we’re looking at a whole-scale collapse of the primary care infrastructure” in british columbia, says renee fernandez, executive director of bc family doctors .
fernandez predicts 40 per cent of b.c.’s family doctors will retire in the next 10 years and that it will be impossible to fill the gap, leaving millions in b.c. without a family doctor. the reason? the way family medicine is practised in b.c. – and in much of the country – is a failed business model, according to a report in the canadian family physician journal.
in 2019, statistics canada reported that nearly 18 per cent of british columbians 12 and older had no family doctor, and fernandez says that number will rise even further.
the college of physicians and surgeons of british columbia (cpsbc) reports that 38 per cent of family physicians in b.c. are 55 or older, two-thirds of them over 60. with the average physician retiring at age 65 , fernandez says that works out to about 1,200 physicians retiring in the next 10 years. if each of those doctors is caring for 1,000 patients, that would leave 1.2 million british columbians searching for a new doctor, she says.
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almost all family practices in the province are run as small businesses by physicians, says fernandez, and high business costs cut into their profits from billings, which haven’t kept up: an office visit for a patient aged two to 49 earned doctors $30.64 in 2016 and $31.62 in 2021 – a 3.2 per cent increase over five years.
another contentious pay issue is on-call phone availability, which the cpsbc mandates family doctors provide, either on their own or through a designated on-call doctor in their group. for example, if family doctors are called at 2 a.m., they earn the same $31.62 as they would during office hours. but the time spent making oneself available in anticipation of a call is “completely uncompensated,” says mccracken.
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fernandez says early career family doctors, who overwhelmingly choose not to practise full-time family medicine, won’t fully replace those leaving the system. mccracken agrees, saying that new graduates “don’t want to run a business,” especially alone. instead, they opt for working temporarily in others’ offices or working in hospitals.
“it’s about not having the entire practice on your shoulders,” he says, and about being able to consult with colleagues and take time off – views that are supported by a recent poll of b.c. family physicians.
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the predominant model in canada is fee-for-service (ffs), in which doctors are paid per patient visit. this deters newer doctors from setting up practice, according to a november 2021 article . valle agrees, saying that learning to bill by ffs was so time-consuming, it felt “soul-crushing.”
one alternative to ffs is “ capitation ,” in which the province pays doctors a fee for each person who enrols in their family practice. b.c. has only a handful of clinics in which doctors are paid this way, one being spectrum health in vancouver.
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the b.c. ministry of health’s response to this is primary care networks (pcns), which directly fund team roles for clinics and provide “ competitive contracts ” for physicians that “include annual overhead costs.” first announced in 2020, these give doctors the opportunity to practice in a team and more flexibility to take vacations, hedden says.
to date, there have been no public reports about the uptake of this model, and the b.c. ministry of health did not respond to requests for an interview.
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