Medavie says new service isn't taking doctors away from family practices

The company that's providing a new alternative form of primary health care for tens of thousands of New Brunswickers says it's not drawing physicians away from conventional family practices.

Medavie Health Services New Brunswick, which operates the two-year-old N.B. Health Link system, calls the model "the next best thing" to having a family doctor.

And it is rejecting suggestions from the New Brunswick Medical Society that its system is so appealing to doctors that it can lure them away from opening their own clinics. 

"We're not there to take physicians out of practice or to close their practice," said Martine Des Roches, Medavie's vice-president for its primary care network.

She said N.B. Health Link uses doctors who have other roles in the health-care system, including emergency room doctors and hospitalists, and who are willing to put in additional hours without the headaches of operating their own office.

The Higgs government launched the system in 2022 as a way to reduce the wait list for family doctors.

The system has been contacting people on the list to register them, though people who are new to the province or have lost their doctor can now contact N.B. Health Link to register themselves.

Once registered, patients are referred to one of the program's 11 clinics around the province for primary care.

They get a similar "continuity" of care as with a family doctor, often seeing the same professionals who have access to their health records, Des Roches said.

An N.B. Health Link clinic team orders tests, reviews results, refers patients to specialists and then follows up, she said.

"Belonging to a medical home, a team-based practice, is kind of where primary care is headed, so we're not too far from that model that exists."

"You will still have that continuity, so we are kind of that next best thing compared to that one-to-one relationship."

Criticism of virtual health-care options

Last week the New Brunswick Medical Society called on the province to restore a "balance" between conventional family-practice doctors and some new alternative delivery methods.

Society president Dr. Paula Keating wrote in a letter that the growing number of people without family doctors "will decrease the quality of care as it pushes citizens to fragmented and episodic primary care channels" with no ongoing one-on-one relationship.

She said the fact that doctors working in those new systems don't have to manage their office, including dealing with their Medicare billings, make them more appealing.

"There are limited incentives for family physicians to take on any patients, let alone increase their roster, as they can practise in a wide range of models and earn similar remuneration or more without the associated administrative burden," Keating said in her Jan. 8 letter.

Des Roches said doctors working with N.B. Health Link aren't paid more. They have a Medicare billing fee "a little bit less than a family practice, but similar."

She acknowledged that part of the pitch when Medavie recruits doctors is the lack of paperwork and other tasks that they take on if they run their own practices.

"You can provide your clinical time to us and then you can leave without any administrative burden or follow-up, without 'owning' that patient," she said.

But because the doctors who see patients for N.B. Health Link already work elsewhere in the system — such as in hospitals — they're not physicians who would otherwise be running a family practice, Des Roches argued.

"We know the golden standard is always to be permanently matched with a provider or a team of providers that you consistently see," she said. 

Still, "as a province and as a system, we have to look at ways where we can maximize the limited amount of hours of clinical resources that we have." 

Recommendations for more incentives

The medical society's letter recommended the province allow family doctors to bill Medicare at higher rates for taking on additional patients, for seeing patients in the evening and for the paperwork and administrative tasks they do in their clinics.

Those measures would give physicians more incentives to see more patients in their own offices.

The medical society says other positions doctors may hold — such as in emergency departments, as hospitalists and at new urgent-care clinics — can also be more appealing than a family practice.

"We are just concerned with the level of support for longitudinal primary-care providers not being sufficiently appealing compared to all of the less complicated options available," said spokesperson Jim Johnson.

Last fall Horizon Health opened an urgent-care clinic in Fredericton to take pressure off the local hospital emergency department.

Opposition parties have called for a more rapid roll-out of collaborative primary-care clinics, and the Green Party has called the reliance on Medavie a move toward privatized services that are costlier in the long run.

N.B. Health Link uses about 40 doctors, with only one them working full time. The others put in anywhere from 16 to 100 hours per month with the service.

About 52,000 New Brunswickers are using the system now, with another 23,000 registered but still waiting for a spot at a clinic.

Only about 2,600 patients using N.B. Health Link have left the system after finding a family doctor or other permanent primary-care provider, the province says.

The medical society says with only "limited incentives" for doctors to operate family practices, or add patients to their existing practices, the number of New Brunswickers without a doctor could reach 100,000 by the end of this year.

The province considers that only 10,000 people are without primary care providers because it views someone using N.B. Health Link as having one.

Des Roches says while the program is intended to be a temporary solution for individual patients without doctors, it's likely to be a permanent part of the health system.

"I think there'll always be an ebb and flow of patients arriving in the province, of physicians retiring, of physicians going on maternity leave," she said.

"The idea is N.B. Health Link is that safety net for the province, and it will grow and shrink as the demands of those unattached patients change over time."