What the new family doctor payment system in B.C. will mean for patients — and doctors

The provincial government is making big changes to how general practitioners are being paid, with the hopes of recruiting and retaining physicians as B.C. struggles with an ongoing doctor shortage.

On Monday, the province announced a new payment model that it says will allow for more time with patients and compensate doctors for the work they do outside the examination room.

How will this change help the estimated one million British Columbians who don’t have a family doctor? 

‘Roster’ system will pair patients with doctors

Health Minister Adrian Dix said the new system — described as a “roster system” — will make it easier for people to find a family doctor, though he wouldn’t make any promises on how soon that could happen. Rather, he said, the system will be implemented by July 1, 2023.

“We don’t want to over-promise you, but this is an important fundamental change that will make things better for people, especially for patients,” he told CBC’s Stephen Quinn, host of The Early Edition.

B.C. Family Doctors Executive Director Dr. Renee Fernandez said implementing the system will be a two-phased approach: first, the province will have to identify who in B.C. does not have a family doctor.

From there, they’ll have to look at how they can match people up with a doctor that’s appropriate for their needs — whether that’s one nearby, or one who speaks a particular language.

According to the province, the new model will also take into account several factors in pairing patients and doctors, including: the amount of time a doctor spends with a patient, the number of patients they see in a day, the total number of patients seen through their office, the complexity of a patient’s issue, and administrative costs.

Dix says this will reduce the administrative burden and responsibilities associated with running a business and allow doctors to focus on providing care for patients.

Doctors to be paid more in new payment model

Currently, family doctors are paid per patient visit in the fee-for-service model.

This doesn’t account for work done after hours, including paperwork, researching patients’ conditions, or any other administration.

The payment model has been heavily criticized by practicing physicians and medical students, who say they’re forced to take on more work than they can handle to be able to afford to run a practice, leading to burnout.

The new model will account for after-hours work, and compensates doctors who do have the capacity to see extra patients.

Ideally, this means doctors will be able to spend more time with patients, particularly those with complex needs. 

“It allows family doctors to be compensated for all the time they spend working, not just that that’s in front of a patient,” Victoria-based family physician, Dr. Jennifer Lush, said on CBC’s All Points West. 

“We can delve into those issues and spend time with [patients] without having to worry about whether or not we’ll be able to pay the bills.”

‘This payment model would have kept me in the game’

Fernandez said that of the 6,800 family doctors in B.C., less than half are practising traditional family medicine, also referred to as longitudinal care by medical professionals.

She said she hopes this new plan will mean those who are working in other areas of family medicine will return to longitudinal care.

Fernandez said she herself left for women’s health and maternity care about 10 years ago because she didn’t have this kind of support to allow her to continue that type of work.

“This payment model would have kept me in the game.”

Additionally, she said, it will make the profession more attractive for medical students. 

“It actually pays better to do every other type of family medicine in the province. If you’re a young graduate leaving medical school with debt of $200,000, you’d be silly to go do in family medicine.

“But now, because there are robust supports in place to cover the costs of running that clinic, doctors can actually focus on what they’re highly trained to do.”

Lush said the plan could also help with recruiting doctors from out of province.

She suggested family doctors have left B.C. for other provinces, but hopes the new model will encourage them to return to B.C.