B.C. has announced major overhauls to the way family doctors are paid, in an effort to address a primary care crisis that has left a million British Columbians without a family doctor.
Instead of being paid $30 to $40 a visit regardless of the severity of a patient’s problem, family doctors will be paid based on time spent with patients, the number of patients seen in a day, the number of patients attached to their practice, the complexity of the patient’s issues, and their office overhead costs.
Health Minister Adrian Dix announced the “transformational” changes Monday in an effort to attract doctors to family practice and encourage current family doctors not to leave for more lucrative medical professions.
Dr. Ramneek Dosanjh, president of Doctors of B.C., said the new payment model “represents a seismic shift in the way we practise (family medicine) in B.C.”
It addresses rising costs of running clinics and allows doctors to spend more time with their patients, “recognizing the value physicians provide when they provide longitudinal care,” Dosanjh said.
Longitudinal care refers to doctors seeing a patient over several years and becoming familiar with their health needs.
The deal means a full-time family physician working 1,680 hours a year, who sees 1,250 patients with cases of average complexity and has 5,000 visits from patients a year, will earn at least $385,000, compared to $250,000 under the current fee-for-service model, according to the province.
The rising costs of running a doctor’s office — staff, building, equipment — typically cost doctors 30 to 40 per cent of their gross income.
There will be no longer be a cap on the number of patients a physician can see in a day, giving family doctors the ability to earn more if they take on more patients. Doctors must work a minimum of one day a week to qualify for the new fee structure.
The new payment model, negotiated among the province, Doctors of B.C. and B.C. Family Doctors, will take effect in February. The province said it will cost taxpayers at least $708 million extra over three years.
Dr. Renee Fernandez, executive director of B.C. Family Doctors, which represents 2,800 family doctors, residents and medical students in B.C., said the changes to the payment system would have enticed her to continue practising family medicine in downtown Vancouver.
“This is the type of thing that would have kept me in the game,” said Fernandez, who now provides focused maternity care and women’s health services.
Working in a clinic on the edge of the Downtown Eastside for 10 years, Fernandez treated seniors and patients with complex health needs and found that the current fee-for-service system “is not well suited for dealing with complex patients.”
“We know that one size fits no one when it comes to primary care,” she said.
Fernandez is confident the new fee model will entice recent graduates of family practice residencies to work in family medicine and also bring back family doctors who left their practice in favour of other types of medicine.
“This will show family doctor residents who are training to do this type of work that this is a viable career option that provides both quality of care for the patients and the province, but also a reasonable ability to balance home life and work life for the doctors,” she said.
Rita McCracken, a Vancouver-based family doctor and assistant professor in UBC’s department of family practice, is skeptical the changes will make a difference for people without a family doctor.
The new payment system may prevent family doctors from leaving the profession but McCracken said the deal isn’t going to immediately “manufacture” the number of doctors needed to provide primary care.
The new deal for doctors is “a really important part of the puzzle of fixing what’s going on with our health care system, but it’s only a part,” she said.
“We also need to make sure that the needs of the patients and the needs of our communities in terms of health are being met. And we can’t do that by only focusing on the doctors. We need to have everybody at the table.”
McCracken, who has been researching the family doctor shortage, would like a shift from a system that expects family doctors to be independent business owners to one where the government provides the medical infrastructure such as clinics, medical equipment, support staff and allows doctors to focus on their expertise.
Dix acknowledged that the fee changes alone won’t fix the system but pointed to the province’s human resources strategy to recruit more health-care workers and incentives announced in June that provides loan forgiveness and a $25,000 signing bonus for family practice resident graduates who take up work as family doctors.
The government will also create a provincial database that allows people without a family doctor to be placed with a GP in their area taking on new patients. The database, which will be developed by the middle of 2023, means that people looking for a family doctor won’t have to call around hoping to be taken on as a patient.
B.C. Green Leader Sonia Furstenau said she wants to see a clear plan for how the province will measure outcomes, which should be measured by the number of British Columbians being attached to a family doctor, the number of family doctors recruited, and an increase in preventive care.
The family doctor shortage means many British Columbians aren’t getting preventive care, can’t get prescriptions filled, facing delayed diagnoses and forcing them to turn to short-staffed and overcrowded emergency rooms.
The government has been working since May with Doctors of B.C. to reform the fee-for-service payment model, which family doctors have said was outdated and didn’t adequately compensate general practitioners for their work.
The province and Doctors of B.C. also reached a tentative three-year physician master agreement that increases funding for specialists, increases funding for rural medicine programs and increases the after hours on-call rates for doctors.
The agreement has yet to be ratified by the Doctors of B.C.
In August, Dix announced $118 million in short-term emergency funding to cover overhead costs for family doctors. As of Monday, 3,164 family doctors were approved for $25,000 each, costing the province $107 million.
Family doctor fees
Here’s the new annual payment structure for an average B.C. family doctor. Based on a practice with 1,250 patients and includes an estimated 30-40 per cent to cover office overhead.
• $130 an hour for 1,680 hours = $218,400
• Plus, $25 an hour for 5,000 visits = $125,000
• Plus, fees for patients with medical complexities = $41,600 (out in quarterly increments)
Total = $385,000
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