Tommy Gerschman is a community-based pediatric rheumatologist currently practising in North Vancouver, BC. Outside his medical practice, Gerschman advocates for physicians by serving in several board leadership roles and recently served as president of Specialists of British Columbia (SBC). Gerschman talks about the need to increase hospitals’ and health authorities’ awareness of the value-added contributions provided by community-based specialists (CBS) to patients and the healthcare system.

Martha Ihunde (MI): Thank you, Dr. Gerschman, for your time. Can you please tell us about SBC?

Tommy Gerschman (TG): SBC acts as the collective voice for specialists in BC. In January 2019, the Specialist Services Committee (SSC) (a collaboration between the Doctors of BC and the BC Ministry of Health) and the SBC jointly hosted a symposium to inform the development of SSC's strategic plan and set a direction for specialist care in the province. One of the outcomes included a plan to identify who the CBS in BC are and increase hospitals’ and health authorities’ awareness of the value-added contributions this group of specialists provides to patients and the healthcare system.  

MI: What challenges did you face as you worked to identify the CBS?

TG: Our biggest challenge was defining the CBS. CBS work in diverse practice settings that span the spectrum of facility-based specialists to those with no hospital privileges to those practicing in a combination of settings falling between the two extremes. As you can imagine, with the variety of delivery settings, each group faced its own set of challenges. SSC initially decided to focus on those providers who practise exclusively in the community with no active hospital privileges. Despite being a critical part of the infrastructure of providing healthcare in BC, these CBS often feel they are operating in a silo.

MI: What obstacles do CBS with no active hospital privileges face?

TG: This subset of CBS is not connected with access to various system-wide initiatives, such as quality improvement training, physician engagement and physician leadership training. These initiatives tend to be accessible via a health authority structure, which does not capture these providers. Furthermore, CBS without hospital privileges have not had access to the same provincial patient information systems that provide access to patient health records. Often the hospitals or health authorities are unaware of who these CBS are and how best to reach and support them.

MI: What are your views on how to help address this?

TG: We need to raise awareness of the specific roles these CBS play. It is challenging to provide resources and programs to providers if they are unknown to the hospitals, health authorities and doctors' associations. The issues and opportunities are about how to strengthen communication and coordination among health authorities, facility-based physicians and the CBS. It is crucial to understand who the stakeholders, decision makers, influencers and allies are. Coming together and identifying common themes is one of the initial steps to finding solutions to problems. The use of personal stories to illustrate gaps and challenges can be effective as well.

As a result of our efforts, the Representative Assembly of the Doctors of BC – a deliberative body of physicians from across BC – acknowledged that the CBS without hospital privileges had been unknowingly omitted in several key initiatives. This acknowledgment occurred in February 2020, right before the start of the COVID-19 pandemic.

MI: Sounds like you were on the right track. Did the COVID-19 pandemic affect your efforts?

TG:  When the pandemic hit, personal protective equipment (PPE) were in short supply. The BC Centre for Disease Control released a PPE allocation framework, which unfortunately made no mention of the CBS. As a result, many CBS were left without adequate access to PPE and, therefore, were limited in their ability to provide in-person patient care. It took nearly six weeks to advocate for and access PPE. The initial omission did, however, shed light on the need to put the CBS on the radar. Later, when the vaccine distribution framework was developed, we saw progress as the CBS were reflected in the plan.

MI: It sounds like you have had success. Is there other work to do?

TG: Yes, we have had great success. It was relatively easy to come together to solve the problem when focusing on common goals, such as PPE and vaccine distribution. My concern is that for our diverse issues, more work and engagement is needed to recognize and support the CBS.

MI: What steps do you think need to be taken to help recognize and support the CBS?

TG: My thought is that health systems should take an interest in understanding which specialists are out there and what care they provide. It is also essential to recognize the value community care offers to the system, including its impact on hospitals' operational planning. The system must ensure an inclusive structure for the CBS during communication of critical information, such as pandemic concerns.

MI: What advice do you have for the CBS that do not have adequate access to leaders and authorities?

TG: Seek out and engage leaders and advocates, such as specialty societies or other provincial physician representative organizations. I encourage writing op-eds for any provincial medical newsletter or magazine to help illuminate challenges and opportunities. 

About the Author

Martha Ihunde, MS, is embarking on a career in healthcare administration in San Antonio, Texas. Ihunde completed this interview in partial fulfillment of her graduate healthcare administration internship under the direction of Vania Sakelaris, principal, VAS & Associates, Toronto, ON, and Michele McGowan, professor and graduate program director, Healthcare Administration, King’s College, Wilkes-Barre, PA, USA.