Riverview family doctor Brian Davidson was forced to permanently close his after-hours clinic in May for financial reasons.
“With the pandemic that we had, the number of patients that we were seeing went down, our expenses didn’t get any better and paying for (support) staff after hours usually involves paying a premium,” he said on Thursday.
In New Brunswick, most family doctors are paid per service, like Davidson.
For the one-off visits that typically happen in an after-hours clinic, they are paid $29.40 per patient, compared with the $47.74 they are paid for the more comprehensive visits that usually happen in a doctor’s regular practice.
Davidson says between inflation and pandemic-related challenges, that just isn’t enough.
“Our operating budget was to a point that we actually had a couple of cheques to staff bounce because of various different things. When you get to that point, you’re not able to sustain different things,” he said.
He explained that staffing was also a challenge, in part because the low pay of after-hours clinic work had doctors looking elsewhere.
“So now you had gaps in the schedule where no one is working, you can’t make any money and expenses don’t go down.”
In a statement sent to Global News on Friday, a spokesperson for the Department of Health explained that in order to be paid the higher rate, doctors need to meet the requirements of a comprehensive office visit, which includes followup care and updating the patient care chart.
This fee structure also applies to the physicians on eVisit NB, an online service where New Brunswickers can virtually consult with a nurse practitioner or a doctor.
The pay rates are negotiated between Medicare and the New Brunswick Medical Society.
Anthony Knight, the medical society’s chief executive officer said in an interview on Friday that he believes there are many factors contributing to after-hours clinics reducing their hours or closing.
“Moncton has the highest number of walk-in clinics in New Brunswick. When you compare Fredericton, there are two. When you look at Moncton, there are 20. That’s a high proportion of after-hours clinics,” he said in an interview on Friday.
While he recognizes the demand for after-hours clinics, he said physician recruitment efforts are more focused on creating permanent practices.
“Ideally in the circumstance of a new physician entering practice, we’d want to encourage them to establish a full-fledged community-based practice and be a steady point of access for 1,000, 1,200 patients.”
He said overall, the system is in a “very stressed state” and it would be hard to ask doctors to do more than they already are.
“I think there are pressures on physicians to provide more,” he said.
“The level of burnout, of exhaustion, of frustration with the system is at an all-time high and we are deeply concerned about the state of well-being of physicians in our province.”
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