P.E.I. tells salaried doctors to see more patients as paycheques change across Canada

Does paying doctors a salary instead of a fee-for-service save the taxpayers money and solve the problem of burgeoning health-care costs?

Some experts say no and one province is telling salaried doctors in no uncertain terms they must see additional patients.

Prince Edward Island's government fired off a letter to its physicians this month in an unusual move that also signals concern across the country - as more doctors shift to a salary or alternatives, productivity is dropping.

And that means the country's problematic doctor shortage is getting worse.

"It's human nature: If you put someone in a job and you say, 'The harder you work, the more money you make,' then they're going to work harder," Dr. Mark Baerlocher, who led a study on productivity in the new systems, told the National Post.

"The flip side is if you start putting people on salary, you take away their incentive to see more patients and work harder."

While some doctors agree they are seeing fewer patients, they argue the workload isn't any less because more time is spent with their clients hearing multiple complaints and fewer physicians burn out.

"I was seeing about 40 patients a day and was going home totally exhausted and questioning a lot of what I did," P.E.I Dr. Rachel Kassner said in the National Post article. "When you're exhausted, you can make mistakes."

The most recent national survey of 18,000 doctors found the percentage of those who receive just a fee-for-service has dropped to 42 per cent from 51 per cent in 2004.

And, a survey in 2007 found fee-for-service doctors on average saw twice as many patients per week compared with those on alternative payment schemes.

In P.E.I., about 70 per cent of doctors over the last decade have opted for a salary. The province knew that meant they would see fewer patients so it allowed for an increase in the number of physicians to compensate.

But some doctors didn't assume the expected 1,500 patients expected by the province, which has meant even with more physicians, the number of islanders without one remains about the same.

Ontario has taken a different approach, creating family-health teams where a group of medical professional work together and receive yearly fees per patient, fees and incentive payments.

They don't see as many patients as those doctors on a fee-for-service plan, but potentially provide better care and lowering the number of emergency room visits. There's no evidence yet these goals are being achieved.

(CBC Photo)