B.C. launches new payment model for family doctors

B.C.'s new payment model for family physicians came into effect on Wednesday, giving doctors the option to do away with the old fee system reported to have driven new recruits and veterans alike away from the job.

The new framework allows physicians to scrap the current fee-for-service system that saw them paid a flat rate per patient visit and be paid instead for a range of duties that come with the job.

"I believe it's the most significant reform to primary care in my lifetime in the history of the public health-care system," Health Minister Adrian Dix said at a news conference outlining the changes.

"It addresses inequities in compensation, helping to attract and retain family physicians and therefore increase the number of physicians able to provide care to people in B.C."

Through the fee-for-service system, doctors are paid around $30 per patient visit — no matter whether they're treating a simple common cold or a complex chronic health condition. 

B.C.'s new model, called the longitudinal family physician (LFP) payment model, sees doctors compensated the number of patients they see daily and the complexity of their needs. 

The province said it means family physicians will be paid for extra time with patients, especially those who need more support — like seniors or patients with mental health conditions.

They'll also be paid for time spent on other necessary tasks like reviewing lab results, consulting with other medical professionals, updating patient lists and clinical administrative work. 

"Today is a new day for family physicians to have choice to provide the care that they have always wanted to do and have not been able to," said Doctors of B.C. president Dr. Joshua Greggain, calling the model "transformational."

Dix said 1,043 of roughly 4,000 eligible doctors from all five health authorities signed up for the new model on the first day. He expected the number to grow "significantly" in coming days and weeks.

Most family doctors in B.C. are independent contractors and run their practices as businesses, paying for overhead costs such as office space and staff and medical equipment. The price of operating a practice has driven many prospective physicians to choose other areas of medicine.

The College of Family Physicians of Canada called in 2020 for alternative funding models to replace the fee-for-service method to better support continuity of care and stop family doctors from leaving their jobs.

Under the new framework, the average family physician in B.C. will see a raise from roughly $250,000 to around $385,000.

The number of people without a family doctor in B.C. more than doubled from 2003 to 2017. The shortage of family doctors in the province has left a burden on other areas of health care, like urgent care centres and emergency rooms.

One in five residents didn't have a general practitioner in the latter year, though Dix expected the number would rise.