New pay model could help solve primary care shortage, improve care: New West doctor

A new pay model shows promise for helping to quell the severe shortage of primary care providers in BC, according to a family doctor located along the New Westminster-Burnaby border.

Dr. Carllin Man said the new pay model, which was announced on Oct. 31 by Health Minister Adrian Dix, “seems pretty exciting,” particularly noting the provision for the amount of time doctors spend working.

Currently, doctors are paid a flat rate per patient seen in their private practices, something Man has previously told the New West Anchor is both a poor reflection of the work done by doctors and hasn’t kept pace with inflation.

Doctors are paid about $35 per patient, up from around $29 a couple of decades ago. But $29 in 2002 would add up to nearly $44 today, according to the Bank of Canada’s inflation calculator.

Luring doctors back to family practice

Man told the Anchor the main issues in primary care are twofold: the flat rate paid per patient (called the fee-for-service model) and the lack of money in primary care.

He noted that, despite the popular belief that there’s a shortage of family doctors in BC, the province actually has the third-most doctors trained in family medicine per capita in the country.

But at the same time, the province has the worst access to family practitioners, with 81% of the population without a regular health-care provider.

The issue, he said, is that doctors typically don’t stay in family practice in BC—as funding has not kept pace with inflation, more doctors, he said, have moved to other areas of practice.

But the new pay model, he said, could bring more of those doctors back into family practice. Some of his friends who are family doctors but work in urgent and primary care centres (UPCCs) or hospitals are “definitely thinking seriously about opening a [family] practice,” he said.

“It’s mainly because they’re working at a UPCC [urgent and primary care centre] or in a hospital, and it just didn’t make sense to start a family practice. … The pay difference was so big that it just didn’t make any sense financially. So this new payment model has really sort of narrowed that gap quite significantly, if not erased it.”

The Health Ministry has estimated that full-time physicians typically make about $250,000 per year—but that could be elevated to over $385,000.

An easier workload

But Man said that might be a bit misleading, as family doctors currently typically work 60 to 80 hours per week. And a big part of that is the administrative work that needs to be done outside of the clinical work, something the new pay model accounts for.

The new pay model would run about $25 per patient seen, while also paying $130 an hour spent on paperwork. And Man said a lot of doctors will likely begin taking on fewer patients to limit burnout and to be able to spend more time with each patient.

While that may seem like a net loss in patient coverage, albeit a gain for those who have family doctors, Man said he believes the increase in doctors in family practice would offset that—and potentially even increase the number of patients with family doctors.

While Man noted that the move could see more doctors currently in BC turning back to family practice, others have suggested that family doctors could also begin moving to BC from elsewhere in the country.

“I truly fear that Alberta doctors will look to BC as a place where the government has issued a very clear intent to build respect and to end chaos in health care,” Alberta NDP Leader Rachel Notley said in a news conference last week.

The current pay model will be available to doctors moving forward as well, but Man said he believes “a lot” of family doctors would make the switch to the new model.

But Doctors of BC president Dr. Ramneek Dosanjh told Capital Daily last week that not all will.

“There's some people that don't want change, and they want to continue to practice exactly the way that they've practiced for years, and they're used to it or they're a few years from retirement,” Dosanjh said.

“We're not here to change that or tell people they have to change.”