Island Health has rolled out a new policy that it says will be used in “exceptionally rare situations,” but Doctors of BC says it raises concerns over physician autonomy.
Island Health has developed a new policy over its most responsible physician (MRP) policy. In a hospital, several doctors might be involved in patient care, and the MRP is the doctor or nurse practitioner who is most responsible for that patient’s care during their stay.
Dr. Ben Williams, Island Health’s chief medical officer and vice president of medicine and quality, said the new policy is that if the health care workers assigned to one patient disagree on who is the MRP, then the hospital chief of staff or a senior physician will make the choice.
“This doesn’t happen very often. Most of the time, the doctors work it out between themselves, but sometimes what happens is there’s a patient who’s come in through the emergency room, it’s clear they need to be admitted to the hospital, and the emergency physician will call ‘Dr. A,’ and Dr. A will say, ‘Hey, I agree this patient needs to be admitted, but I’m not the best doctor. I think they should go to a different service,’” Williams said in a Zoom interview with CHEK News.
“And then the emergency physician will call ‘Dr. B,’ who will say, ‘You know what, we agree this patient needs to be admitted. We’re happy to help out, but really, they’d be better off admitted under ‘Dr. C,’ and it’s hard to sometimes work through that. And the emergency physician who should be looking after their next two or three patients can get stuck trying to mediate that dispute.”
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Williams said these disputes are “exceptionally rare,” and in his 10 years of being a senior medical leader, he estimates he’s been asked to step in to mediate fewer than 10 similar disputes.
However, Dr. Adam Thompson, president of Doctors of BC, says physicians have been reaching out with concerns about how this policy can be overused.
“Doctors of BC is really quite concerned about Island Health’s decision to allow the Chiefs of Staff to assign the most responsible physician role on an involuntary basis,” Thompson said in a Zoom interview.
“A policy is a policy. Ultimately, when something’s written down as a process, it will remain up to the physicians to interpret that and to implement it. And ultimately, it doesn’t matter whether it’s rare, we’re seeing these challenges a lot in hospitals, so this kind of policy could be used much more frequently than on rare occasions.”
Thompson said doctors’ concerns go beyond just how often the policy will be implemented.
“Doctors really are concerned that they may be pressured to accept patients when they haven’t got the resources, capacity, or even potentially the expertise, to provide that care safely for the patient,” Thompson, who is also a family doctor in Courtenay, said.
“And that’s the big concern we’re hearing from physicians is that ultimately these rules could impact patient safety and patient care, and that’s why we encourage a collaborative approach with with all physicians in Island Health to ensure that the policies brought forward support both the physicians and patients in providing safe care.”
Thompson says Doctors of BC is calling on Island Health to pause the rollout of this policy, and do engagement with physicians across the health authority to find another solution.
“We would like the health authority to roll this back and to start again and to have a truly collaborative process with all physicians,” Thompson said.
“Both of those in the representative bodies like the medical staff associations, as well as through their medical advisory committees, to ensure that the solutions brought forward, all physicians in Island Health are comfortable with.”
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However, Williams said Island Health conducted engagement between March 2025 and March 2026, which involved sending multiple emails to all doctors’ personal emails and holding town halls.
“In the end, the group that chose to give us feedback was 50 physicians, and as you can imagine, there was a range of opinion for some physicians,” Williams said.
“Particularly those working in the emergency room, they said, ‘This is great. Thank you for helping solve this problem.’ For other physicians, they worried, and they want to make sure if they’re being asked to be the most responsible physician, that they’re the best situated physician to look after a patient, and of course, we agree with that.”
Thompson said that Doctors of BC did not feel there was adequate engagement, and that other medical staff associations feel the same.
Williams said Island Health also made modifications to the policy based on feedback provided during the engagement. He also said that the health authority has committed to reviewing the impact of the changes and how often they’re used in one year.
“And we’ll monitor it every day to see if we’re seeing anything unexpected,” Williams said.
