FNW clinical counselling initiative: Reducing physician burnout and improving access to care

The Fraser Northwest Division of Family Practice has partnered with Fraser Health and SHARE counselling organization to provide local patients with regular, timely access to a clinical counsellor. The program is part of the division’s goal to improve patient and provider experience of care through primary care networks, driven by concerns raised by division members who were struggling to support their patients with mild to moderate mental health challenges.

Providing this kind of support takes more than a standard 15-minute GP visit. New Westminster GP Dr Stephanie Aung knows this firsthand—she provides frontline care for her patients’ mental and physical concerns, and recognizes that the privilege of being trusted by her patients to support them when they are struggling comes at a cost.

“Often one appointment can span up to 50 minutes trying to counsel a patient,” explains Dr Aung. “Having one 50-minute appointment in a day is already challenging, but it could be up to 5 counselling appointments in a day, and it is exhausting.” In addition to long days, Dr Aung found herself doing insurance and disability paperwork for patients on evenings and weekends. “I was burning out as a family physician, and I was not improving my access—if I thought I wanted to take on more patients, I found I wasn’t able to.”

Dr Aung expressed her concerns to the Fraser Northwest Division of Family Practice through the division’s ongoing member engagement structure, which includes surveys and a “Fast Facts” feedback submission process. “The division encourages members to keep talking so we don't have to feel like we’re dealing with issues alone,” says Dr Aung. By sharing the symptoms of burnout she was experiencing as a result of supporting her patients with mental health challenges, she learned that she wasn’t the only local GP who was feeling overwhelmed – “I was so comforted knowing I wasn't the only one having this struggle,” she said.

When the new SHARE clinical counselling program became available, Dr Aung noted the improvement in referral times immediately. While access to a mental health and substance use referral could take three to six months in the past, the new referral system provides doctors with almost immediate notification that their patients have been referred for counselling support. “One thing I find refreshing with the new referral process is that I get notification that help is on the way within 24 to 48 hours,” she says. This streamlined referral system and expedited counselling support means the world to both her and her patients. “It means a lot to someone who is asking for help to know that someone recognizes their need for support, and can step in to assist.” She continues, “When I call to check in on my patients, they are often ready to go back to work and are applying coping strategies. They tell me things are better, and I’m thrilled to hear that.” Knowing she can refer her patients to a counsellor who can see them promptly to support their needs has gone a long way toward relieving her feelings of burnout and isolation. “I feel like I’m part of a team, and that I’m not trying to help patients alone.”

Dr Aung credits her division’s strong collaborative partnerships in making the SHARE clinical counselling initiative happen. “Our division took a great approach,” she says. “We listened to what the problems were in our community, we identified a solution through our working groups and PMH committee, we leveraged our relationships and local partnerships with the community, and we tackled the project with a good team.” Dr Aung concludes, “Excellent change happens when everyone works together and recognizes a common problem.”