of our work and subsequent appropriately aggressive billing confirms our FFS and APP income levels. Consequently, it might make sense for all Emergency Physicians to sit down, review the preambles, and agree on the spirit and interpretation within which the codes should be used. We can thereby begin to create a consensus standard.

Guidelines for prompt payment: a discussion with government: We need feedback from FFS Emergency docs: Are your problems with delays and arbitrary billing rejections worsening or steady over the last few years?

New Fees: There is funding within the recent Master Agreement for new fee items that has yet to be used. I am hoping to move this issue forward this year.

SSPS & SSC: Michael Ertel sits as our representative on the SSPS (I also attend as an observer).  The pre-election deal between government and the BCMA gives specialists additional $$$ under the control of a new joint MoH/BCMA committee, the SSC, modeled after the successful GPSC. The monies are to be put toward new fee items (or enhanced old ones) that will encourage behaviors by specialists that enhance patient flow & access to care. Any ideas?

Starting the 2012 negotiation cycle.

The key to success is being at the table. That is how we have successfully represented your interests the last few years. William Cunningham deserves much of the credit for this, and he continues to make a huge time commitment on our behalf. Michael Ertel has put his name forward to represent us on the SSPS negotiations committee, which will also be a large amount of time and effort.

 APP issues

EMC/Workload Model (WLM): Our present EMC Memorandum of Agreement expires next March 2010. The spirit with which government approaches the EMC in the next 8 months will do much to determine whether it is renewed or we return to a site-by-site negotiation process that sucks up time, energy and political capital.

The physician representatives on the EMC and Tod MacPherson will meet with all site leaders and/or their representatives after our September 22 SEM Executive meeting from 1300-1500 in the afternoon to review the figures. Then, barring changes, they will meet with the full EMC (Government & Health Authority representatives) at the end of September to decide what will be done this year and moving forward.

Template Contract:  There has been no movement on the new template contract for Emergency.  Some in government retain a hope that they can renegotiate the definition of our FTE that has been set for almost a decade: 1340 direct + up to 340 indirect. Eliminate the “up to”, get groups to invoice all “indirect hours” and cut funding to health authorities if less than 340 hours of indirect work/FTE is invoiced; these are the methods that seem to have been chosen. We must all be very vigilant on this issue.

Update for Pediatric Emergency Group

No change. Our old contract was renewed in April for another 6 months.

UBC Department of Emergency Medicine

Faculty Appointments: Anyone teaching or training Medical Students or post-graduate trainees (residents) should apply for and receive an appointment in UBC Faculty of Medicine under your chosen Department (Family Practice, Surgery, Emergency Medicine or Pediatrics). This protects you medical-legally should a patient suffer and/or complain cared for by you and a trainee.

The UBC contract to Clinical Faculty is not necessary for your appointment. You should read it carefully, negotiate clear terms with your Department, and clarify/amend/detail/revise it before signing it.

Headship Search: The search process is underway for the first Head of the Department of Emergency Medicine. Whoever is selected will need to build upon the topography of the political landscape of British Columbia. Issues of importance will be fundraising for academic positions in research and education, maintaining the yearly Ministry of Health funding stream, integrating and supporting the central large sites while also providing support and energy to the smaller peripheral sites, establishing a departmental governance structure and creating a transparent budgetary process. Applicants from outside British Columbia will need to adjust to the reality of funding here: unlike some other provinces the clinical funding envelope is separate from the (much smaller) non-clinical funding. Our Department Head will have control only over the small academic funding envelope.

Messages from the Department of Emergency Medicine:

Research Day March 31^st, 2010  …. Save the date!

Full Faculty meeting for the Department of Emergency Medicine

will be held on:  September 15, 2009 @ 1000-1200 hrs

Diamond Health Care Centre Room 2263 (Vancouver General)

Videoconferencing Sites:

§  Surrey Memorial Hospital Room 1752

§  Prince George Regional Hospital Room 5011

§  Royal Jubilee Hospital, Victoria, Room 130

§  Royal Inland Hospital, Kamloops, Room TBA

§  Nanaimo Regional General Hospital, Room G244

Teleconferencing Info for March 31st: 

Toll-free Dial in Number:

1-866-211-8005        Conference ID PIN: 6678685533   #   

Press 1 to begin Conference Call

All faculty are encouraged to attend one of the videoconferencing sites. If you are unable to attend in person, please call the toll-free teleconference line. 

Membership Update:

Plea to recalcitrant Emergency Physicians who have yet to join the Section of Emergency Medicine (you know who you are):  please contribute to the effort we make representing your economic and political interests. Please join the Section. BCMA members can join online the BCMA website www.bcma.org with a credit card, or by completing the attached formand mailing a cheque. Non-BCMA members may also join the Section - please see instructions on the attached form. The more who join the stronger we are as a profession. 

We will be updating our membership lists site by site in the next 2 months. Please be proactive and urge your new colleagues (and some old colleagues) to join.

Sincerely,

David Haughton

President, BCMA Section of Emergency Medicine

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