New Doctors of BC prez vows to push against forms, work on other issues

Dr. Joshua Greggain has just taken on the leadership of Doctors of British Columbia as the president for this year. A rural family physician for 15 years, he’s no stranger to challenge. With some landmark accomplishments just delivered by the medical association—an innovative new FP longitudinal care payment model and a resolved Physician Master Agreement (PMA)—Dr. Greggain will be drawing on his own approach as he works to fully manifest the promises embedded in his predecessor, Dr. Ramneek Dosanjh’s achievements. He spoke to the Medical Post’s B.C. writer Ann Graham Walker about his vision for 2023. Q: Can we start with your name? How should we pronounce it? I tell my pediatric patients it kind of rhymes with Dragon. Q: Well, thank you so much for making time for us. Let’s talk about your presidency. What inspired you to take it on? I was reading about how you spent time doing humanitarian in West Africa, as a young man. But that’s probably not involved in your decision to take on the presidency. Or maybe it is…? The West Africa thing was before I was a physician, when I was applying to medical school. As a physician, you have the true privilege to be involved in people's lives, in any parts of the world.... It was a real inspiration for me to be trusted to be looking after people who are involved in different circumstances. And so that’s really what spurred my medical journey, if I could call it that. My leadership journey has been an ongoing growth and development of realizing the ability for each of us to serve our patients, our colleagues and then the system. And so I get to serve as the president of the (approximately 14,640) doctors in B.C. this year, with the hope and willingness to serve our membership and our association at a time when we need and want optimism, hope, and inspiration going forward. And I generally come at life with that sort of perspective. Read: Sweeping new act strips B.C. docs of their voice on regulatory college board Q: Just logistically, is it a full-time job that requires you to put your career on hold for a year? For 17 or 16 years, working in Hope, B.C. I was a full-time family doctor with office patients and hospital patients and outreach to underserved communities. I was medical director (at the Hope Medical Centre and Fraser Canyon Clinic), site medical director (at Fraser Canyon Hospital), the chair of the Chilliwack Division of Family Practice. I sat at provincial tables. A year ago, I walked away from that for family and personal reasons. I've taken a much more balanced approach to life, time and medicine. And so, the last year, I’ve worked virtually or in-person and done locums in all five health authorities. I’ve almost finished my master's, through McGill, in international healthcare leadership. I’ve taken some time away from, I’ll use the word “burden,” and joy of my long term practice. I will continue to do clinical work, either virtually or locums, or urgent care work, to ensure that I keep my clinical skills up. Q: How many hours a week do you think being president is going to take up? It’s going to vary. Dr. Dosanjh before me and Dr. Matthew Chow before her and Dr. Kathleen Ross before him—because of COVID —struggled to get out to the (different parts of the) province. I am very willing to be out meeting people in the communities across B.C. There’s also—as we are doing right now—media requests, and interviews and board meetings... It will be a full-time job. Q: 2022 was epic for Doctors of BC, with the new FP longitudinal care payment model. Are there other similarly large undertakings that you will be inheriting? The payment plan is geared to start Feb. 1.… We are working in the background to nail down all the little salient details like billing codes. But the expectation is that information will be forthcoming in the coming days to weeks, preparing people to have the opportunity to start Feb. 1. Not everyone’s going to start Feb. 1. People may want to see how it goes for a period of time. But I believe this is a model for the future, not only to help lift family medicine up, but also to help create the care that we so need as British Colombians. Q: Are FPs actually coming back into the system, or not retiring, because of the payment plan? Or is it too early to tell? We have heard some conversations, with clinics saying, “I’ve lost my episodic or walk-in clinic doctors because they’re going back to longitudinal family practice.” Some hospitalists are considering coming back (to longitudinal care) now. There’s going to be some push and pulls and I’ll be be happy to keep you abreast of those great stories and the challenges. Q: Across the country, people are really watching this new B.C. payment model. And we’re excited about people watching us because we believe that, as always in British Columbia, we do things a little bit differently, a little bit creatively a little bit innovatively and expect that (the payment model will) change the face of primary care. Q: Are there other similarly large challenges still on the table that you are now inheriting? I think there’s a series of challenges that both the longitudinal family practice model (LFP) and the PMA didn’t solve. Those are agreements. But that doesn’t mean that they are solutions, right? They are just agreements to make the work happen. So there is still work ongoing to decongest emergency rooms, there is still work ongoing to try and ensure people have access to diagnostic services, there is still work ongoing to ensure that oncology care gets the opportunity to be looked after COVID. (For the Medical Post’s story on current issues in B.C. cancer care see here.) There is still work to ensure that our office-based specialists benefit from the same decanting of the heaviness of papers and forms and burdens that family physicians experience. So this is by no means the end-all-be-all of solutions, there is still lots of work and both Doctors of BC and our members are working hard to create solutions that are not just transient, but sustainable indefinitely. Q: Regarding that paperwork burden, are you targeting certain insurers or whatever, saying do you really need doctors to fill out all these forms? Sometimes they do. Sometimes those forms (require) that level of medical expertise. But sometimes those forms—I’ll pick on the forms in particular, because that’s what our physicians tell us are burdensome—really don’t need the level of expertise of a physician. And so, looking at whether they are necessary at all, or whether they can be done by someone else who knows the patient, we are continuing ongoing collaborative conversations with our partners. Q: Will you be creating a series of committees? Many of those committees are already in existence, like the specialist services committee. And the society of emergency medicine, alongside the Ministry of Health, has been working for months now to try and find solutions for the emergency challenges. The physician burdens committee has been working for months, if not a year, on how to decant some of those things. Looking at—how we can, at a system level—give providers and physicians their time back, which gives them the ability to then look after patients. That’s really what we all went to medical school to do, Q: Is there anything else you want to say about your 2023 agenda? Again, the difficulty (people face) accessing primary care and emergency room and oncology care and diagnostic services (in B.C.). Inadequate or insufficient team-based care, including nurses, etc. These are all challenges that we are collectively faced with. I personally am not going to solve all of them. But I absolutely commit to a sense of optimism and hope and inspiration to collaborate across our partners. Collaborate and listen to our members so that we can create solutions together that make sense. Not for 2023, but long beyond that, because I think we’re at a time in history when we’ve been through the pandemic, we’ve struggled a lot, we’ve really had to drill down and strip down what we really, really need. And now we’re at a place where we can build, transform and renew a system to ensure that we have something long beyond my presidency, or maybe even my lifetime. Q: Anything else? I think one of the things the new announcement on the payment model does is that the medical students are now inspired and will consider longitudinal family practice as a viable option. So again—I’m going to lean on the hope that as we implement (solutions), we inspire the future generation of physicians, while creating team-based models—to serve the patients that we so desperately want to look after. In a good way. Again, we believe and I believe that if we continue to lift the primary care service, that may create less primary care needing to be done by specialists, which then gives them the ability to do the specialists’ services (they) are wanting and needing to do. So a lift for family medicine, I believe helps the entire system.

New Doctors of BC prez vows to push against forms, work on other issues

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