British Columbia’s family physician compensation model deters future physicians from continuing their work and contributes to the province’s continuing shortage of family physicians, according to a report released Friday.
The report, published in the Canadian Family Physician Journal, found that emerging family physicians are choosing hospital-based work and specialty practice more than family medicine – in part because they worry about the consequences of British Columbia fee-for-service. service model.
Depending on the payment model, doctors and hospitals are paid by the province for each office visit, test or operation. To stay afloat, they have to continuously work with a large number of patients and run a business at the same time.
“The problem with this type of payment is that it forces the family doctor to do everything related to the care of the patient – medical care, nursing and administrative work,” said Dr Goldis Mitra. , family doctor and assistant professor who co-authored the report.
“As patients have become more and more complex, it becomes clear that it is not working for patients or for providers. “
Most family physicians in British Columbia are paid around $ 30 per patient visit, whether they are treating a simple cold or a complex chronic condition.
Physicians run their practice like a business, paying overheads like staff and offices at an average rate of around $ 60 an hour or more.
Many would rather be part of a team: report
The report – which surveyed 63 young doctors in three provinces, including British Columbia – found that many respondents would prefer other funding models.
“Many of the doctors we spoke to said they wanted to get into [an] practice in an office – so they wanted to be what we think of as the traditional family physician – but they avoided getting into this type of practice because fee-for-service, in some ways, prevented them from providing the patient care they thought was needed and deserved, ”Mitras said.
She said many would prefer to work as part of a team of healthcare professionals like nurses, physiotherapists and social workers.
They would also have the help of administrative employees to take care of the tasks related to running a business. The province would fund the clinic and the health care practitioners would receive a salary.
“This allows the family physician to focus on medical care: prevention, diagnosis and treatment of disease,” said Mitras, who is also a clinical assistant professor in the Department of Family Medicine at the University of British Columbia. .
In places where these models have worked well, Mitras said, there are risk-adjusted payment models, which means clinics are more funded and supported to care for more complex patients.
“We know that everyone needs a family doctor, but especially some of the sickest patients who need the most care,” she said.
The report’s authors, including Mitras, are part of a team of health policy researchers examining how early-career family physicians choose to work and why. The doctors they interviewed were from British Columbia, Ontario and Nova Scotia.
In May 2020, the College of Family Physicians of Canada also called for alternative funding models to replace the fee-for-service method to better support continuity of care and prevent family physicians from leaving their homes. use.
In a statement, the health ministry said there are alternative physician compensation models available to doctors in British Columbia, such as contracts with the ministry and health authorities. He said the budget for alternative funding represents about 20 percent of the total compensation available to physicians in British Columbia.
Mitras said it was a good step, but the province needs more “clear and sustained” investments.
LISTEN | Dr Goldis Mitra explains the fee-for-service model and its shortcomings:
7:59Why British Columbia’s Fee-for-Service System Fails for Health Care
Dr Goldis Mitra Talks With Stephen Quinn About The Need To Change BC’s Fee-For-Service Model For Family Physicians 7:59
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