About a million British Columbians don't have a family doctor, which has had a ripple effect throughout the health care system and contributed to delayed ambulance response, ER closings and growing waiting times for critical treatment.Jeff Roberson/The Associated Press
British Columbia is overhauling the way it pays family doctors with a new model that will offer about $135,000 more in gross annual pay, as part of a package aimed at recruiting and retaining general practitioners.
The change is one aspect of the tentative $708-million, three-year Physician Master Agreement, announced Monday by Health Minister Adrian Dix and Doctors of BC president Ramneek Dosanjh. The PMA, yet to be ratified, includes payment increases for all doctors, as well as more funding for overhead costs and rural programs.
About a million British Columbians do not have a family doctor, which has had a ripple effect throughout the health care system and contributed to delayed ambulance response, emergency department closings and growing wait times for critical treatment.
The new payment model, co-developed by the province, Doctors of BC and BC Family Doctors, moves away from a fee-for-service model that has been criticized for incentivizing short appointments and episodic care to one that compensates based on several factors, including the medical complexity of patients. Family doctors will be able to opt in beginning Feb. 1.
Dr. Dosanjh said work on the new payment model and the tentative PMA agreement have been “a true collaboration,” shaped by the voices of B.C. doctors.
“There is still much work to be done, but I believe today we are at a milestone,” she told a news conference. “The new PMA that will be going to our members for a vote in the next few weeks – it is by far the best agreement negotiated for physicians in Canada this year, and I believe it is one of the best that has ever been negotiated here in B.C.”
Under the fee-for-service model, family doctors are paid just over $30 a patient visit, regardless of the complexity of the patient’s issue. Their practices are operated as businesses, with physicians handling administrative tasks and paying for overhead costs, such as leasing clinic space and hiring staff. Critics have said it’s an antiquated model that reduces patient visits to a series of billable fee codes and fails to account for the complex needs of an aging population.
Under the new model, payment is based on time spent with a patient, number of visits a day, number of patients in a doctor’s practice and their medical complexity. Doctors are also able to spend time on aspects of their work they were not previously compensated for, such as clinical administration and clinical teaching.
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In 2021-22, a family practice doctor working full-time under the fee-for-service model received about $250,000 before overhead. Under the new model, that doctor would earn about $385,000. Doctors must work a minimum of one day a week to opt into the new model, while there is no cap to hours of service, number of visits or patients attached.
By mid-2023, B.C. will also be implementing a “rostering system” in which family practices maintain and report on who they are caring for, and will be part of a provincial process to attach people with family doctors.
“You’re going to see a system that responds better to people, that builds up the number of family doctors and allows people to access them by a provincial system,” Mr. Dix said.
Andrew Longhurst, a health-policy researcher and PhD candidate at Simon Fraser University, said it’s a good step to move away from the fee-for-service model but cautioned that the higher-compensation alternative could have unintended consequences.
“That raises concerns, just from a system perspective, when you’re having potentially a 54-per-cent increase in compensation,” Mr. Longhurst said. “I know that’s being argued as something that is going to retain and draw new students into family medicine, but there is research literature showing that increases in physician compensation actually result in reduced services.”
He cited the “induced productivity decline hypothesis,” which posits that excess physician compensation beyond a target income causes a fall in productivity, and said the details will be in how the new model is operationalized. He added that there are other long-standing issues, such as the need to build out primary-care infrastructure, that cannot be addressed through payment reform.
Liberal health critic Shirley Bond said she’ll be watching the rollout closely and called for measurable benchmarks.
“It is one thing to make an announcement; it is something completely different to make sure that it’s rolled out effectively,” she said.
“This does mirror what physicians and the opposition have been calling for for months now, so I’m relieved that there is a step in the right direction. But again, we want to see more detail, timelines, metrics and measurements.”
With a report from Justine Hunter in Victoria