Canada is full of publicly owned hospitals—so why not primary care clinics?

Some doctors have lauded B.C.’s ability to attract more family physicians since the province launched its new opt-in payment model two years ago, but more research and funding needs to be put into fixing infrastructure, said Dr. Lindsay Hedden.“I don’t think the way that we choose how to pay physicians is the first thing we need to think about when it comes to fixing primary care,” said Dr. Hedden, an assistant professor and health-services researcher at Simon Fraser University’s faculty of health sciences. Her comments came from a panel discussion called 'The Future of Primary Care in Canada,' at the Canadian Doctors for Medicare Health Summit, which took place in Toronto earlier this month. Her presentation touched on the recent trends defining Canadian primary care, including new payment models, virtual care and corporatization.Reductions in capacity and supplyDr. Hedden said that research shows that while there are more family doctors in Canada, there is less available service for individual patients looking for primary care. There has also been a trend, since the COVID-19 pandemic, of more physicians retiring early and/or reducing their clinical activity pre-retirement. Dr. Hedden’s current research is focused on the increasing role of virtual care in primary care, the effects of the increasing corporatization and privatization of Canada’s healthcare system and interdisciplinary team-based models of primary care practice and planning. In February last year, the CBC reported an increase of more than 700 doctors practising family care since the longitudinal family physician (LFP) model was introduced in B.C., a year before. The framework, which gives doctors the option to scrap the fee-for-service model, and instead pays doctors for the number of patients they see, the complexity of their needs, and the time spent on reviewing lab results, consulting with other medical professionals, and other necessary tasks, went into effect in the province on Feb. 1, 2023. Since then, Nova Scotia, Manitoba and Saskatchewan, have introduced similar payment models to attract more doctors into family care, trying to solve a shortage of family doctors in their respective provinces. According to a report published by the Canadian Institute for Health Information (CIHI) in December, the rate of family physician growth slowed from nearly 3% between 2015 to 2017 to 1% from 2021 to 2023. While the CIHI indicated that the growth rate kept its pace with population growth, the data showed a continuing trend of family physicians in Canada seeing fewer patients. On average, the CIHI found that there has been an 18% decline over the past 10 years—from 1,746 patients in 2013 to 1,430 patients in 2022. “The total levels of services provision and per-physician practice size is declining despite physician supply increases,” said Dr. Hedden during the presentation. The benefit of these payment models, said Dr. Hedden, is that there is a move away from fee-for-service and the commodification of primary care, at least somewhat. She also said that the models improve total compensation and specific compensation for indirect care activities. The risk, she said, is that there is a potential for a reduction in overall capacity and a continued reliance on physician owned and operated clinics. Invest in public infrastructure“A lot of newer grads don’t want to be small business owners,” said Dr. Hedden, referring to the conversations she’s had with recent graduates and new medical doctors.Most current models still rely on physician-owned-and-operated clinics, rather than a team-based model that she said recent medical graduates are used to and hoping to be put into once they enter the workforce. The other threat, she said, is of more clinics being bought-out by private equity. “There should be public money put into buying up spaces,” Dr. Hedden told Canadian Healthcare Network. “Ultimately, I’m arguing for publicly owned clinics, the same way we have (mostly) publicly owned and operated hospitals.”“I think we will always have physician owned and operated clinics—unless they are all bought-out by private equity. But I think we need more public ones too so that these newer grads who don’t want to be small business owners have a place to go. And to create more direct lines of accountability to the communities we are supposed to be serving.”

Canada is full of publicly owned hospitals—so why not primary care clinics?

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