“A step in the right direction”: British Columbia announces new payment model for family doctors

Even opposition party leaders have positive things to say about the decision, but have raised questions about the implementation

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Minister of Health Adrian Dix. Photo: Government of British Columbia Flickr

In a deal hailed as “one of the best ever negotiated here in British Columbia” by Doctors of BC President Dr. Ramneek Dosanjh, the BC government announced a new way for doctors to be paid.

The three-year interim framework agreement between the province and family physicians includes an option for family physicians to move from the fee-for-service model to a new compensation plan that takes into account overhead, time they spend with each patient, the number of patients related to their practice and the medical complexity of each patient.

Health Minister Adrian Dix announced on Monday that the changes are meant to be “transformational” and attract and retain more family doctors in a province where one million people live without access to a primary care physician. A number of walk-in clinics have closed in Greater Victoria alone in the past year, leaving an estimated 100,000 people without care.

“For many doctors, I hear the value of shock: that they have been heard,” Dr Dosanjh told Capital Daily. “They feel valued and appreciated in a payment system that is actually going to be set up for them to thrive.”

Negotiations for the new agreement began in June 2021, and a letter to Doctors of BC members last August referenced some of the features announced today: support for rising business costs, continued independence from health authorities and compensation for time spent on clinical and administrative activities. work.

The current fee-for-service model involves a flat fee of approximately $31 per patient visit, and family physicians who run their practices pay overhead such as rent, staff, and equipment out of that fee. .

Under the current model, the Department of Health estimates that a full-time family doctor earns about $250,000 a year before taxes and overhead. The new agreement will increase this amount to $385,000 per year. Physicians can choose to switch to this system in January, and it will come into effect on February 1.

The Minister of Health also announced the creation of a roster system by mid-2023, whereby patients seeking a family doctor can register with a provincial registry and then be matched with a primary care provider in their community.

The province has yet to announce benchmarks for the number of family physicians it hopes to attract with this new model, or the number of patients it expects to match with one physician over the next three years.

Doctors vote on deal

The fine print of this new agreement will be shared with family physicians over the next two weeks.

“The new payment model is, quite simply, a much better arrangement than continuing to pay for it and we believe it’s a much better arrangement for patients,” Dix said. “A deal doesn’t solve all the problems we face… It’s a step, but I would say it’s a pretty big step and one that people have been waiting for for a long time.

According to Dr. Dosanjh, members of Doctors of BC will vote on whether to ratify the agreement on November 14. She believes most will jump at the chance to leave behind the “outdated” fee-for-service model, but not all.

“There are people who don’t want a change, and they want to keep practicing exactly the way they’ve been doing for years, and they’re used to it or they’re a few years away from retirement,” Dr. Dosanjh said. said. “We’re not here to change that or tell people they need to change.”

Physicians will have the option to stick with the current model even if the new agreement passes.

After reading the outline of the agreement announced today, Dr. Sienna Bourdon, family physician and medical director of Shoreline Medical in Brentwood Bay, is optimistic about the new model.

“I think paying doctors for indirect time is a huge step in the right direction,” said Bourdon, who is still reviewing the details of the deal.

Rising costs for doctors to run their practices have led to an increase in the number of private practitioners who operate outside the MSP and charge their patients a monthly or annual fee to access health services. Earlier this year, Capital Daily told the story of a doctor in Victoria who decided to charge his patients a subscription cost, raising questions about creating a two-tier healthcare system.

The decision to leave fee-for-service in the past received support from BC Green Party Leader Sonia Furstenau, who released a statement calling it a “good step forward”.

But following the announcement, she noted a lack of benchmarks in the proposed deal.

“What we had to do with this plan is how the government will measure results, and those measures should include the number of British Columbians attached to a family doctor, the number of family doctors recruited and an increase in care preventive,” wrote Furstenau. . “We also hope this is a signal from this government that it will move away from emergency primary care centres, which have been blatantly ineffective.”

The province’s announcement included a nod to these UPCCs, of which the government has opened 29 since releasing its primary care strategy in 2018. They will continue to play a role in Colombia’s overall primary care network. British, said Dix.

B.C. Liberal Party Leader Shirley Bond told reporters in the Legislature on Monday that she will wait to see how the model and slate system are implemented.

“It’s one thing to make an announcement; it’s something completely different to make sure it’s deployed effectively for doctors,” Bond said. “I believe there is a step in the right direction but again we want to see more details, timelines, [and] metric.”

Until the new payment model takes effect, the province continues to provide a short-term emergency funding stream to help family doctors with overhead costs. This stabilization fund of $118 million is provided to approximately 3,500 doctors from October to the end of January.

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About Matthew R. Dailey

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