B.C. doctors urge province to expand new 'precedent' that could improve family medicine crisis

An unexpected move to pay British Columbia’s family doctors for the extra time required to assess high-risk COVID-19 patients has a physicians’ group urging the province to recognize many others deserve more time with their primary doctor as well.

Starting July 1, family doctors are able to bill the health-care system for up to an hour to assess whether a patient meets the criteria for Paxlovid, an anti-viral drug prescribed to prevent serious illness or death, in seniors and those with certain health conditions.

“This work is challenging and time-intensive,” reads an announcement by BC Family Doctors to their members. “In order to support physicians who are doing or wish to do this work, we are happy to announce a new fee code to support the time and complexity of the care and care coordination.” 

The move comes two months after CTV News was first to report tens of thousand of doses of the drug are sitting unused in British Columbia at a time few people can get an appointment within the five-day window to start the treatment.

Family doctors are already questioning why the provincial government won’t approve payment codes for other complex diagnoses or medications, which advocates have been calling for for months. 

“I think it's really encouraging that they're acknowledging that family doctors' time is valuable,” said Dr. Jennifer Lush, a member of Family Doctors for Better Patient Care in B.C. “A precedent has been set for paying family doctors for their time and it's important that we treat our patients who have COVID-19 – but so is cancer, and mental health and diabetes. and any patient that needs the care of a family doctor deserves to have the time spent with them that their clinical condition requires.”

HEALTH MINISTER NONCOMMITAL

B.C. doctors are paid under a fee-for-service system, in which they are paid per patient visit, no matter how long it takes to assess, treat or prescribe to that patient, and many say that’s the reason they’re leaving family practice. Complex patient issues and the review of test results or consultations with specialists, for example, are not recognized. 

CTV News asked the health minister why he isn’t allowing “time modifiers” to allow them to bill for other medications and conditions that require more time with patients in light of the Paxlovid policy.

“We make adjustments all the time,” replied Adrian Dix. “In the case of Paxlovid, there are specific reasons and circumstances that people would be diagnosed and that's why those time modifiers are being changed.” 

The minister, who’s angered family doctors several times in recent months, did not commit to any other method of recognizing some patients require more time with doctors, who should be compensated for the additional care.

THE KEY ISSUE IN FAMILY MEDICINE CRISIS

The issue has been the subject of intense advocacy by B.C.’s physicians, who’ve been trying to explain the closure or scaling back of family practice due to the increasing complexity of their jobs, without a commensurate change in compensation or recognition of the demands on them and time required outside of the actual patient visit. 

In Alberta, family doctors are paid on a fee-for-service basis, but time modifies are part of their system and hundreds of doctors are accepting patients of all stripes at a time an estimated one million British Columbians cannot find one. 

While it’s difficult to gauge the average salary of a family doctor since the province only tracks the amount they bill to the system, which is the gross amount paid to them and does not include rent, supplies, staff and other business expenses that must be paid from the payout, sources within the medical field say it’s typical for a doctor to make $150,000 per year in family medicine, and upwards of $250,000 per year working as hospitalists or contract physicians in telehealth companies.