The program will be piloted in the South Island and the Victoria primary care networks from October 1, 2022, to March 31, 2026. It will have an ongoing evaluation that will inform conversations with the Ministry about provincial spread. The Victoria Division of Family Practice will be responsible for local implementation of the pilot in Greater Victoria.

Although we recognize there are significant challenges everywhere, Victoria and the South Island have an extremely high rate of patients without a longitudinal family physician (30–40%). The goal is to test this concept, evaluate the outcomes, and then, based on early results, expand it across the province in a timely way.

• Accepting locum applications: ongoing until filled
• Accepting host physician applications: starts August 8, 2022
• First locums in clinics: October 2022
• Pilot end: March 2026

Over the past several months, the pilot program working group held focus groups with stakeholders and obtained feedback. In many cases, the suggestions were integrated into the proposal. Stakeholders included: family physicians, residents, locums, divisions of family practice, the health authority, and FPSC. Care was taken to coordinate with the Rural Coordination Centre (the home of the Rural Locum Program).

The Victoria Division is responsible for the local administration, coordination, and reporting. The FPSC provides provincial leadership, coordination and oversight of the program’s evaluation, financial management and accounting.

The BC Ministry of Health is funding the locum contracts and overhead. FPSC is funding the program administration over the pilot period.

These criteria were agreed upon during the program’s creation, and again by the pilot’s Oversight Committee, as a way to initially limit the scope of work and create manageable parameters while we build our pool of locums, and for the purpose of testing the concept and evaluating outcomes. In the future, and with successful evaluation results, the goal is to rapidly expand the program across the province and to a wider demographic of family physicians.

The program meshes and complements the rural locum program. The Urban Locum Program was designed to support the Rural Locum Program—as opposed to conflicting with it. Further anticipated work includes collaborating with the other Joint Collaborative Committees, rural communities, and mid-size communities to develop a comprehensive provincial urban locum program. More information about this effort will be shared in the fall of 2024.

Eligible host family physicians:

• Are a full-service family physician working a minimum of 0.5 FTE providing clinic-based longitudinal care to a panel of patients
• Are a member of their local primary care network (PCN) in Greater Victoria (Victoria, Westshore, or Saanich Peninsula)
• Agree to the program’s Memorandum of Understanding (MOU), including hosting rules and responsibilities

These criteria were agreed upon to initially limit the pilot scope and create manageable parameters while we build a pool of locums, and for the purpose of testing the concept and evaluating outcomes. In the future, and with successful evaluation results, the goal is to rapidly expand the program across the province and to a wider demographic of family physicians. If there is a surplus of locums during the initial pilot phase, criteria will be expanded at that time.

Eligible locum physicians:

• Are licensed to practice medicine in BC
• Have malpractice liability insurance with the Canadian Medical Protective Association (CMPA)
• Are enrolled in the Medical Services Plan (MSP) of BC
• Availability for at least five days of locum coverage per quarter

During the pilot, preference will be given to new-to-practice physicians from inside and outside of BC who are not currently attached to a patient panel. In addition, family physicians nearing retirement who are seeking increased flexibility or work/life balance and international graduates are anticipated to participate.

In what hour increments can host physicians request daily coverage?

Host physicians can request coverage for 4-hour half days of service or 8-hour full days of service.

Locums are paid $1286.81 per 8-hour day of service for the first 60 days, pro-rated for any partial day of service (compare with LFP). The daily rate increases to $1386.81 from day one once locums complete 60 days of service (paid retroactively in a $6000 bonus). Calculation of the completion of 60 days of service will include both full days of service and any accumulated partial days of service (e.g., 55 full days of service and 10 half days of service).

The payment for in-clinic work will be through a contract, offering a guaranteed payment per day/hour. Hospital, maternity on-call, and work done outside of ULP can continue to be billed outside the scope of your contract.

Yes, $1286.81 is the take-home amount.

The program’s overhead payment to hosts is $404.76 /day (pro-rated for partial days).

The program’s working group reviewed multiple contracts available to family physicians in BC in order to make recommendations on a compensation model.

Hear from a fellow locum physician, Dr. Noémi Duguay, about what it’s like working with the ULP and the benefits the program can offer.

We do ask that locums to provide a minimum of 5 days coverage in a 3-month period to join and continue in the pilot. The requirement will be prorated based on your contract length (e.g., a 12-month term requires 20 days of coverage). The locum has the flexibility to accept coverage dates that work with their schedule.

Host physicians are advised prior to a match an approximate number of patients the locum sees during a shift. Generally this is anywhere from 2-4 patients per hour during direct care time. It’s important to recognize that our locums have various levels of experience, your patients are of varied complexity, and it may be a locums first day at your clinic and/or working with a new EMR.

We ask that the locums and host physicians collaborate together to come up with a schedule to allow the locum to complete all tasks within the scheduled hours. Generally Indirect patient care per shift is approximently allotted in a 3:1 direct patient care:indirect patient care ratio. For example, an 8-hour day of service would be scheduled for 6 hours direct and 2 hours indirect patient care. Half a day of service would be scheduled for 3 hours of direct patient care and 1 hour of indirect patient care.

Indirect patient care means patient-specific service provided when the patient is not present. Examples of indirect patient care include, but are not limited to patient-specific conferences, team meetings and chart/report writing, review and follow up of lab results and other patient related correspondence.

Yes, locums can work under more than one contract or payment form as long as that work is completed outside of the physician’s contracted ULP pilot hours.

No, there are no evening or on-call requirements. All contracted hours are to take place in-clinic/telehealth, between regular weekday business hours. If a locum does decide to do any work on behalf of the host physician out-of-office/out-of-hours (e.g., hospital or home visits) it must be billed to fee-for-service outside the contracted hours.

Yes, locums can decide to do out-of-office/out-of-hours work for host physicians; however, this must be billed outside the contract.

Coverage requests are based by clinic and can vary from partial to full weeks. Depending on the offerings and what shifts locums are interested in, locums might decide to work all week in the same clinic or part-time at one and fill in shifts at another. For ease of coordination and consistency, and to give locums a better chance of being in a clinic for a longer duration, we are encouraging multi-physician clinics to consider taking back-to-back weeks.

There is certainly flexibility with scheduling, however, this will depend on the available practice coverage offerings.

The ULP Program is using an online scheduling platform called Connecteam, with the ability to post and claim shifts via a mobile and web application. The ULP Project Team posts all host physician coverage requests on this platform and ULP locums are able to claim shifts directly from the platform. All new locums to the program are provided with orientation on the use of Connecteam and feedback thus far has indicated that the platform is intuitive and easy to use.

Presently we have greater host need than available locums, so we are encouraging hosts to select coverage dates that do not fall during peak times in order to increase the likelihood of a match. We post all host physician requests and encourage flexibility from both the hosts and locums. It is our hope that as the program grows, our locum pool will be such that we can support the needs of all interested local physicians.

Yes, up to one hour of orientation will be provided at each clinic that is new to the locum, and this is included in the locum’s billable hours. Our hope is to try to match locums with EMRs they are familiar with or interested in learning. However, if this is not possible, an EMR overview would be provided by the host physician clinic.

Yes, our locums have access to peer coaches and those new to Greater Victoria can receive a general orientation (e.g., community services, Island Health services, etc.) and can be taken through sign-up for Pathways and other local systems.

Yes, access to qualified MOAs for the duration of locum coverage is required by the host clinic.

You can view the host physician roles and responsibilities within the Memorandum of Understanding (MOU).

Host physicians have to sign a Memorandum of Understanding indicating that they will make all necessary patient follow-ups after the locum’s coverage is complete.

It is the host’s responsibility to secure after-hours and on-call coverage for their attached patients for the period of the locum coverage. Locums are expected to follow up on non-critical results the next clinic day, regardless of when the results/tests/consults arrived.

Provincial oversight and evaluation of the pilot will enable FPSC to learn how a locum coverage program can be an effective tool for recruitment and retention of physicians in community-based longitudinal family practice, particularly in under-served communities, and to build appropriate structures and supports in preparation for an expanded provincial roll-out of the program, if future funding is secured. Should the locum coverage program expand to other BC communities in the future, the leadership role of the FPSC may also evolve and expand accordingly.

Both locums and hosts will be required to participate in the evaluation of the efficiency, quality, and delivery of the Urban Locum Program pilot (e.g., peer and interdisciplinary reviews, surveys).