Forget fee-for-service: Doctors need a salary, says physician association

There’s a “voracious” appetite among doctors in British Columbia for a switch from fee-for-service to a salary model, according to leaders at Doctors of B.C. “I hear from so many members that are desperate to stay within their practice and are looking for an opportunity to do things differently,” Doctors of B.C. president Dr. Ramneek Dosanjh said during a recent livestream discussion about the shortage of doctors in B.C. When asked if the province’s doctors are keen to dump fee-for-service, Dr. Dosanjh responded with “absolutely,” according to a Vancouver Sun report. While not all doctors want this change, there’s a lot of support among doctors who want the province to take care of their practice’s management and infrastructure so they can “take care of the doctoring, or what I do best,” she added. Read: How UPCCs are trying—but failing—to solve Victoria's FP shortage and what locals are doing about it Switching to salaries from fee-for-service could help solve the province’s dire physician shortage, which is driven in large part by doctors leaving their practice for other locations or to seek other specialties. Close to one million British Columbians don’t have a family doctor. With hundreds of doctors set to retire over the next 10 years, an additional 1.2 million people will be left without primary care, according to the College of Physicians and Surgeons of B.C. Critics have lambasted fee-for-service as being outdated. Under this model, physicians are paid $30 to $40 a visit regardless of the severity of the patient’s issue. Fee-for-service doesn’t compensate doctors adequately, making it hard for them to keep up with the rising costs of running a practice.More importantly, it encourages doctors to focus on quantity rather than quality time with patients, said Dr. Josh Greggain, president-elect at Doctors of B.C. Read: No room! B.C. doc says stop building big residential housing where there are no FPs to care for newcomers “The metrics for fee-for-service produces volume. If you want to make sure the lights stay on, you have to see more and more patients, which limits their time with the provider,” he said. Dr. Greggain estimated that about 30% to 35% of a family physician’s gross income goes towards staff wages. On top of that “I have to pay the rent, the lights, my staff, my office staff … based on this singular fee code,” he said. The online Q-and-A preceded a grassroots rally that happened on May 19 on the grounds of the B.C. Legislature in Victoria. Hundreds of healthcare workers and patients without a primary care attended the rally. One patient, Roy Nelson, told a CHEK News reporter his family doctor of several decades is retiring in November. Read: Physician assistants could fill part of B.C.'s need for more doctors: advocates “I’m getting a new knee soon, it’s going to mean something if I don’t have someone to check on me,” said Roy. Dr. Michelle Workun-Hill, a family physician who drove from Nanaimo to attend the rally, said that the walk-in clinic where she works is “the only one we have left.” “It’s pretty dismal so I’m telling probably 10 people a shift that there’s nothing I can do to help them get a doctor,” she said. “The care we’re providing is not the kind of care you should be giving, it’s very complicated mental health, chronic care, we have cancer we have bipolar disorder, we have things you can’t manage with an eight minute walk in appointment with no follow up.” The group B.C. Health Care Matters says the province has been graduating more family doctors than before, but many are choosing to pursue other specializations or work in hospitals, where they don’t have worry about overhead costs and perform unpaid tasks. Read: Call me maybe? Why doctors who trained in N.L. want to work there, but don't “Lack of trained individuals is not the cause of this crisis, lack of political will is,” said organizer Camille Currie in a statement. Premier John Horgan and B.C. Health Minister Adrian Dix met on May 17 with Doctors of B.C. and committed to a “clear process” with “firm timelines” to find solutions to fix family medicine. “I’ve heard from physicians throughout the province that they are both overworked and frustrated by the pressures they are under, which are compounded by the ongoing consequences of the pandemic,” said Horgan. Read: There is no doctor shortage

Forget fee-for-service: Doctors need a salary, says physician association

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