11/1/2018

1

What is the capacity and current support for

rural emergency services?

The BC Landscape.

Julian Marsden June 7 2018

Objectives

1. Describe one aspect of EM care in BC.

2. Introduce potential research opportunities.

2014 BC Emergency Physician

Workforce and Training Survey

Chantel Archibald

Jim Christenson MD, FRCPC

Julian Marsden MD, CCFP(EM)

Disclosure Slide

Relationships with commercial interests:

Grants/Research Support: None

Speakers Bureau/Honoraria: None

Consulting Fees: None

Other biases:

CCFP(EM) residency trained

Former CCFP(EM) Program Director

Only worked in urban EM

Survey of ED physician leaders in BC to:

1. Estimate the current number of physicians caring for patients in EDs;

2. Understand the certification relevant to EM; and

3. Estimate physicians practicing primarily EM or in combination with family practice.

4. Estimate the shortfall in emergency physicians now and in 3 and 5 years;

Methods

1. 2013: List of BC’s hospitals from BC MoH website

2. Each hospital was then contacted to confirm that they had a functioning ED:

“An area of the hospital that provided acute care of patients who presented without prior appointment, either by their own means or by ambulance.”

3. Name & contact information for MD leader of ED

4. 2014: Email survey x 3 with phone follow-up as needed

11/1/2018

2

1) Your'Name:''

2) Your'hospital:''

3) Your'preferred'phone'number:''

4) Currently,'how'many'individual'physicians'care'for'patients'in'your'emergency'department?''

5) Ideally'how'many'more'physician'staff'do'you'need?''

6) How'many'physicians'in'your'department'work'only'in'emergency'medicine?'(could'include'emergency'administration,'education'or'research??''

7) How'many'physicians'in'your'department'practice'emergency'medicine'in'combination'with'Family'Medicine'or'General'Practice?''

8) How'many'emergency'practitioners'in'your'department'have'post'graduate'certification'in'emergency'medicine?''

9) How'many'of'those'have'certification'with'the'Royal'College'EM?''

10) 'How many have certification with the Canadian College of Family Practice

EM? '''

11) How'many'have'certification'with'the American'Board'in'EM?'''

12) How'many'physicians'in'your'department'have'taken'other'Enhanced'Skills'Training'in'Emergency'Medicine?'''

13) Please'try'and'estimate'how'many'new'physicians'you'will'need'in'your'emergency'department'in 3'years'(2016)'''

14) Please'try'and'estimate'how'many'new'physicians'you'will'need'in'your'emergency'department'in'5'years'(2018)'?'''

15) 'Please'add'any'questions'or'comments''''Thanks'again'for'your'time'and'help.'

One p

age s

urv

ey

Results

ED Physician Numbers: Full-time & Part-time

0

200

400

600

800

1000

1200

BCCH Fraser Interior Island Northern VCH/PHC Total

NumberofMD’s

#ofPhysiciansPracticingintheED

#PracticingonlyEmergencyMedicine

#CombinedwithFamilyPractice

1056

HealthAuthority

0

200

400

600

800

1000

1200

Fraser Interior Island Northern VCH/PHC TOTAL

38186

70 14150

485

156

85

9821 179

539

Nu

mb

er o

f M

D’s

Health Authority

# Without EM Certification

# With EM Certification

EM Certification

1024

229162168271194

Known Certification

0

50

100

150

200

250

300

350

400

Fraser Interior Island Northern VCH/PHC Total

4119 17

1

72

150

111

6479

19

104

377

6 4 3 218

33

NumberofMD's

HealthAuthority

FRCP-EM CCFP(EM) ABEM

560

Estimated Physician Shortfall

199

287

399

2014 2017 2019

NumberofMD's Total

VCH/PHC

Northern

Island

Interior

Fraser

450

400

350

300

250

200

150

100

50

0

11/1/2018

3

Limitations

1. Results relied on estimates of site leads: Survey bias

Physicians with variable involvement with ED

2. Some physicians work at multiple sites: Active and provisional numbers similar in FHA

3. Physician numbers not FTE numbers Different work/life balance probably exists between

communities

4. Estimating future demand was left entirely to the

responder’s discretion.

1. Certification breakdown by type of site

2. Number of patients seen: with/without EM certification

Post Survey Analysis

30%

62%

8% 3%

43%54%

Certification Breakdown by Site Type

1% 7%

91%

CCFP(EM) FRCP-EM

1°FM/EM: 56 Sites

412 MD’s

Both EM & FM/EM

12 Sites

148 MD’s

1° EM: 24 Sites

464 MD’s

Neither Certification

2013-14 Visit Numbers = wide range

-

20,000

40,000

60,000

80,000

100,000

120,000

Port

Alice

Hosp

ita

l

Ste

wart

Gene

ral H

osp

ital

Ba

rrie

re H

ealth C

entr

e

St. B

art

holo

mew

's H

ealth C

entr

e

No

rthern

Haid

a G

waii H

osp

ita

l and H

ealth C

ent

re

Bella C

oo

la G

enera

l H

osp

ita

l

Queen C

harlott

e Isla

nds

Genera

l H

osp

ita

l

Dr. H

elm

cken

Mem

ori

al H

osp

ital

R.W

. La

rge M

em

ori

al H

osp

ita

l

Sp

arw

ood

Hea

lth

Centr

e

Arr

ow

La

kes

Hosp

ital

Che

main

us H

ea

lth

Care

Centr

e

Pem

bert

on D

and

T C

ent

re

Stu

art

Lake H

osp

ita

l

Fort

Nels

on

Genera

l H

osp

ita

l

Queen V

icto

ria

Hosp

ita

l

Port

Ha

rdy H

osp

ita

l

St. J

ohn

Hosp

ita

l

Lady M

into

/G

ulf

Isla

nds

Hosp

ita

l

Fra

ser

Ca

nyon

Hosp

ital

Lake

s D

istr

ict

Hosp

ita

l and H

ea

lth C

ent

re

Ko

ote

nay L

ake H

osp

ita

l

Elk

Va

lley H

osp

ital

Bound

ary

Hosp

ital

Cre

ston

Va

lley H

osp

ita

l

Ko

ote

nay B

ounda

ry R

egio

nal H

osp

ita

l

South

Okanag

an G

enera

l H

osp

ita

l

Pow

ell

Riv

er

Genera

l H

osp

ita

l

Shus

wa

p L

ake G

enera

l H

osp

ital

Roya

l Ju

bilee H

osp

ita

l

Whistler

D a

nd T

Centr

e

East

Koote

nay R

egio

nal H

osp

ita

l

Daw

son

Cre

ek A

nd D

istr

ict H

osp

ita

l

Fort

St. J

ohn

Genera

l H

osp

ita

l

Mount

Sa

int Jo

sep

h's

Delta H

osp

ital

Pentict

on R

eg

ional

Ho

spital

Vern

on J

ubilee H

osp

ital

The

Univ

ers

ity H

osp

ita

l of

Nort

hern

British

…

Eag

le R

idg

e H

osp

ita

l and H

ea

lth

Care

Centr

e

Ric

hm

ond H

osp

ital

Vic

tori

a G

ene

ral H

osp

ital

Lions

Gate

Hosp

ita

l

Roya

l In

land H

osp

ital

Ke

low

na G

ene

ral H

osp

ital

Burn

ab

y H

osp

ital

Vanco

uve

r G

ene

ral H

osp

ital

Average = 22,037 visits

Median = 13,973 visitsRange = 1,011 – 113,006

Patient Visits:

EM Certification vs. Non-EM Certification

-

0.200

0.400

0.600

0.800

1.000

1.200

1.400

Fraser Interior Island Northern VCH/PHC Total

0.496

0.226 0.235

0.039

0.340

1.336

0.108

0.225

0.083

0.214

0.052

0.682

NumberofVisits

(millions)

HealthAuthority

#PtsSeenbyEMCertified

#PtsSeenbyNon-EMCertified

2.016

Conclusions

1. 1024 physicians provide EM care in BC

2. Just under half of physicians practice EM as

part of their family practice

3. Approximately half of physicians providing

EM care in BC have EM certification: 70 percent in CCFP(EM)

28 percent in FRCP-EM

4. The certification breakdown varies by type of

site

11/1/2018

4

Conclusions

1. More sites have MD’s providing EM care as part

of their Family Practice

2. More patients are seen by EM certified MDs

3. Estimated need for 20 percent more physicians to

provide EM care in BC in 2014

Another 399 needed by 2019

Thank you.

Questions and Comments?