The following has been sent to all medical staff on behalf Dr. Michelle Weizel, Associate Vice President Medicine & Deputy Chief Medical Officer
7 March, 2025
Dear colleagues,
I want to acknowledge the significant and growing pressures on inpatient care across Island Health. All of our sites are facing a shortage of Most Responsible Physicians (MRPs), leading to unsustainable workloads for existing providers, extended Emergency Department (ED) boarding times, and difficult decisions about how to allocate limited resources.
While Medical and Academic Affairs is working with groups to actively recruit additional medical staff and integrate alternate providers, including Nurse Practitioners (NPs), Associate Physicians (APs), and Physician Assistants (PAs), the reality is that our collective resources remain finite. No area of our system has excess capacity and our MRP providers are overburdened. In some cases, this has resulted in patients remaining under the care of emergency physicians for extended periods—a situation that we recognize is far from ideal.
There is no simple solution, and there is no external entity to "hand off" this issue to—this is a challenge we all share. Collaboration between medical staff across departments, sites and our administrative partners is valuable during challenges like this to ensure patients receive the safest and most appropriate care possible under the circumstances. This includes:
- Determining which patients require daily MRP visits and which can be managed differently.
- Maximizing pathways to community service providers and balancing risks of discharge to minimize admissions.
- Assessing opportunities for earlier transfers for patients requiring higher-level care and repatriation.
- Adjusting inpatient and hospitalist models where possible, including specialists providing MRP service to their inpatients, to enhance capacity.
- Leveraging non-physician staff to improve patient flow and care coordination.
- Strengthening discharge planning efforts to reduce inpatient pressures.
- Exploring virtual care models to supplement on-site MRP coverage.
These ideas, and many more, have been raised in recent discussions with medical staff across the health authority and they are a strong starting point for problem-solving across our sites. The key is ensuring that we remain united in finding solutions, rather than allowing these pressures to create divisions between departments, or between medical staff and administration.
Emergency departments are often the last stop in the system: they cannot simply close their doors when inpatient resources are exhausted. Our goal must be to prevent situations where the ED becomes the default holding area for admitted patients, and to instead find ways to distribute the burden more equitably, while maintaining the highest possible standard of care.
I recognize that these challenges are complex and that solutions will not come easily. However, by working together, we can develop strategies that balance patient needs with provider sustainability. I encourage all medical staff to continue to engage in these discussions at their sites, and I welcome further input on system-wide approaches that could help us move forward.
Thank you for your continued dedication to patient care in these exceptionally difficult times.
Best regards,
Dr. Michelle Weizel, MD, CCFP-EM, MBA (she/her)
Associate Vice President Medicine & Deputy Chief Medical Officer