Doctors say new model is a ‘seismic shift,’ with physicians able to leave fee-for-service system in February.
The government of British Columbia is ushering in a new payment model for family doctors in February.
Provincial health officials announced the news Monday morning, saying physicians will be able to opt out of the current fee-for-service system in the new year. Under that system, doctors are paid based on the number of patients they see in a day.
The new model will take into account factors that include how much time a doctor spends with a patient, the complexity of their needs, the number of patients a doctor sees daily, as well as the total number of patients a doctor supports through their office and their administrative costs.
Most family doctors in B.C. are currently paid about $30 per patient visit, whether they’re treating a common cold or a complex chronic health problem.
In September, Health Minister Adrian Dix acknowledged B.C. has been in a health-care crisis since at least the beginning of the COVID-19 pandemic.
The number of people without a family doctor in the province has grown from about 340,000 in 2003 to 908,000 in 2017 and is expected to be higher this year, he said.
Since he became health minister in 2017, Dix said, 38,000 new staff have been added to the health system in B.C. Addressing the press and public Monday, Dix said the new payment model will make it more attractive for doctors to enter family practice and to retain existing physicians. He said it will give family doctors the flexibility and autonomy to create the kind of practice that works for them.
“We are making family practice the priority it should be,” said Dix.
Family physicians will be getting a significant raise under the new compensation model.
The provincial government says a full-time family doctor will be paid about $385,000 a year, up from the current $250,000, under the new three-year Physician Master Agreement reached with Doctors of B.C. last week.
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In addition to pay increases, the government says in a statement that the funds will also cover income disparities and new hourly premiums for after-hours services.
The statement says the agreement provides more equitable payment for the work of family doctors and better recognizes their value in providing full-service primary care to patients.
Full-service family doctors are those who work in communities to provide ongoing primary-care services for their patients.
Dr. Ramneek Dosanjh, president of Doctors of B.C., praised the new agreement Monday — calling it the best in the country and a “seismic shift” for the better in B.C.
The goal is not only to stabilize family practice, but to make it sustainable and rewarding, Dosanjh said in the statement.
“Everyone deserves a family doctor, and this new option is a major step toward making that goal a reality,” he said.
The new master agreement, which was developed between the Doctors of B.C., the province and B.C. Family Doctors, must still be ratified by physicians.
In November 2021, a report published in the Canadian Family Physician Journal found up-and-coming family doctors are choosing more hospital-based work and specialized practice rather than family medicine — in part because they’re worried about the consequences of B.C.’s fee-for-service model.
The agreement would be accompanied with a new “roster” system, to be introduced by mid-2023, where those looking for a family doctor can register to be linked with practices in their community instead of searching one out themselves, an official said Monday.
Dix said the payment model will help protect and strengthen B.C.’s health-care system. However, he said the government doesn’t have a specific estimate for its impact in terms of the number of people who will get a family doctor, or the number of doctors recruited as a result.
“It’s going to have a very, very positive effect. We can’t be exact,” he said, adding that it’s not a one-step solution but is part of a broader overhaul of health services.
One of the complaints from family doctors has been the high overhead costs of operating a practice, averaging between $80,000 and $85,000 a year, that comes out of their pocket, an official said.
The new model aims to close the pay gap between family doctors and hospitalists, who are paid close to $300,000 a year to work in hospitals and have the same training but not the overhead costs.
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