BC Green Party calls on province to overhaul billing model for family doctors

The NDP government needs to urgently overhaul its billing system for family doctors in the province, the BC Green Party says.

BC Greens leader Sonia Furstenau said in a press conference Wednesday morning that the current fee-for-service (FFS) model, in which family doctors are paid a flat fee per patient regardless of the reason for or length of their visit, is discouraging prospective doctors away from family practice and leading to a focus on “quantity over quality.”

“The billing model is very outdated and does not provide the stability needed for good medical care,” Furstenau said in a press release.

“Doctors are basically running a small business instead of putting their focus into caring for their community members.”

The FFS model is one that’s come under criticism from Canadian doctors in recent years. A report published in the medical journal Canadian Family Physician last November said the model has “fallen out of favour”, especially for those early in their careers.

“Reasons include concerns about the quality of care provided to patients under this model, the negative impact of ‘one problem per visit’ and time limitations commonly associated with FFS, and difficulties in serving marginalized or less advantaged patients,” the report read.

And the COVID pandemic complicated matters further—adding to income instability and the need for quick changes within the practice that outpace fee schedule cycles.

The report noted three alternative payment models that have been implemented in a patchwork fashion in some provinces: salaried, capitation (where physicians are paid a fixed amount per patient per year, with some adjustments for factors like age and patient complexity), and blended compensations.

Researchers surveyed 63 early career family physicians from BC, Ontario, and Nova Scotia, some of whom were deterred from practicing family medicine if FFS was the only payment model available to them.

“Participants shared serious concerns about burnout, viewing a career in a hospital-based or focused area of practice as a way of protecting themselves from the unsustainable demands of FFS-based comprehensive [family medicine],” the report said.

And the report emphasized that it wasn’t simply a dislike of FFS that was deterring early career physicians from pursuing family medicine, but the opinion that FFS “impeded their ability to provide high-quality medical care in alignment with their values.”

“We want to set up practices; we want to care for a set population; we want to follow them. This is why we went to school; this is what we went into residency for. [Yet] a lot of us don’t do that work because the system in BC is not set up to do that,” one BC physician told researchers.

Furstenau said young prospective family doctors want to prioritize consistent salaries, teamwork, time with their families, and focus on providing healthcare itself rather than running a business that aims to get as many patient visits in per day as possible.

The BC Greens are calling on the province to modernize the “outdated” FFS payment model to improve healthcare for British Columbians, and expand alternative payment models “to better reflect the demand for in-person, longitudinal, and team-based care.”

The General Practice Services Committee describes longitudinal care as providing patients with ongoing medical care, maintaining records, and managing referrals to other healthcare providers or specialists as required—essentially, care that builds a relationship between patient and physician.

The report said that shifting to alternative payment plans can allow more collaborative, team-based care “because funding can flow independently from direct physician-patient interaction.”

“This would reward physicians for providing quality health care while letting them stay independent of government. We need to make it desirable to be a family doctor in British Columbia,” Furstenau said.

“We should be rewarding physicians for providing quality health care, and that begins with a care-first funding model. We should be working to make it desirable to be a family doctor in British Columbia. We need family doctors to want to work in this province, so that people get the care they need and lead healthier, more fulfilled lives.”

That’s something that a group of Burnaby physicians, nurses, specialists, and community organizations are trying to emphasize as part of their work with the Burnaby Primary Care Network (PCN).

Burnaby Divisions of Family Practice board chair Dr Birinder Narang said last month that the real success of the PCN model comes from its “deep connection and participation” in the community itself—in this case, Burnaby.

And it also works to include patients who aren’t attached to a family doctor.

Between 750,000 and 900,000 people in BC don’t have access to a family doctor—in Burnaby, the number was as many as one in six residents in 2019.

As Global News reported, the BC Liberals last week presented a petition calling on the NDP government to take urgent action on the family doctor shortage in the province.

Health minister Adrian Dix defended the government’s work on that issue by pointing to the 27 new urgent and primary care centres and 54 primary care networks established in BC, including the Burnaby PCN and the Edmonds Urgent and Primary Care Clinic.

“The issues that are raised are a struggle in the community. That’s why we continue to take those actions, continue to add resources to primary care,” Dix said.

“Since 2017, we’ve had more than one million visits to urgent and primary care centres in B.C., providing team-based care to people in the community. That is a specific and compelling response to a family practice shortfall and a primary care shortfall that existed prior to 2017, as the member will know.”

BC does have an alternative payment program in place that “aims to secure sufficient access to care in situations where fee-for-service arrangements may not guarantee physicians the financial support or stability to be able to provide needed care.”

Those situations include teaching hospitals, community and hospital-based psychiatric services, and physician services in rural areas—but physicians need to submit an application to the province before they can switch to the program.