The government of British Columbia plans to launch a new payment model in February to try to recruit and retain more family doctors in the province, where one in five residents does not have one.
Provincial health officials announced the changes during a Monday news event, saying physicians will be able to stop participating in the current fee-for-service system in early 2023. Under that system, doctors are paid about $30 per patient visit, whether they're treating a common cold or a complex chronic health problem.
The new payment model will take into account factors that include how much time a doctor spends with a patient, the complexity of their needs, the number of patients a doctor sees daily, their administrative costs and the total number of patients a doctor supports through their office.
"We are making family practice the priority it should be," said Health Minister Adrian Dix.
Most family doctors in B.C. are independent contractors and run their practices as businesses, paying for such overhead costs as office space and staff and medical equipment. One of the complaints from family doctors has been the price of operating a practice, which, on average, is between $80,000 and $85,000 a year, an official said Monday.
The number of people without a family doctor in the province has grown from about 340,000 in 2003 to 908,000 in 2017 and is expected to be higher this year, according to Dix.
WATCH | Adrian Dix speaks about the details of the new agreement:
Physician pay raise
Family physicians will be getting a significant raise under the new compensation model.
The provincial government says a full-time family doctor will be paid about $385,000 a year, up from the current $250,000, under the new three-year Physician Master Agreement reached with Doctors of B.C. last week.
In November 2021, a report published in the Canadian Family Physician journal found up-and-coming family doctors are choosing more hospital-based work and specialized practice rather than family medicine — in part because they're worried about the consequences of B.C.'s fee-for-service model.
In addition to pay increases, the government says in a statement that the funds will also cover income disparities and new hourly premiums for after-hours services.
Green Leader Sonia Furstenau said in a statement that while the announcement seems to address major concerns expressed by family doctors, it's important that the plan also measures outcomes.
Shirley Bond, former B.C. Liberal health minister and current opposition health critic, said while she is relieved to see some action, she would like to see more details.
She said while the plan mirrors what physicians and the opposition have been calling for, it is, at this stage, solely an announcement.
"What's missing are timelines, benchmarks, measurements, those kinds of things," said Bond.
Dr. Ramneek Dosanjh, president of Doctors of B.C., praised the new agreement Monday — calling it the best in the country and a "seismic shift" for the better in B.C.
The goal is not only to stabilize family practice, but to make it sustainable and rewarding, Dosanjh said in the statement.
"Everyone deserves a family doctor, and this new option is a major step toward making that goal a reality," he said.
The new master agreement, which was developed between the Doctors of B.C., the province and B.C. Family Doctors, must still be ratified by physicians.
Dr. Renee Fernandez, the executive director of B.C. Family Doctors, says she believes the new model will allow family doctors that are doing other types of work across the province to return to the type of family medicine that they were trained to do and encourage those who are currently training to be family doctors to continue this type of community-based family medicine care.
"We'll be adequately funding the family medicine clinic infrastructure throughout the province and making it a viable work environment for family doctors and a viable clinical care environment for patients," she said.
The model also aims to pay physicians for the time spent dealing with paperwork and administrative burdens, work that is currently unremunerated.
Additionally, Fernandez says she wants to see family doctors and clinics move towards a team-based care approach where groups of doctors can work together with nurse practitioners, pharmacists, and social workers and create a high-functioning primary care system.
"So vacation coverage, what we call locum coverage for physicians is a critical step towards ensuring that physicians, like everyone else, can take a break or when they are ill, themselves, that there's someone to step in so that people can continue to receive care."
She says the model is the first step towards ensuring family doctors can do their jobs to take care of all five million British Columbians.
"Family doctors are not only health care providers. We're human beings, and so in order to provide the type of care that British Columbians need and deserve, we need the same human supports and working conditions that others do … This new payment model and the physician master agreement that were announced today are a first step towards creating those tools and supports."
New roster system
The agreement would be accompanied with a new "roster'' system, to be introduced by mid-2023, where those looking for a family doctor can register to be linked with practices in their community instead of searching one out themselves, an official said Monday.
Dix said the payment model will help protect and strengthen B.C.'s health-care system. However, he said the government doesn't have a specific estimate for its impact in terms of the number of people who will get a family doctor, or the number of doctors recruited as a result.
"It's going to have a very, very positive effect. We can't be exact,'' he said, adding that it's not a one-step solution but is part of a broader overhaul of health services.
The new model aims to close the pay gap between family doctors and hospitalists, who are paid close to $300,000 a year to work in hospitals and have the same training but not the overhead costs.
The health ministry says physicians interested in participating in the new payment model will be able to register in January.
Concerns raised about net reduction in patient-care capacity
Lindsay Hedden, an assistant professor of health services research at Simon Fraser University, worries there could be a net reduction in capacity for patient care at least in the short term as this new model is being rolled out.
"Instead of needing to churn through 25 or 30 patients in a day to keep the lights on in the clinic, [doctors will be] able to spend more time with each patient and see fewer of them, which is gonna have a net effect of actually contracting our capacity within this system," she said.
Hedden says the medical community has been overworked during COVID-19 and medical practices may end up scaling back to spend more time with each patient, which could ultimately be a great move but result in longer wait times to secure an appointment.
"Even if you're one of the lucky folks in our province who does have access to a family physician, there's going to be fewer appointments available on a given day," she said.