B.C. announced a new payment system for family doctors Monday (Oct. 31), which promises to compensate them based on total time spent rather than by patient visit.
The much-awaited new model will offer an alternative to the fee-for-service system, which family doctors have long pegged as one of the primary causes of the province’s doctor shortage.
Under the fee-for-service system, doctors are paid around $30 per visit regardless of its complexity or length and regardless of how much time they spend on patients outside their actual appointments. Family physicians say the model has left them underpaid and burned out.
In 2021/22, the average full-time family physician made $250,000, according to the Ministry of Health. However, an estimated 30 to 35 per cent of that, or $80,000 to $88,000, went to overhead costs, leaving doctors with a salary far lower than their health-care equivalents in hospitals.
A significant pay increase
Co-developed by the province, Doctors of B.C. and B.C. Family Doctors, the new payment model looks to correct that with a 54 per cent increase in gross salary, and a system that compensates doctors for visits, hours, and volume and complexity of patients.
Beginning on Feb. 1, 2023, full-time family physicians who opt in to the new model will make $385,000 per year. This, the Ministry of Health says, is based on a doctor working 1,680 hours, holding a roster of 1,250 patients with average complexity and completing 5,000 visits a year.
Broken down, family physicians will make $25 per visit and $130 per hour. They’ll make a starting amount of $41,600 per year based on the number of patients they see and the complexity of the patients’ needs.
Doctors will also have the option to work more or less as desired, with a minimum of one day a week. There will be no maximum on the number of patients a doctor can take on or how many hours they can put in, but Health Minister Adrian Dix said they will likely set a daily visit maximum as a quality-control measure.
Whether doctors sign up for the new model or stick to the fee-for-service one will be completely up to them. The Ministry of Health says there are about 3,400 full-time family physicians who would currently qualify for it.
A $708 million price tag
The cost of the new payment model is wrapped up inside the latest Physician Master Agreement, which the province and Doctors of B.C. tentatively agreed upon on Oct. 25. The three-year agreement still needs to be ratified, but proposes a $708 million cost increase by the end of the three-year contract over its predecessor. Beyond the pay increase for family doctors, the $708 million would also include new hourly premiums for after-hours services, increased funding for rural programs, enhanced physician benefits and more funding for the shift toward primary care networks, among other things.
Moving toward more integrated care
Longer term, the Ministry of Health says it is moving toward a system where patients can be seamlessly cared for by a team of health-care professionals, whether they need to see a doctor, a nurse practitioner, a social worker or a mental health professional. It says it’s working on a referral system for family doctors so when they encounter a patient with substance use or mental health challenges, for instance, they can easily connect that person with the supports they need.
Once all of B.C.’s primary care networks are in place, the Ministry of Health says there will also be a system linking family practice clinics with urgent care, walk-in and virtual care clinics. This will allow for easy referrals, and the transfer of doctors and nurse practitioners between clinics if needed to cover vacation time, sick days and parental leave.
Beginning mid-2023, the ministry is also promising its first-ever provincial rostering system, where patients looking for a family physician can sign up. The onus will then be on the province to find a doctor for people, the ministry says.
All of the new changes are the result of months of discussions between the Ministry of Health, Doctors of B.C. and B.C. Family Doctors. Prior to Monday’s announcement, the province promised $118 million in interim funding to help cover family physicians’ overhead costs until the new payment model came into place, new prescribing powers for pharmacists to take some weight off doctors, fewer barriers for internationally-educated doctors, and 128 new medical school spots to be rolled out between fall 2023 and 2028.
Doctors of B.C. estimates there are close to one million British Columbians currently living without a family doctor.
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