Family Physician 100-1736 (Permanent Family Practice)

Victoria PCN High Complexity Care Team (HCCT) is looking for a Family Physician to join their team.

The HCCT is a physician-lead initiative in collaboration with the Victoria PCN, Ministry of Health, Island Health, Divisions of Family Practice, and Indigenous Health Collaborative. Within the HCCT, all clinical staff function autonomously in a team-based setting on the same patient panel. Each member is expected to make their own day-to-day decisions, with the responsibility for overall clinical direction of the team and panel as a population resting with the HCCT’s Physician Lead. The Nurse Practitioner (NP) and Clinically-Focused Physicians (CFP) are expected to incorporate this overall direction into their practice with the patients. The CFP role includes overall care planning (e.g. intake and complete physical) with integration of patient's overall health goals, management of high-acuity and conflicting chronic disease (e.g. medication management psychosis in a patient with congenital long-QT), and planning around acute care utilization reduction. Practitioners will work collaboratively including for purposes of handover and follow-up; the Physician Lead may allocate tasks to any or all practitioners to support optimizing team-based, patient-centered care and the overall direction of the practice.

The Family Physician provides service for complex, resource-intensive unattached patients, or attached patients requiring additional complex care, in Urban Greater Victoria PCN Boundaries and First Nations communities of T’Sou-ke, Scia-new, Pacheedaht, Songhees and Esquimalt. Priority will be given to patients who meet the complexity criteria in multiple dimensions and to parent-child or other family groupings wherein all family members meet the complexity criteria. Patients will be identified by patient consenting-referrals with the assistance of Island Health, the Division of Family Practice, and community/specialty practices.

The practitioner will act as the regular and most responsible primary care provider for a minimum patient panel; the minimum patient panel size per FTE (partial FTE pro-rated proportionately):

• Year 1 – panel size of a minimum of patients shared by HCCT
• Year 2 – panel size of a minimum of patients shared by HCCT
• Year 3 – panel size of a minimum of patients shared by HCCT

For further clarity, physicians will provide the following to HCC patients: first appointments; follow-up appointments; home visits or offsite visits (as appropriate), with travel time not to exceed 25% of clinical care time. Support for hospital, home, rehabilitation and/or long-term care facilities: (specify): inpatient supportive care visits and discharge planning (to include direct liaising with inpatient MRP); mobile services in the home.

Below lists other services or commitments for the position.

Consultative Services:

1. ED and Inpatients

Consultative services at Victoria General Hospital, Royal Jubilee Hospital, or at the clinic via rapid follow-up for patients who are attached to other providers, but for reasons of complexity, time or workload, require further assessment, recommendations or follow-up in order to develop a care plan or be followed for a short time to reduce hospitalizations.

2. Victoria Community Health Units/Community FPs

Consultative services to other family physicians through direct referral, or through contact with the Victoria Community Health Units. The team plans weekly rounds at the unit to assist as appropriate.