Doctors call for clarity on roles, responsibilities in collaborative care

At a time when multiple professionalsare playing a bigger role in primary care, two papers released Wednesday callfor clearly defined roles for family physicians in collaborative care settings.

TitledThe Backbone of Primary Health Care: The role and value of family physicians in Nova Scotia, the work is a joint effort by Doctors Nova Scotia and the Nova Scotia College of Family Physicians.

Dr. Tim Holland, president of Doctors Nova Scotia, said the doctors thought it was important to articulate what they see as the role and value of family doctors in collaborative care teams.

Uncertainty leads to frustration

Holland, who works in several collaborative settings, said when the teams work, they're an excellent way to serve patients. The problem, he said, comes when members of a team are uncertain of their roles and responsibilities.

"Understanding the unique value that you bring the team allows you to also respect the unique value that they bring so that you can all work together to be able to deliver the best care," he said.

• Read the firstandsecond papers.

Some doctors have grown frustrated about the uncertainty of how they fit in the system, he said, and that uncertainty can lead to people feeling threatened. Often when there is that frustration, it has be directed at the increased role nurse practitioners are playing in primary care.

Holland said while the papers set out what doctors believe to be their unique diagnostic skills and ability to treat complex patients, theyaren't intended to be negative toward other members of health-care teams.

"We didn't want it to be territorial," said Holland."We wanted this to be simply about where the family physician fits into this,solely about where they fit into the team and how the can interface best with those teams."

Negotiations ongoing with government

The papers come at a pivotal time for doctors, as they are negotiating a new master agreement with the provincial government. Holland said the timing of the release is coincidental, giventhe papers were almost two years in the making.

Still, the papers also reiterate calls for new payment models for doctors and increased remuneration at a time when Nova Scotia ranks near the bottom of physician compensation in the country.

Katherine Fierlbeck, a political scientist at Dalhousie University who studies health policy, said she's not surprised by the doctors' efforts to highlight their strengths and value to the system.

"My first inclination is to think if I were in their shoes, I'd be doing the exact same thing," she said.

Fierlbeck noted the province, through necessity, has built a primary care system relying on a variety of professions, including paramedics, pharmacists and nurse practitioners, as it contends with doctor shortages. The irony is the province is seen as innovative for the move, she said.

Feeling taken for granted

Both Holland and Fierlbeck agreed the role of family doctors has started to shift, with less complex cases falling to other providers while physicians spend more time focusing on challenging patients.

The problem, said Fierlbeck, is compensation hasn't kept up with that shift and so there's a sense the bottom line for doctors is being chipped away at as they are asked to spend more and more time with complex patient visits that take longer.

"I do think they're concerned that they're being taken for granted," she said.

A spokesperson for the provincial Health Department said health authority officials work closely with collaborative care practices as teams are developed and evolve and roles are clarified. Evaluation is part of the process, Tracy Barron said in an email.

"In many cases, a physician co-leads the team and teams decide how to effectively support patients," she wrote.