Photo: Associate Physicians Dr Elie Al Tebechrany (left) and Dr Rand Al Ramahi (far right) join the KGH team

The KGH Hospitalist service provides 24-hour care to over 330 patients on a daily basis. Staff shortages have created vacancies and unfilled schedules which can’t be addressed through traditional hiring methods.

In 2022, the Government of BC announced a new clinical associate physician program.  International medical graduates (IMGs) who are not yet eligible for full or provisional licensure in B.C. may be eligible to work as an associate physician (AP), allowing them to care for patients under the direction and supervision of an attending physician within an acute-care setting.

Through Facility Engagement, and in anticipation of using the program as soon as possible, KGH assessed the feasibility of starting a clinical associate program at the hospital to help support patient care.    

Discussions were led by Dr Blair Main, who brought together the Interior Health physician recruitment specialist, the hospital Chief of Staff Dr Cara Wall, and Hospitalist representative Dr Sohayl Ghadirian. They explored College requirements, and what the model could look like and achieve at the hospital.

Results: accreditation, funding, and four new physicians

• An application for becoming an accredited associate physician (AP) program was submitted to the College, minor adjustments were made, and following an interview, accreditation was granted.
   
• Funding was approved by the Ministry for nine FTE associate physicians to be hired.
   
• Advertising for applicants started and two APs, Dr Elie Al Tebechrany and Dr Rand Al Ramahi, were hired – each receiving a 12-week orientation. 
   
• Orientation for the next two APs, Dr Jacob Wong and Dr Adnan Boutari, is nearing completion, which will result in four full time APs working at the site by mid-July, 2024.
   
• Kamloops, Victoria, and Northern Health have been in touch with KGH about their work.

Success factors

• Facility Engagement funding was instrumental to support initial meetings and conversations between physicians, Interior Health, and HEABC;, and the complex process over many months to explore accreditation with the College, and feasibility to run the program.
   
• The group connected with physicians in Lower Mainland to learn from their experiences.
   
• The health authority was involved sooner rather than later for input, data support, implementation support, financial and in-kind resources. 

What have we learned?

• The process for applying for the AP program wasn’t known in advance, which created extra steps.
   
• Progress challenges were experienced between the College, the health authority, and getting everyone on the same page, but it was important to continue to working through them together. 
   
• As assumption made that the supervising physician role would be similar to supervising residents was not the case. There has been a learning curve to determine specific policies and procedures for APs.
   
• Once up and running, the physical lead continued to work with the Manager of Medical Staff Contracts with Interior Health South to streamline the process for APs.
   
• With the new program, and KGH was the first site to implement it, many aspects of having an AP join the service were learned along the way. They include how to set up APs from an information technology perspective, how much access they have within a patient’s chart, how unit clerks process their orders, and how MOST forms should be completed by an AP – a challenging issue related to patient resuscitation status that are normally signed by a physician after having a discussion with the patient.

Next steps: expansion to other services

• Creation of an orientation manual and FAQ document based on learnings from the process. A critical success factor has been having project management support for the physician lead to develop this resource. 
   
• So far at KGH, AP have been hired for the hospitalist line. Acute care services is looking at APs as well, and engaging in a separate accreditation for AP surgical assists. 

“Overall, this has been a very feel-good experience, you get to meet new Canadians who want to be part of our system and are keen on getting involved. Some of them have already been in Canada and have struggled to find work. We have so much available work out there and these Associate Physicians have been nothing but an added bonus to our service.” – Dr Blair Main, physician project lead