Before your meeting with a practice coach on ______, please complete:
1
Prince George Version 1.5 July2011
Sections A, B, C
Section D (Excluding #91-100)
SectionsE, F, G, H, I
Payment Forms
1
Prince George Version 1.5 July2011
Prince George Division of Family Practice – Physician Assessment
Section A: Physician Information
Demographics:
- Last Name: ______First Name(s): ______
- Age:25-34 35-44 45-54 55-6465+
- Gender: Male Female
- Years in Practice: ______
- Medical School Attended: ______
- Place of Residency Training: ______
- Are you a CCFP Member? Certificant Fellow Non-Member BOTH Certificant & Fellow
- *PSP* Do you have any additional training (e.g. CFPC-EM, enhanced OB, enhanced palliative, GP-anaesthesia, etc?) Yes No
If yes, please specify:______ - Estimated years until retirement:1-2 3-4 5-9 10+ n/a (Retired)
- The primary language in which you practice medicine: English French Other (Specify: ______)
- Do you speak a secondary language fluently enough for patient care? Yes No
Which language(s):______
Section A: Physician Information – Continued
Your current satisfaction levels: This section is meant to be a snapshot of your satisfaction with your practice, work life, and life outside of work. Please think of your life over the last year.
- How satisfied are you with your professional life? (1 = very dissatisfied, 3 = neutral, 5 = very satisfied)
In your primary care office?1 23 4 5 N/A
In medical practice outside of the office? (e.g. sessional work, ER, WIC, MOCAP call)
1 2 3 4 5 N/A - How satisfied are you with the care you are able to provide your patients? (1 = very dissatisfied, 3 = neutral, 5 = very satisfied)
1 2 3 4 5 N/A - How satisfied are you with your life outside of work? (1 = very dissatisfied, 3 = neutral, 5 = very satisfied)
The amount of time available? 1 23 4 5 N/A
The quality of time available? (e.g. pager on…)1 23 4 5 N/A - How satisfied are you with the financial remuneration you receive for your office/primary care practice?
1 2 3 4 5 N/A
Comments on Q 12-15? ______
Section A: Physician Information – Continued
Your current work life: This section is meant to be a snapshot of your current practice/work life. Please think of what you have done over the last year. If you have taken any recent lengthy periods away from practice (e.g. maternity leave, sabbatical), please focus on the time that you spent working, but make note of the time away from practice in Prince George in Question 32.
- Do you currently practice office-based primary care medicine?
Yes Continue to Question 17
No, I stopped practicing office-based primary care medicine in (year) Skip ahead to Question 38(page 6)
No, I never practiced office based primary care medicine. Skip ahead to Question 38 (page 6) - Where do you practice primary care medicine?
Please do NOT include After-Hours/Walk-In Clinic, ER or other specialty here. Enter those into Question 3839.
Your own office Other private offices (i.e. locums) CINHS UPC Clinic Other (Specify:______) - *PSP* Please check off times that you are routinely scheduled to see patients in your office. If you work regularly at more than one site (in Question 17), please clarify which site.
Morning office / Location/Site / Afternoon office / Location/Site / Please elaborate if not standard am/pm booking pattern
Monday / /
Tuesday / /
Wednesday / /
Thursday / /
Friday / /
- *PSP* Do you generally stay in the office after seeing your last scheduled patient? Yes No
If yes, how long? <30 min 30-60 min 60-90 min 90-120 min 2-3 hours >3 hours
Section A: Physician Information – Continued
- In an average week, how many hours do you practice primary care at the site(s) in Question 17? (If paperwork or practice management is done at home after the work day, please also include that time.)
Note: Other types of non-primary care work will be explored in later questions. (e.g. meetings, sessions, Committees)
Specify Site:
/ Specify Site: / Specify Site:
Time in direct patient contact (i.e. appointments):
/ hours / hours / hours
Time spent charting (if done separately in a chunk of time after your last appointment): / hours / hours / hours
Time spent doing direct patient-related paperwork
(reviewing labs, consults, imaging reports, etc.): / hours / hours / hours
Time spent doing 3rd party paperwork/ forms/etc.:
/ hours / hours / hours
Time spent doing panel or practice management
(e.g. audits, recalls, etc.): / hours / hours / hours
- *PSP* In an average week, how many hours do you spend out of office on work related to your main practice/patient population?
(e.g. inpatient rounding, nursing home visits, surgical assists, etc.)
None <1 hour 1-3 hours 3-5 hours 5-8 hours >8 hours - *PSP* Do you have active hospital privileges? Yes No
- Do you do inpatient care? Yes No
Are you in a weekend call group? Yes No Frequency of call weekends: 1 in ______ - Are you a member of the In-Patient Care call group (formerly Doctor of the Day)? Yes No
- Do you do nursing home care?Yes No
If yes,how is your call set up for weekends?
Solo Shared with Partners Call Group Other (Specify: ______)
How many patients do you currently have in nursing homes? None 1-2 3-5 6-10 11-15 >15
Section A: Physician Information – Continued - Do you do obstetrics?*PSP* Yes No
If yes, how is your call set up for:
weekdays? Solo Shared with Partners Call Group Other (Specify: ______)
weekends? Solo Shared with Partners Call Group Other (Specify: ______)
How many deliveries per year? <10 10-19 20-29 30-39 >40
Do you accept prenatal/obstetric referrals from other practices? Yes No - Do you do palliative care? Yes, including hospice admissions. Yes, but no hospice admissions. No
*PSP* If yes, are you confident in supporting all patients and families in end-of-life care? Yes No Somewhat
In what areas might you need support? ______ - Do you do procedures (lumps and bumps, IUD insertions, etc.)?
Yes, only using my office. Yes, only using ambulatory care at UHNBC. Yes, using both locations.
No, I do not do procedures. - Do you do locums? True locums Just to “help out a colleague” Both Neither
- How much of your primary care office work is:
Fee-for-Service ______%
Alternative Payment Plan ______% (i.e. sessions at CINHS, UPC, but still doing primary care medicine) - In an average year, do you regularly take any lengthy time away from practicing primary care in Prince George? (e.g. 2 months on/2 months off, working only every third week, etc.) Yes No
If yes, please explain: ______ - Have you taken any significant time off in the last 3 years? (e.g. maternity leave, sabbatical, etc.) Yes No
If yes, please explain: ______ - Do you anticipate taking any significant time off in the next 3 years, ? (e.g. mat leave, sabbatical, etc.) Yes No Unsure
Do you have plans of cutting back in your office work, moving, or retiring in the next 3 years? Yes No Unsure
If yes, please explain: ______
Section A: Physician Information – Continued
- Are you currently in the process of trying to, or within the next year planning to: (Check all that apply.)
Recruit another physician to work in your office /
Merge your practice/office with another existing practice/office /
Find a replacement (e.g. to move or retire) /
Find a long-term locum (e.g. for a maternity leave, sabbatical) /
Find short term locum coverage for holidays, CME, etc /
Other: specify /
Other: specify /
- Are you interested in trying to increase capacity in your office? Yes No Unsure
- Are you interested in trying to increase efficiency in your office? Yes No Unsure
- Do you have a “vision” of changing the way you practice primary care medicine in the future? (For example, this might involve moving from Fee-for-Service to Alternative Payment Plan, moving from a solo to group practice, or focusing your practice on a sub-specialty or a specific patient population.) Yes No Unsure
Please elaborate: ______
______
______ - Do you practice in any other clinical setting, including after-hours/walk-in clinic? *PSP* Yes No
If yes, how many hours, shifts or sessions do you spend doing other clinical work in the average month, for the following?
Check all that apply*PSP* / Amount of Time
Emergency Room / / # shifts/mo:
GP anaesthesia / / # hours/mo:
GP referrals (e.g. vasectomies) / / # hours/mo:
MOCAP call (e.g. IPC, sexual assault, psychiatry, trauma, etc.)
Specify:______
Specify:______
Specify:______/
/
# shifts/mo:
# shifts/mo:
# shifts/mo:
Question 38, continued / Check all that apply*PSP* / Amount of Time
*PSP* Nechako After Hours Clinic (WIC) / / # shifts/mo:
Sessionals (e.g. oncology, palliative, geriatrics, detox, psychiatry, women’s health clinic, etc.) Specify:______
Specify:______
Specify:______
/
/
# shifts/mo:
# shifts/mo:
# shifts/mo:
Surgical assists (for patients not in your practice) / / # hours/mo:
Private medical services (e.g. botox, laser treatments) / / # hours/mo:
Worker’s Compensation Board (WCB) / / # hours/mo:
Other (e.g. Corrections/Forensics, Occupational Health, etc.)
Specify:______
Specify:______/
/
# hours/mo:
# hours/mo:
- *PSP* How many hours do you spend doing non-clinical work (paid or unpaid) in the average month for the following?
Amount of Time
Administrative Position (e.g. Department Head) / # hours/month:
Board Position (e.g. AIHS, PGDFP, NMS, etc.) / # hours/month:
CME lectures (e.g. noon or evening rounds, small groups) / # hours/month:
Hospital committees / # hours/month:
Meetings, unpaid (e.g. Departmental, Staff, UBC/UNBC ) / # hours/month:
Teaching / (see Questions 36-38)
Other (e.g. sports team doctor, PARTY program volunteering, etc.)
Specify: ______
Specify: ______
Specify: ______/
# hours/month:
# hours/month:
# hours/month:
Section A: Physician Information - Continued
Teaching: Northern Medical Program/UBC Family Practice Residency
- Do you have learnersin your primary care office? Yes – fill out below. No
Type: Residents Medical Students Nurse Practitioner
Time: For residents: Family Medicine block Native Health block Elective time
Time: For medical students: 1 term/yr 2 terms/yr Elective (i.e. full time) Students
Time: For NP students: Describe the amount of time they spend in the office: ______ - Do you supervise learnersin any other clinical location? (e.g. palliative care, geriatrics, ER) Yes – fill out below. No
Type: Residents Medical Students Nurse Practitioner
Where? ______
What amount of time? ______ - Do you teach at UNBC or on 5th floor? (e.g. lectures, Problem Based Learning sessions, preceptoring exams, etc.)
Yes (Specify: ______hours/year) No - Do you have a faculty position? Yes (Specify Position: ______) No
- Do you spend time on research? Yes No
- In the last year, how many weeks did you take off for recreation? ______weeks
- In the last year, how many days did you take off for CME activities? ______days
Between BCMA and REAP, how much of your CME activities were reimbursed?
0-20%21-40%41-60%61-80%81%-99% 100%
Section B: Office Information This sectionrefers to your primary care office, whether it is a private practice, or a clinic such as CINHS or UPC. If you are a locum or do not do office-based medicine, skip ahead to Section E (page 23). LOCUM only?
- *PSP* How many physicians work in your office space? 1 (i.e. only you; skip to Q50) 2 3 >3(Specify: ______)
- If more than one physician works in your office space:
Who do you usually share with? List names:______
Do you share: space staff common expenses/overhead *PSP* patients - Do the patients have an official "main provider” documented in the chart? Yes No
If no official main provider, what proportion of patients have an “unofficial” main provider? (i.e. patients often
request specific doctor) (Hint: ask your MOA) 0-20% 21-40% 41-60% 61-80% 81-100%
If youdo notsharepatients, do you cross-cover for office appointments? Yes No Inpatient care? Yes No - In an average week:
What are your office’s “telephone hours”? (i.e. when the patient line is answered e.g. 8am-4pm)______
Is there any time Monday to Friday, during standard office hours, that your office is closed? Yes No
If yes, please elaborate: ______
How many hours per week is your office open with one or more physiciansseeing patients? ______hours
What is the total number of “physician hours” per week? (For example, if you see patients 30 hours, and your partner
sees patients 25 hours, overlapping in time with you, the number of “physician hours” is 55.) ______hours
If you have another primary care provider (i.e. nurse practitioner), how many hours are they available per week?
______hours - *PSP* How many administrative staff do you have? (MOA, transcriptionist, office manager, file clerk, etc.)
1 2 3 4 Other ______
What is the # of administrative staff FTEs per physician FTE? (e.g. 1MOA : 1MD, 2Staff : 1MD) ______
- *PSP* Do you have multidisciplinary team members associated with your clinic?
Yes, check all below that apply or No
Nurse Practitioner LPN RN Dietician Social Worker Integrated Health Team for Seniors
Addictions Counsellor Spiritual Elder/Counsellor Other (Specify: ______)
Section B: Office Information – Continued
- *PSP* Would you benefit from having additional access to multidisciplinary care team members in your practice? Yes No
If yes, which ones? NP LPN RN Dietician SW IHTS Counsellor Other (Specify: ______)
If yes, do you have room in your office to accommodate additional staff? Yes No - *PSP* As a physician, do you think you perform tasks daily that could be done effectively and safely by non-physician staff or patients? Yes No If yes, give an example? ______
- *PSP* Are you aware of the following GPSC incentive payment programs? Please select the programs that you are familiar with, and whether or not you routinely bill them (when applicable).
Familiar with? / Routinely billed?
Acute Care Discharge Conference Fee (14017) / /
Community Patient Conferencing Incentive Payments (14016) / /
Complex Patient Care Incentive Payments (14033, 14039) / /
Condition Based Incentive Payments Diabetes (14050), CHF (14051), hypertension (14052) &/or COPD (14053) / /
Facility Patient Conferencing Incentive Payments (14015) / /
Family Physician Obstetrical Premium Payments (14004, 14005, 14008, 14009) / /
Maternity Care Network Initiative Payment (14010) / /
Prevention Incentive Payments (14034 CV Risk Assess, will be 14066 as of Jan 1, 2011) / /
Mental Health Patient Care Incentive Payments (14043, 14044, 14045, 14046, 14047, 14048, 14049) / /
End of Life Incentive Payments (14063, 14069) / /
Telephone advice with a specialist/GP with specialty training (14018, 14021/22/23) / /
- Do you subscribe to Pharmanet (through an application like Medinet) for access to patient prescription records? Yes No
- *PSP* How many patients do you see in an average 3 hour stretch? ______patients
Section B: Office Information – Continued
- How frequently are your appointments booked? (e.g. q10min, 4/hour, etc.) ______
- *PSP* How many different types of appointment time blocks are there in your schedule?(e.g. PAP, Complete Physical, etc.)
1-2 3-4 5-6 >7 - Do you practice:
“Advanced Access" (encouraging 40%+ of same-day appointments)
or Traditional booking (appointments booked far in advance)
- *PSP* Looking at an average work day, if a patient called at 8am, when is the third next available appointment they could book with a primary care provider (in business days)?
Today 1 day 2 days 3 days 4-5 days 6-10 days 11-15 days >15 days (i.e. 3weeks) - What percentage of appointments is scheduled within 36 hours of the patient phone call? (i.e. same day or next day appointments) 0-20% 21-40% 41-60% 61-80% 81-100%
- *PSP* On average, how long does it take for a patient, from the time they come in, until they leave, to complete the visit process? (i.e., Cycle Time)
<15 min < 20 min < 30 min <45 min >1 hour - Does your office have a process to measure patient cycle time (i.e. time from patient sign-in to departure)? Yes No
If yes, do you use it regularly? Yes No Unsure - *PSP* How often do you feel rushed when seeing patients?
Never Rarely Half the Time Frequently Almost Always - *PSP* Do you check ahead in your daysheet/appointment list with the intention of preparing for appointments, tracking down results, anticipating difficult visits/patient, etc.?
Never Rarely Half the Time Frequently Almost Always - *PSP* Do you generally start and end your primary practice office as scheduled?
Start on time?: Yes NoEnd on time?: Yes No
Section B: Office Information – Continued
- *PSP* Do you have a mechanism in place to get office staff and physician opinions and ideas about patient flow, task distribution, office routines, etc.? Yes (Elaborate:______) No
- *PSP* Do you have staff policies, procedures, and job descriptions? Yes No
- Have you ever organized a group office visit? *PSP* Yes No
Do you continue to do group visits, or plan to do group office visits in the future? Yes No Unsure
Where? ______Frequency? ______
What type? ______
Do you use a facilitator from Northern Health? Yes No If no, from where? ______ - How is after-hours care provided to your patients? After-hours phone line Referral to the After-Hours Clinic Both
Other (Please elaborate: ______) - Are you taking on new patientswith the intention of becoming their primary care provider (i.e. complete, long-term patient care, not simple transient visits/WIC follow-ups/obstetrics, etc.)?
*PSP* Yes No Only in specific circumstances (e.g. family of current patients, patients met at WIC, etc.)
If yes, or only in specific circumstances, approximately how many new patients do you (or your office, if you share
patients)take on, in the average month? ______patients
If no, what is preventing/deterring you from taking on more patients? ______
______ - Do you see patients in your office that you do not intend to take on/begin a primary care relationship with? For example, prenatal referrals, follow-ups from the ER or WIC, or out-of-town family members of patients? Yes No
If yes, what proportion of your appointments do you think these people represent in an average week?
0-1% 2-3% 3-5% 5-10% 10-20% 20-30% >30%
- Do you accept new nursing home patients? (i.e. not previously your own patient)
Yes No, but I am willing to. No, and I am not interested.
Section C: Electronic Medical Records
- *PSP* Does your office have an EMR? Yes (Specify which one: ______) No (Skip to Question 87, p.17)
Current EMR Users/EMR Implemented in your Office
- What year did you start using an EMR? ______
- When you first implemented an EMR in your office, what was your biggest challenge (i.e. physician based)? ______
______
______ - When you first implemented an EMR in your office, what was your staff member(s)’s biggest challenge?
______
______
______ - *PSP* To what extent do you use your EMR (check all that apply)?
Scheduling/billing Full charting (no paper) Patient recall/decision making - Please rank your office’s EMR usage:
EMR Function / Consistently being used / Inconsistently used (<50% of time) / Not currently used, but would like to. / Not used, and not interested at this time.
Scheduling/Daysheet Management / / / /
Billing/Invoicing / / / /
Storage of results (lab, imaging, consults, etc.) / / / /
Lab Interface for direct download of results for:
Phoenix/Hospital/Cerner LifeLabs/Excelleris / / / /
Writing Consult Letters / / / /
PatientEncounter Notes / / / /
Question 80, continued:
EMR Function / Consistently being used / Inconsistently used (<50% of time) / Not currently used, but would like to. / Not used, and not interested at this time.
Maintaining up to date Problem Lists / / / /
Maintaining up to date Chronic Medication Lists / / / /
Performing Recalls (e.g. for PAPs, 1year CT scan follow-up, etc.) / / / /
Reporting (e.g. audits, practice management, patient registries) / / / /
Messaging/Tasking Staff / / / /
Messaging Colleagues / / / /
Other: specify / / / /
Section C: Electronic Medical Records – Continued