Is the state of family practice (particularly in British Columbia) as dire as social media and traditional media is painting it currently?

[gogogo]

On 7/12/2022 at 8:42 PM, zoxy said:

Is this legal under the Canada Health Act? My understanding was that as long as you're accepting provincial government Medicare, you can only charge for services that aren't covered by the provincial government, making such fees untenable as long as you intended to operate within the public sphere.

Edit:

It's apparently legal in every province but Quebec and is supposed to cover services that government insurance does not cover. And it's only legal if patients are given the option of paying per diem for the additional services that the annual fee is supposed to go towards. If patients are paying ahead, how are they to know if they will be requiring uninsured service for the year? Would they then get a refund if they don't require the uninsured service that they've already paid for? Something tells me GPs wouldn't be refunding patients in this case.

Too bad. I would love to build a roster who pays me $500-$1000/year each. That’d be much fairer pay than what the government offers. And in this climate, where going to a mid-tier restaurant can cost you and a friend $100 or Netflix costing $120-$240/year, $500-$1000/year for a happy family physician is not excessive.

[Findanus]

On 7/13/2022 at 1:59 PM, Vya said:

@FindanusCan you give me a TLDR about why the government is pouring money into the UPCCs? I dont really understand the difference between these and regular walk-in clinics. Is it because they staff them mostly with NPs, so the province thinks it can save money?

Gov wants to directly control care costs  instead of leaving it to independent doctors. Their ideal model is one where all allied health professionals work for the UPCC and make roughly the same amount of salaried money a year. Government administrators control the practice, not doctors. This is obviously a very bad idea.

[indefatigable]

On 7/11/2022 at 10:48 PM, medisforme said:

The 295k doesn't include overhead (so subtract 20-40% from that) and the signing bonus works out to $120 and change/week (no where near worth the grief you will encounter).  The amount is actually insulting given the amount of unpaid work family doctors engage in.  Also, the government basically has not addressed the issue of overhead costs in any way.  That is the main issue preventing new grads and old grads from practicing community family medicine.

Furthermore, family medicine fee codes have been stagnant for 20+ years.  Check out the graph below to see how the basic visit fee (ages 2-49) code lags further and further behind inflation.  Actual data used to form the graph is from Doctors of BC. .  It is a joke how little family docs in BC earn compared to the amount of work they do.  I honestly feel it is likely the only medical specialty where the workload increases after residency as you are sheltered from a lot of the paperwork, documentation and business side of it in residency.

It seems like BC FPs are getting a better contract now?

Presented as “an alternative to FFS” which FPs can choose to take up, beginning at the end of February, the new LFPPM model:

• Preserves the FP’s autonomy, enabling them to continue independently billing BC’s Medical Services Plan (MSP) as independent contractors like they do under FFS. They’ll just be billing differently as it won’t be volume based. 
• FPs will continue running their own practices. They will not be working under the umbrella of a health authority.
• The new model pays doctors according to factors that include the time a doctor spends with a patient; the number of patients a doctor sees in a day; the number of patients a doctor supports through their office; the complexity of issues a patient is facing.
• Details are still a bit sketchy but the base pay for FFPs seems to be  $130/hour, with $25 per patient “encounter” whether that be in person or on the phone. Fees for long-term care are not yet determined, with more info expected in the new year. 
• There is a rural retention fee, like under FFS. But there remain many unclarified details such as how rural docs will be paid for the hospital and ER work.
• On the issue of paperwork, under the new model, FPs will be able to bill an hourly rate for indirect patient care such as tasks like insurance forms, lab reports and phone calls to specialists.
• Docs will also get paid for hours spent on quality improvement and education. (At present, it appears that the $130 hourly rate applies across the board).
• There is no set number of required hours, nor limit on how many hours a doctor can work. A doctor can work as little as one day a week under this plan—which Vancouver FP and researcher Dr, Rita McCracken told CBC News will increase the pool of available doctors by encouraging retirement-age doctors and doctors with young children to continue working.
• There is no money for office overhead. However several doctors told the Medical Post the increase in reimbursement is significant enough that their overheads—in the $80,000-$100,000 range in BC—will be covered by the increases generated by the new model. Doctors of BC said at the outset that their goal was for community FPs paying high overhead to achieve parity with hospitalists, who pay no overhead.
• Doctors will receive additional money for complex patients but full details have yet to be announced as to how complex will be defined.
• A full-time panel of patients is 1,250. Doctors’ panels may be larger or smaller. They will receive a payment once-a-year, related to their panel size and its complexity. Health Minister, Adrian Dix, announced there will be a provincial patient roster (replacing the current fragmented system) which is expected to be up and running next spring.

...

ome of the BCHCM questions, quoting from the agreement: 

• “How will the (stated) requirement to ‘Work with other physicians and healthcare providers in your community to provide care’ be operationalized?”
• ”How will physicians need to document their time?”
• “What about family doctors ‘providing a mix of care?’”
• “What happens if the model is ridiculously successful and payments under the new compensation model exceed the limit?
• “How will success of the overall system be measured and reported on?”
• And finally, “Where is the actual ‘agreement’?” 

https://www.canadianhealthcarenetwork.ca/bcs-new-fp-billing-model-seismic-enough-save-primary-care?utm_source=omeda&utm_medium=email&utm_campaign=NL_CHN_Physician_REG&oly_enc_id=6234G2816812E5Z