Doctors Nova Scotia blames doctor shortage on fee-for-service system

​Nova Scotia is losing family doctors to other provinces, notably New Brunswick, because of the "antiquated" way it pays for their services, says the president of Doctors Nova Scotia.

On Saturday, a group of family doctors met in Dartmouth to discuss different options of being paid for their work.

"We're in an antiquated model right now where the majority is fee-for-service, so it's a volume-driven service. Nova Scotia has to consider options other than fee-for-service or salaried models that don't really, frankly, do much for anyone," Dr. Manoj Vohra said.

"At present, right now, people are leaving, going to New Brunswick, they're going to all other places in Canada because other provinces have put those models in place and it's about time we start doing it."

For example, New Brunswick recently made changes that not only pays doctors on a per-patient basis, but also offers an "access adjustment" for providing patients with timely care.

As well, in that province, if one physician in the group is away or not available, the others can jump in and look after their patients until they return.

Doctors Nova Scotia favours a blended system that combines fee-for-service with:

• Capitation: a doctor is paid a fixed amount to provide care to a defined group of patients or "patient roster." Physicians are paid per patient, not per service or visit. 
• Negation: if a patient assigned to a certain family doctor visits a walk-in clinic, the fee paid to the clinic is recouped from the family doctor's next payment for that patient. In other words, the physician loses money when his patient seeks treatment at a walk-in clinic.

Tim Holland is a family doctor who practices in Indian Brook and is also the-president elect of Doctors Nova Scotia for 2018-2019.

"Fee for service is based on a 15-minute appointment and you just can't attend to the complexity of patient needs in 15 minutes," he said.

"We're looking at shifting to a blended model that is more focused on capitation, where the family physician is paid for the patient themselves whether they deal with them in the office by the phone or by email. They are overall focused on that patient so this capitation model is going to be one of the cores of this new blended model we are working towards."

Vohra said the Nova Scotia government needs to participate in discussions, such as the one held by family doctors Saturday, to come up with better and fairer ways of compensation.

"The patient population at this point is getting older, they require more time and our present models don't actually reflect the amount of time and compensation the physicians need ... to make sure patients get healthy care," he said.

If changes don't occur, Vohra said Nova Scotia will continue to have difficulty attracting and retaining family doctors.

Last September, Health Minister Randy Delorey said he's heard the doctors' concerns, but said the pay structure is complex.

"You can imagine the diversity of services being offered by physicians … and that would be an area that would require quite a bit of study," he said.