‘Voracious’ appetite to dump fee-for-service model for BC family doctors

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Dumping the fee-for-service payment model in favor of a salary model could be one of the solutions to fix the crisis facing BC family medicine.

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Almost one million British Columbians do not have a family doctor. Many family physicians are leaving the practice or seeking other specialties due to rising costs of operating clinics and the current fee-for-service model, which critics say is outdated and does not adequately compensate doctors for their work.

When asked whether there was an appetite to dump the fee-for-service model in favor of salaries, Dr. Ramneek Dosanjh, president of Doctors of BC, said “absolutely.”

“I hear from so many members that are desperate to stay within their practice and are looking for an opportunity to do things differently,” she said.

While the sentiment isn’t shared by all doctors, there is “voracious” appetite among those who want government to take care of the management and infrastructure, and “I will take care of the doctoring, or what I do best.”

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Under the fee-for-service model, physicians are paid $30 to $40 a visit regardless of the severity of the patient’s issue.

Doctors of BC president-elect Dr. Josh Greggain estimates about 30 to 35 per cent of a family doctor’s gross income goes to pay staff. That’s in addition to overhead costs. “I have to pay the rent, the lights, my staff, my office staff… based on this singular fee code,” he said.

“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.”

Dosanjh and Greggain’s comments were made during a livestream discussion about the family doctor shortage in BC with Postmedia columnist Daphne Bramham.

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The online Q-and-A comes a day ahead of a grassroots rally planned Thursday outside the BC Legislature in Victoria starting at 11 am

Rally organizers encourage attendees to wear white if they have a family doctor and black if they don’t have one.

The group BC 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 to worry about overhead costs and perform unpaid tasks.

“Lack of trained individuals is not the cause of this crisis, lack of political will is,” said organizer Camille Currie in a statement.

On Tuesday, Premier John Horgan and Health Minister Adrian Dix met with Doctors of BC and committed to a “clear process” with “firm timelines” to find solutions to fix family medicine.

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“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.

Dosanjh, who plans to attend the rally Thursday, said one of the top priorities is to urgently address the overhead costs of family doctors currently practicing.

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She has heard from many colleagues who are in “moral distress” and exiting the profession. “We are at risk of losing the ones we have currently in practice,” she said. “We already know we have a crisis, that may just be the demise of primary care.”

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— with files from The Times Colonist

Watch Daphne Bramham’s Q&A with Doctors of BC president Dr. Ramneek Dosanjh and president-elect Dr. Josh Greggain. Subscribe today to secure your invite to our next reader-exclusive live Q&A.

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