N.B. doctors say province must 'balance' new online services with family clinics

New Brunswick doctors say the Higgs government needs to "balance" its promotion of new virtual primary-care tools with more incentives for doctors who see patients in conventional family-practice clinics.

Doctors providing services through N.B. Health Link can earn similar fees from Medicare as they do in their clinics, but without the same paperwork headaches, the New Brunswick Medical Society says in a letter to Health Minister Bruce Fitch.

The result is doctors "making very rational choices to practise in settings other than community-based family practice," leading to no improvement in the number of people with their own doctors, society president Dr. Paula Keating says in the Jan. 8 letter. 

"I don't think we've gone too far" with virtual services, she said, "but we need to have a balance." 

The severe staffing crisis at the emergency department in the Dr. Everett Chalmers Hospital in Fredericton over Christmas was the culmination of the lack of primary care access, Keating said.

And she warned that the situation will only get worse without changes, predicting the number of New Brunswickers without family doctors could surge past 100,000 for the first time before the end of the year.

"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," she says in her letter.

Keating predicts continued growth in the wait list "will decrease the quality of care as it pushes citizens to fragmented and episodic primary care channels" such as N.B. Health Link.

Those services were created to ease pressure on the system but now have the unintended consequence of making it less attractive for doctors to maintain conventional family practices, she said.

The society is urging the province to increase billing fees for doctors who take on more patients in their clinics and who add evening hours to their offices.

It also says doctors should be able to bill Medicare for services that nurses provide in their clinics — something they pay for themselves as part of their overhead — and for the time they spend on paperwork and other administrative tasks.

With services like N.B. Health Link, doctors are paid the same or even higher Medicare fees, but the record keeping and administrative work is done by someone else.

"There's more support, it seems, right now, than for family physicians in the traditional primary care settings," Keating said.

The province launched N.B. Health Link in 2022, aimed at New Brunswickers without family doctors who might otherwise visit a hospital emergency department.  It provides both in-person and online appointments.

Keating said the combination of more convenient hours, no overhead costs and less administrative work "is very attractive to many physicians," drawing them away from their own clinics and compounding the problem.

"Those things are fine for short, quick, non-serious medical illnesses, but there is some fragmentation in care that results from those," she said.

The long-term goal should be an increase in team-based community clinics where multiple medical professionals can collaborate on caring for a roster of patients, she said.

The New Brunswick Health Council also warned in 2022 that the growth of the new services, while positive, risked spreading doctors too thin.

 Health Minister Bruce Fitch did not make himself available for an interview about the society's ideas.

But his department said in a statement that 52,000 New Brunswickers now use N.B. Health Link. Another 23,000 are registered and waiting for new clinics to open or existing clinics to expand.

Spokesperson Sean Hatchard said several initiatives are underway to "support team-based care models that will help to lift some of the pressures on overworked physicians."

More than 2,600 people who had been using N.B. Health Link now have permanent doctors or nurse practitioners.

Hatchard said the department is reviewing the society's proposal and expects to meet with them in the coming weeks.

Fitch told the legislature last fall that recruitment efforts led to a net increase of 45 doctors in the province between last April and last October, and 125 new nurses.

Keating's letter says, however, that an increase in doctors in the Fredericton area "has had a negligible impact" on the waiting list.