N.L. medical association calls on province to explain cost for 811 appointments
811 appointments cost more than double in-person doctor visits, say NLMA
The province's medical association says a five-year contract for 811 services will pay a private company more than double what a family doctor makes for a routine visit.
The Newfoundland and Labrador Medical Association sent a letter to its members on Tuesday, stating that it's seeking an explanation from the provincial Health Department on the cost of 811 Healthline services.
The contract between the provincial government and Fonemed sets aside more than $31 million for 2022 to 2027, with an expected volume of 72,000 calls per year. The money works out to $82 per call in the first year, rising to more than $92 per call in the final year.
After 72,000 calls, the cost drops to between $57.50 and $66.10 per call.
Those numbers present a big problem for the NLMA, since family doctors are limited to $37 for a routine in-person appointment, and $47 for a virtual appointment, with a limit capped at 40 virtual appointments per day.
"Like Fonemed, a family doctor's clinic also operates as private businesses with their own staff, equipment and overhead," reads the letter from NLMA president Kris Luscombe. "Family physicians in the province are already feeling overstretched and undervalued, so we will continue to seek an explanation from government of the large discrepancy between physician rates and what is being paid for non-physician virtual care."
The province's Department of Health and Community Services says the cost reflects Fonemed's entire suite of services — such as 24/7 administrative support to nurse practitioners on call 12 hours a day and dietitians available three days per week.
"Family physicians are a valued member of our healthcare system," reads a statement from the province. "We are currently working with the NLMA on blended capitation and the provincial locum recruitment program. These measures should support family physicians in their current practice. 811 can be used adjunctively as a support system for health care and triage to the most appropriate care for the patients in our province."
Doctors unhappy
Doctors were quick to share the letter on social media and add their own concerns.
"And this, folks, is why family medicine is dying," wrote former NLMA president Lynette Powell. "Our government values a virtual visit by a provider who does not know the patient over the continuous, consistent in-person care by a family doctor."
Several spoke about how 811 often refers patients to emergency rooms or recommends they see a doctor within 24 hours — leading to multiple Medical Care Plan billings for the same patient and the same outcome as if they'd just gone to the ER in the first place.
"811 is the bane of my existence as an ER physician," wrote Dr. Kayla Furlong on Twitter. "I wish there were more family docs to manage outpatient problems so less people would require emergency services."
CBC News has requested comment from the provincial Health Department.
Fonemed has been active in Newfoundland and Labrador since 1999, when it set up a call centre in St. John's. It employs more than 20 nurse practitioners and operates the 811 Healthline app.