A year after committing to updating how Alberta’s family doctors are paid, the government has unveiled the new primary care physician compensation model that it hopes will not only help the province’s existing, overworked physicians — but also attract new ones.
The new model, which the government said makes Alberta’s family doctors the “strongest-paid and most patient-focused in the country,” is structured to encourage physicians to grow the number of patients they care for and encourage full-time practice.
It’s also aimed at making family practices more attractive to new medical school graduates.
“We expect the model will be a game-changer in attracting family physicians from other provinces and countries,” said Health Minister Adriana LaGrange.
The model comes after doctors have been leaving Alberta for years amid financial challenges, a strained relationship with the government, and delays on an updated pay deal.
Alberta Medical Association president Dr. Shelley Duggan said the new model will positively impact the health-care system for years to come and ensure financial viability for family clinics, which are essentially small businesses run by doctors.
“Our fee-for-service system has served us well since Medicare first began, but it is less and less able to support the kind of care that Albertans need. Today’s announcement recognizes and invests in physician-led primary care, making it possible for these physicians to do with only they can do,” Duggan said.
“It is our hope that the model will help to restore Alberta as a destination of choice for physicians, residents and medical students who want to practice comprehensive care.”
Incentives include increases for:
- Maintaining high panel numbers (minimum of 500 patients), which will incentivize panel growth and improve access to primary care for patients
- Providing after-hours care to relieve pressure on emergency departments and urgent care centres
- Improving technology to encourage using tools that help streamline work and enhance patient care
- Enhancing team-based care, which will encourage developing integrated teams that may include family physicians, nurse practitioners, registered nurses, dietitians and pharmacists to provide patients with the best care possible
- Adding efficiencies in clinical operations to simplify processes for both patients and health care providers
“This new model is unique,” said LaGrange. “It’s a blend between fee-for-service and elements of what is paid through other non-fee-for-service models, making it the first family physician compensation model of its kind in Alberta. It sets the stage and conditions for Alberta to be a national leader in the retention and recruitment of family physicians.”
The government said it recognizes and pays for the critically important work of physicians, including the number of patients seen and patient complexity, as well as time spent providing direct and indirect care.
“This model also includes various incentives, such as providing an additional 10 per cent for time that physicians spend on administrative duties, as well as an incentive to encourage physicians to enhance team-based care.”
“We estimate compensation will be competitive with similar models in both British Columbia, Manitoba and as also in Nova Scotia.”
Dr. Sarah Bates is a comprehensive family physician that also works at the University of Calgary. She’s part of the Alberta Medical Association team that’s been working with Alberta Health on the new funding model for the past year.
“The last five or six years have been a really, really bad time for family medicine in Alberta,” she said, but added she hopes this new model turns that around.
Bates said working on the compensation rules has been a lot of hard work but the results are gratifying: the clinical portion of a family physician’s practice could see a 25- to 30 per cent increase in net income as a result of the new billing model.
“I think this model more accurately reflects the work that is actually being done in a family physician’s office. So fee-for-service means that you’re sitting in front of me, we have an interaction, you leave, go home, I bill for that interaction,” Bates explained.
“What is missing is all the work that might go on as a result of the interaction — so all of my charting, the consultation letters I may write, the letters I have to review, the labs I have to review, the practice management piece of running a family practice.
“All of that was missing before. It wasn’t compensated.”
Bates said that added up to a dozen or more extra hours of unpaid work in a week for family doctors, making the practice less attractive than other medical specializations.
“This model starts to more accurately reflect the work that is being done, and it starts to support family physicians to do the work that they really are passionate about doing.”
As Alberta’s population ages, doctors are spending more time dealing with complex medical cases and Bates said the new model acknowledges that.
“Primary care has changed an awful lot in the last few decades: our patients are more complex, they have more chronic diseases, they have more medications associated with them. Their treatment has become a lot more complicated and it’s really the family physician who is the quarterback and sees all of those pieces, sort of has a view of the field and has to coordinate all of those pieces.
“So that is what this model starts to recognize.”
While not all of Alberta’s roughly 5,000 family doctors are expected to switch from the fee-for-service payment plan, earlier this year LaGrange said she thought a “good portion” will make the change.
Not all doctors work solely in family practices but instead also split their time working in acute care hospitals or teaching, and LaGrange said those doctors will see a rate increase.
The government said family physicians who are not compensated through the traditional fee-for-service model will now receive higher pay rates under their payment model, known as the alternative relationship plan, which includes those who provide inpatient care in hospitals and rural generalists.
The alternative relationship plan rate has not been updated since it was initially calculated in 2002, and LaGrange said while they have seen increases as part of contract agreements with the AMA, the rates are no longer competitive.
The government said it’s increasing the ARP to ensure hospital-based family physicians and rural generalists also receive fair, competitive pay that reflects the importance of these roles.
“These family physicians are providing care both in the community to vulnerable populations and on hospital wards, and are critical to a fully-functioning health care system,” LaGrange said.
“Physicians will, of course, need to consider what works best for them and their patients,” Duggan said. “But we are thrilled to see that we now have a new model that will support comprehensive, community-based family and rural medical care.”
The Alberta NDP said with nearly a million Albertans not having a family doctor, the new fee model is a good start.
“This agreement is way overdue and although it is better late than never, this agreement should have been done back in May when the premier promised it would be signed within a couple of weeks,” said Sarah Hoffman, the shadow minister for health.
“Hopefully, this will stop the further hemorrhaging of health-care workers who have had to close practices, move away from our province, and even leave the profession.”
Enrolment in the primary care physician compensation model will begin in January with full implementation in spring 2025, provided there are at least 500 physicians enrolled, the province added.
A report last spring from the Canadian Institute for Health Information found the number of family physicians per 100,000 people in Alberta has been declining since 2017, from 130 to 119.
In October, the province also came out with a new compensation deal for medical residents that includes wage increases of three per cent in each of the first two years, and two per cent in each of the last two years.
— with files from The Canadian Press