B.C. doctor leaves family medicine despite new payment model

A Vancouver doctor has informed his patients he’s leaving family medicine, suggesting recent provincial changes to the compensation model don’t go far enough to address his concerns.

One of his patients, Jon Girard, shared the physician’s letter online. It outlines a number of concerns, including the assertion that B.C.’s new pay model “still promotes quantity over quality to professionally survive,” adding, “the proverb ‘trying to get blood out of a stone’ seems to describe the situation painfully well.”

Girard shared the letter on Reddit, with the post generating hundreds of responses.

He says he’s siding with his doctor, believing the province could do more.

“He’s got to make a living, all of these doctors do, for the amount of debt they’ve taken on, for the amount of schooling and years of continued education that they have to all do,” Girard told CityNews.

“Even though they are making six figures, there’s a huge difference in $100,000 or $200,000 compared to a specialist.”

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Dr. Joshua Greggain, president of Doctors of BC, says he feels for the physician in question. He tells CityNews he’s had a chance to read the letter, adding the physician is echoing what many in the industry have been feeling over the last several years.

“You get the sense of some burnout and some real frustration in the letter,” he explained. “The challenge, of course, is that leaves patients without a family physician.”

But, in his view, this doctor’s situation does not represent the mainstream view of physicians in the province.

Greggain notes there’s been a net gain of roughly 150 doctors since the new payment model came into effect.

“I’m heartbroken for him or her, but realistically I think we’re headed in the right direction for the first time in quite some time. Despite the pressures of the healthcare system, of the pandemic, we’re moving in the right direction,” he explained.

“It’s not perfect but it’s going in the right direction and people will hopefully be assured as physicians but also as patients moving forward.”

B.C. family doctor payment model changes

The updated payment model is a departure from the fee-for-service model, and brings with it several changes. B.C. Health Minister Adrian Dix previously said this was “the most significant reform to primary care” in his lifetime.

The province has said it takes into account 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; and the complexity of the issues a patient is facing. It also addresses the administrative costs paid by family doctors.

The new model, however, is not mandatory, Greggain points out.

“The new payment model is a choice so people definitely have choices,” Greggain said.

“I think my biggest sentiment is still disappointment over his or her behalf because of the work that we’ve done alongside the government, because of the work that we’ve done to engage with our physician members, and the public over the last year, for sure, really got us to a place where there has been a significant investment into family practice. In this circumstance, it wasn’t enough for this person to continue which, again, is heartbreaking for the physician and their patients.”

Regardless, Girard now finds himself joining the nearly one million people in B.C. without a family doctor.

“I assume it will take years to find another doctor at this point,” Girard said, adding this isn’t the first time he’s found himself in this situation either.

Girard says this is the second time he’s had to go on the hunt for a family doctor, after his previous physician retired a few years ago

He adds he’s supportive of his latest doctor taking a stand, despite understanding the impact on other patients.

“Good for him. It’s obviously going to hurt the patients but at the end of the day this is something that I think needed to be said for a long time. No one’s really put it into words quite that eloquently, I think, you know, humanized it. It’s a good thing, I think, in the long run,” Girard said.

Girard is also disappointed because as a member of the 2SLGBTQ+ community, he says it can take additional time for patients like him to find a doctor they can trust and who are unbiased in dealing with some of the specialized health considerations specific to that demographic.

B.C. Ministry of Health says new payment model ‘results have been heartening’

Meanwhile, when it comes to the new payment model, the B.C. Ministry of Health says in a statement to CityNews “so far, the results have been heartening.”

“Forty-seven per cent of physicians recorded as practicing full-service family medicine in 2021/22 have signed on to the new model, while 160 family physicians who were not practicing family medicine last year, or are new to B.C., have signed contracts and will begin practicing full-service primary care shortly,” a spokesperson for the ministry says in an email.

“The model includes payments for patient visits, time spent on direct care, indirect care and clinical administration, and the size and complexity of a family physician’s patient panel. It also compensates family physicians for time spent managing and coordinating their patient’s care, which we know may involve much more than the initial visit with a patient.”

The ministry adds the new model “dramatically streamlines and simplifies the administrative burden relative to other compensation models.”

In addition, the spokesperson says the Ministry of Health is putting together a working group to “identify opportunities to reduce the amount of administrative burden in physician practices,” as well as establish a “patient rostering system.”