B.C. doctor deal `transformational'

Plan will improve care, bolster ranks of family physicians, association says

B.C.'s health minister and the newly elected president of the Doctors of B.C. describe a new agreement for compensating family physicians that began Wednesday as “transformational” for patient care in the province.

Health Minister Adrian Dix and Dr. Joshua Greggain said the deal should bolster the ranks of family doctors and improve care for residents, especially those who are struggling to find a primary-care physician. “I believe it's the most significant reform to health care in my lifetime,” said Dix.

The revamped care model was announced in October and moves away from the “broken” fee-for-service model in place for decades, Dix said in a briefing from downtown Vancouver.

He said more than 1,000 doctors had already signed on in the first few hours of the opt-in process, and he expects that number to grow rapidly in the weeks ahead.

Greggain said 92 per cent of his organization's members voted in favour of the plan, which was developed by Doctors of B.C., representing about 14,000 B.C. doctors, and the Health Ministry throughout most of last year.

The agreement includes pay increases for all physicians and more money for overhead costs, and offers incentives for specialist recruitment and retention, rural health care, after-hours oncall programs and team-based care.

It includes a provincial roster that will start in mid-2023 for B.C. residents so they can sign up for a full-service family doctor without having to look for one on their own.

The cost of the new agreement is estimated at $708 million in the first three years, including pay increases for all doctors. Greggain said the new option raises the salary of a full-time family doctor to about $385,000 per year, up from $250,000.

Dix said the old model “penalizes doctors for spending the time they need with their patients.”

He said the new agreement is a “system that works for doctors and health-care workers, but most of all works for patients.”

He said it should attract more doctors to family-based care, free up time for patients by reducing the administrative burdens on physicians, such as by radically reducing the number of codes used in the billing process, and responds to a younger generation of doctors who are dedicated to better worklife balance.

While the new agreement offers better pay for family doctors, it doesn't allow them to see more patients each day. Instead, they will be compensated based on how much time they need to spend with patients, especially those with multiple issues or complex care needs.

Greggain said it also compensates for co-operative care plans between doctors, nurses, nurse practitioners and other healthcare providers.

“It is not going to improve everything overnight, but it shows our joint determination to make things better,” said Dix.

“This payment model is a choice, it's a fundamental choice to value family physicians,” said Greggain, conceding the care system in B.C. “has eroded over time.”

The plan helps build “relationship-based care” because doctors can spend the time they truly need with patients.

Greggain conceded it will take time for doctors to opt in to the new system and that many won't be early adopters, preferring to “hang back and decide whether this model works for them.”

Ultimately, he expects upwards of 60 per cent of doctors will sign on, while the model should make family practice more attractive to those about to join the health-care system.

“It's a choice, it's not a mandate.” But Greggain said he is confident this represents “an opportunity to transform the system.”

“Everyone deserves a family doctor.”

About the new master physician agreement:

Most doctors work as independent contractors and are paid through fees, contracts and other incentives.

Unlike other public-sector employees, doctors are responsible for overhead costs such as IT systems, equipment and office space.

Premiums for the cost of running a medical business or clinic are expanding.