BACKGROUND:
More British Columbians than ever do not have access to a family physician – nearly 900,000, or 20 per cent of the province’s population.1 At this critical time, the Doctors of BC (DoBC) and the provincial government have been negotiating a new Physician Master Agreement (PMA) since January 20222, with the most recent 3-year agreement having expired in March of this year.
The government faces significant inflationary pressures as it negotiates other public sector contracts and faces personnel shortages in many different fields of health care at the same time. But access to primary health care services is a foundational issue for the health care system and the economy as a whole.
Without access to family health care services, employers across B.C. will find themselves at a significant disadvantage compared to other jurisdictions where family physicians are available and accessible. The effects of the “Great Resignation” are not necessarily evenly distributed.
Access to timely and effective primary health care will make a significant difference for all sectors of the B.C. economy when attempting to attract and retain employees – for good or for bad.
Access to family medicine is also significantly more cost effective to government than the alternatives. Each emergency room visit involves many other areas of the hospital, from diagnostic imaging and housekeeping to administration, bringing the full hospital cost of an ER visit to $304 in 2018–2019.
The regular office visit (called the 0100 fee in B.C.) for family doctors varies slightly based on the patient’s age, but the average office visit is paid by the BC government’s Medical Services Plan at $33.06 – a cost savings of nearly 90 per cent compared to an emergency room visit.
The increasing crisis in family physician access is due in large part to an antiquated compensation model for family physicians, which pays for services provided without accounting for the actual time physicians spend with their patients and the significant costs and time associated with operating their clinics and ensuring they are available to the public.
In August of this year, DoBC and the province announced a $118-million stabilization fund3 designed to help cover the business costs of family practice clinics so that their doors can remain open to patients while the new PMA is negotiated and implemented, a process that is anticipated to be complete by January 2023.
The DoBC and the province have indicated4 that the new payment model for physicians in this new PMA will contain the best of fee-for-service (FFS) and contract models, simplify billing and recognize rising business costs and the complexity of providing longitudinal care.
Compensation for physicians will be determined by a number of factors, including:
Time: Physicians would be able to bill for the time in which they provide primary care services. This would recognize the additional time that physicians spend with more complex patients and will also cover time spent on clinical administrative services.
Encounters: In addition to billing for their time, physicians would also be able to bill for each patient encounter. This will provide an incentive to offer patients greater access to primary care services.
Attachment/Complexity: In addition to billing for time and encounters, physicians will also be paid for each patient on their panel, with additional payment for patients with more complex conditions. This would provide an incentive for physicians with larger and more complex patient panels.
The principle behind this compensation model is that the total pay for a physician who works full time under this model with a full patient panel of average complexity should generate an income after business costs that is equitable with physicians practising in hospitals and clinics administered by provincial health authorities.
The Kamloops and District Chamber of Commerce recommends:
That the provincial government:
1. Ensures that a new Physician Master Agreement is in place prior to the end of the stabilization funding period;
2. Ensure that the new PMA fully and properly compensates family physicians for the time they spent dealing with patients and for the time and cost of keeping their clinics open and available to patients;
3. Prioritizes reducing the number of British Columbians without access to a family doctor.
Resources:
1 Nearly 900,000 British Columbians don’t have a family doctor, leaving walk-in clinics and ERs swamped – The Globe and Mail
2 Negotiating the Physician Master Agreement | Doctors of BC
3 Stabilization funding announced for family physicians | Doctors of BC
4 Strengthening patients’ access to primary care by supporting family doctors | BC Gov News