In British Columbia this week, the provincial government has taken a bold and costly step that it hopes will help recruit family doctors for an estimated 1 million people. Adrian Dix, the Minister of Health, has introduced a new plan that could see the gross income of a typical family doctor increase by C$135,000 a year, to around $385,000.
This is a problem that resonates in other provinces. This week I traveled to Nova Scotia for an upcoming climate story. In informal conversations, the shortage of family physicians in the province kept coming up.
Nova Scotia’s latest monthly tally, released in mid-October, showed 110,640 people, or 11% of the population, were on the waiting list for a family doctor.
Nova Scotia and British Columbia are not alone. The recently re-elected Government of the Coalition Avenir Québec reneged on its promise to ensure that everyone has a family doctor. More than 800,000 Quebecers do not have it. In Ontario, the provincial family physician advocacy group estimates that 1.8 million residents not having a family doctor and an additional 1.7 million people are cared for by doctors over 65 who are approaching retirement.
Desperation to find a doctor prompted Janet Mort in British Columbia to take drastic action. She placed an ad in a local newspaper looking for a doctor to fill her 82-year-old husband’s prescriptions after his doctor retired, as reported by Global News. His strategy succeeded.
For others, the process of finding a family doctor has meant working on the phone calling individual clinics or getting on growing provincial waiting lists. Those who turn to family physician walk-in services find longer wait times and no continuity of care. And some people are adding to the overcrowded hospital emergency departments.
Although BC’s new plan would increase the income of family physicians, it is not a simple increase. Rather than simply increasing payments, the province is completely changing the way family doctors bill the government. Under the current fee-for-service model, physicians in British Columbia and most provinces are paid approximately C$30-40 each time they see a patient, regardless of how long they spend or the complexity of the patient’s medical problems.
The system was first put in place to end a doctors’ strike in 1962 after Saskatchewan became the first province to introduce public health care. But critics say it encourages medical students to seek out other specialties where government fees better reflect the time and skill needed for treatments and which generally yield higher incomes.
Under BC’s new plan, a doctor’s income will increase based on a number of factors, including the amount of time a doctor spends with a patient, the number of patients they see each day , the number of patients in his practice and the complexity of the patient’s medical condition. The new system will also pay some of the office staffing and operating costs, a move that addresses a long-standing grievance of many family physicians.
In an interview with The Vancouver Sun, Dr. Ramneek Dosanjh, president of Doctors of BC, described the new system as “a seismic shift.” The province estimates it will increase health care costs by C$708 million in its first three years.
Even Mr. Dix, however, acknowledged that the new payment system is unlikely to completely solve the shortage of family doctors.
I spoke with Katherine Stringer, director of the department of family medicine at Dalhousie University in Halifax, about the department’s efforts to increase the number of family doctors in Nova Scotia.
One step was to design a program that ensures students spend part or all of their two-year family medicine residencies in smaller communities around the province rather than Halifax, a decision she says often has brought new family physicians to stay where they trained.
She also acknowledged that although family physicians are in fact small business owners, the training they receive on how to run their business while in medical school is “very rudimentary.”
As a result, Dr. Stringer said, for many new doctors, “it’s a very stressful first year.” Emulating a strategy used for new technology companies, the medical school brought in mentors to help new doctors find their way. Dalhousie is also working with the province on setting up teams to put in place all the compilation of patient records needed for a new practice.
But Dr Stringer said the key to making family medicine more attractive will be another shift to a model where patients deal with a group practice of doctors rather than a single doctor. Such arrangements better distribute workloads, allowing physicians to share office costs and reduce administrative tasks.
“We are able to free up a doctor’s time and therefore accept more patients,” Dr. Stringer said.
Dalhousie is converting its two clinics in Halifax into collaborative practices, she said, and aims to be able to serve an additional 3,500 patients.
“The future of family medicine in Canada must be based on teamwork,” said Dr. Stringer. “We can achieve efficiencies and focus care so patients receive care from the right health care provider at the right time.
This week’s Trans Canada section was compiled by Toronto-based New York Times research journalist Vjosa Isai.
Originally from Windsor, Ontario, Ian Austen was educated in Toronto, lives in Ottawa and has reported on Canada for The New York Times for the past 16 years. Follow him on Twitter at @ianrausten.
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