B.C. announces new payment model for family doctors

The B.C. government has announced a new payment model for family doctors that officials hope will help address some of the trouble attracting and retaining physicians in the province.

Health Minister Adrian Dix said the new model will be presented as an optional alternative for family doctors, who are now largely compensated based on the number of services provided, and be available beginning in February.

The alternative moves away from that "fee-for-service" system, and will see physicians paid based on the time they spend with patients, the number of patient visits, the number of patients in their practice and the medical complexity of those patients, officials said.

"It would give family doctors a more equitable payment option, one that better recognizes their value in providing primary care," Dix said at a news conference Monday morning. "Importantly, it will help maintain their business autonomy, giving them more flexibility to create the kind of practice that works for them – and most importantly, for their patients."

A full-time doctor will receive about $385,000 per year under the new model, up from $250,000 currently, according to the province.

Dr. Jennifer Lush, a family doctor in Saanich, just outside Victoria, said the plan makes her optimistic.

“We will hopefully be able to not only retain the doctors we have, but also recruit more family doctors. So ultimately what that means for patients is it should, over time, become easier to have a family doctor, and that's what everybody needs and deserves,” she told CTV News in an interview.

The new payment model was developed in partnership with Doctors of B.C. and is being delivered through a three-year tentative physician master agreement, which comes with a total incremental cost increase of $708 million by the end of the third year.

That master agreement must be ratified by physicians before it can come into effect.

Dr. Ramneek Dosanjh, the president of Doctors of B.C., said supports offered in the new model along with the payment system will allow physicians to get back to doctoring.

“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.” she added.

In addition to pay increases, the government said the deal will also cover income disparities and new hourly premiums for after-hours services.

MATCHING PATIENTS WITH DOCTORS

It is estimated that as many as one million British Columbians do not have access to a primary care provider, with an additional million waiting for specialist care.

Dix said six months after the new fee system goes into effect, a roster should be set up to match doctors with patients – though he couldn’t say how people might be prioritized.

Opposition health critic Shirley Bond said the plan to connect people with family doctors is lacking details and metrics.

“Making an announcement is one thing, making sure that it works and that we can measure success, that's what's critical,” Bond told reporters at the legislature Monday.

Doctors have attributed the shortage, in large part, to the "fee-for-service" payment model, which they have criticized as outdated. Doctors of B.C. estimates each patient visit nets physicians less than $30 on average, due in part to the high cost of overhead and administrative work they put in.

Doctors in the province need to find and lease their own space, hire their own staff and source their own equipment, meaning they spend hours running their businesses instead of practicing.

The stress led some to retire, close their doors, or work in hospitals, noted Lush.

“Under the old fee-for-service system, B.C. had amongst the lowest paid family doctors across the country, and so we were not only losing doctors to hospitals and other areas of practice, we were losing doctors to other provinces as well," she added. 

For patients, this model can mean less time with doctors and fewer available appointments since it limits the amount of time their doctors are available to practice and incentivizes seeing a higher volume of patients rather than providing comprehensive care.

In addition to the hundreds of thousands without access to consistent care, the crisis has led to increased pressure on already struggling and short-staffed 911 centres, ambulances, and hospitals.

In August, the ministry announced $118 million in interim funding for primary care providers – with eligible physicians receiving an average of $25,000 each in order to keep their practices running while the new payment model was being negotiated.

With files from CTV News Vancouver's Lisa Steacy and The Canadian Press