B.C. doctor asks for $125 monthly retainer fee, re-igniting health-care debate

A family physician in Victoria is asking patients for a monthly fee of $125 to access enhanced services such as longer appointments and home visits – re-igniting debate about British Columbians' access to health-care.

A letter from Dr. Perpetua Nwosu outlining the changes, which was obtained by CTV news, says those who pay the fee can have longer appointments and discuss multiple concerns, and may be eligible for home visits. The money will go toward administrative and operational costs, including recruiting mental health counsellors and nurses to be part of the team.

CTV News spoke to a patient who wished to remain anonymous, who said she couldn't afford to pay the fee.

Nwosu didn't answer questions from CTV News on Monday. On Facebook she explained, "I will work with a team of professionals, all under my supervision for the vision of family medicine I was trained in. The family medicine that stays with you from birth until you take your last breath."

Victoria resident Barb McMillan said she thought the idea was “terrible.”

"It really erodes our health system here in Canada," McMillan added.

Doctors can charge what are called “block fees,” but only for what's not covered by the Medical Services Plan – and they must be optional. A practice standard from the College of Physicians and Surgeons of B.C. states, "Registrants who offer this option must not require that a patient pay the block fee before accessing an insured or uninsured service; treat or offer to treat patients preferentially because they agree to paying a block fee; or, terminate a patient or refuse to accept a new patient because the individual chooses not to pay a block fee."

Health Minister Adrian Dix said the Medical Services Commission is now reviewing this case.

"I don't know what this doctor is doing, specifically. That's an issue for the commission,” he said. "The rule in general is that such extra billing is not allowed."

The commission's mandate is to ensure access to quality health-care in B.C., and is made up of three government officials, three representatives from the Doctors of B.C. and three people representing the public.

A government website states patients can't be denied service if they don't pay and should be given the choice to pay them as they occur or through a block fee.

The site goes on to state charges aren't allowed for things like gowns, rental charges for instruments and facilities, but are permitted for therapeutic drugs, devices like splints and crutches, as well as extensive dressings.

Nowuso isn't the first doctor to charge patients an additional fee.

The Riverview Medical Clinic in Kamloops asks for $179 a year for one person, or $289 for a family, to cover what MSP doesn't.

A different, and more expensive option is Telus Health's Lifeplus Program, which costs more than $4,500 a year for priority access to a multidisciplinary care team that will create a custom care plan. That program is also under review by the Medical Services Commission. 

Telus noted the program doesn’t charge for access to public family doctors, and said its focus is primarily on employer-focused programs. 

"TELUS Health fully supports and is committed to publicly funded health-care as the foundation of our health-care system in Canada," a spokesperson said in an email. 

A physician in Saanich, Dr. Jennifer Lush, said the practice of billing for what isn't covered may become more common as many doctors face expensive overhead and other costs.

"Until such time the government chooses to compensate doctors adequately to provide the exceptional care we provide we're going to see more and more doctors coming up with such strategies," she told CTV News.

Dix said the province is in discussions to change the compensation model for doctors.

McMillan has a family doctor and considers herself lucky, but urged government to do more.

"I think you should pay him a lot more. I charge $150/hour for counselling and he gets, what, 30-something to see me. Both have nine years of education. It's not fair"