Health-care practitioners across Canada are closely watching a promised overhaul of British Columbia’s payment model for family doctors – changes that some say are a “step in the right direction” toward addressing a “crisis” in family medicine.
The new system, announced earlier this week, moves away from the traditional ‘fee-for-service’ model of payment for family doctors, which pays a flat fee of about $30 for each patient visit, regardless of the severity or complexity of the case.
When the new model is implemented in February, factors such as the amount of time a doctor spends with a patient, the number of patients a doctor sees daily, administrative costs and the number of patients a doctor has in their practice will be taken into account.
It will mean a big pay raise for family doctors in B.C., who will earn on average about $385,000 annually, up from the current $250,000.
While the finer details of these changes and how they will roll out are not yet fully known, Dr. Lawrence Loh, CEO and executive director of the College of Family Physicians of Canada (CFPC), says it appears to be a positive move toward addressing calls for governments to recognize the more complex needs of patients seen by family doctors in recent years.
“It seems to be a step in the right direction,” Loh said.
“We recognize that the care that patients need – especially in our aging population, especially post the COVID-19 pandemic – is increasingly complex and challenging. And it seems that some of the provisions around the announcement (Monday) are really about changing the way family doctors are remunerated and the way practices are organized so that patients can get better quality care and better access to care.”
Dr. Alika Lafontaine, president of the Canadian Medical Association (CMA), says he is “excited” the B.C. government co-developed this new model with doctors in the province.
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The changes appear to address many of the longstanding issues and concerns that physicians have been highlighting for years, he said.
“We’re really struggling with these outdated models of how to provide care that is centered around hospitals and acute care and not enough in primary care and preventative care,” Lafontaine said.
“Having these discussions is the first step, and we likely won’t get it right the first time around. But what’s important is that we continue to have these conversations and (have) the right people around the table. And as far as what we’ve heard is going on in B.C., it does sound like the right people are around the table to have the conversation.”
Across Canada, there has been a growing deficit of family physicians, which has left many Canadians without access to primary care. Nearly five million Canadians over the age of 12 did not have access to a family doctor in 2019, according to the latest available data from Statistics Canada.
Family doctors in provinces across the country have been closing their practices either to retire early, due to burnout, or to work in hospitals or other specialty areas, where they can earn more and do less paperwork.
Attracting new doctors to family medicine has also become more challenging. Medical students are increasingly choosing not to study family medicine, opting instead to focus on more specialty areas of medicine that come with higher salaries, the college says.
The fee-for-service model has been flagged by both the CFPC and CMA as one of the main reasons why family medicine has become less attractive, as it not only pays family doctors less than other specialties, it also turns family doctors into small-business owners in charge of running their own offices, including hiring staff and dealing with things like commercial rents, overheard and ordering medical supplies.
Family doctors want to focus on health care and many would prefer to work in teams that include administrative help and other allied health professionals, such as nurse practitioners, dietitians and pharmacists, Loh said.
These kinds of ‘medical homes’ or ‘medical teams’ could better address the growing number of patients in Canada dealing with more complicated health issues, especially after two years of almost no access to preventative health care, Loh said.
The changes in B.C. appear to be moving toward compensating family doctors more for the complex care they provide – one of the solutions all provinces should be looking at to address a “crisis” in primary care, he said.
“I think we will all be watching carefully what happens in B.C. in terms of whether they’re able to retain physicians and improve access and improve care for patients in that setting,” he said.
Dr. Eva Grunfeld, a family doctor in Ontario, says she believes B.C.’s plans to pay family doctors more could provide a short-term solution to retaining family physicians and attracting more medical students into family medicine if Ontario were to follow suit.
But she cautioned it could also lead to a bidding war between provinces, which are already competing against one another for a dwindling pool of health workers.
If she wasn’t so established after more than 30 years practicing in Ontario, she says she likely would have moved to B.C. for the higher salary.
“It’s … taking from Peter to pay Paul,” she said. “Salary solves a problem for one province, maybe. But in terms of the bigger Canadian picture, not really.”
Other solutions should include addressing work-life balance concerns that stem from running solo practices as well as confronting a kind of “disrespect” that exists among physicians, who often don’t view family medicine as having the same “cache” as other specialties, Grunfeld said.
Any steps toward increasing Canadians’ accessibility to family doctors would go a long way toward helping Canada’s ailing urgent care system, Lafontaine said.
When patients can’t access a family doctor, they end up in emergency rooms, and when ERs are overwhelmed, other parts of the hospital become overcrowded – a domino effect that is currently playing out in hospitals across the country, he said.
That’s why he hopes the moves in B.C. will lead to more talks between the provinces and the federal government to hash out tangible solutions and system transformation that is urgently needed to prevent all areas of health care from “full-blown collapse.”
“Primary care forms the foundation for all health care,” he said.
“If we can enable patients to reconnect with family physicians and their primary care providers within a team-based structure so they can see the people that they need at the time that they need them, I think we have a real chance to transform the way that Canadians receive health care and really improve the experience on both patient and provider sides.”
– with files from Global News’ Jamie Mauracher
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