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B.C. family doctors say time-based payment model one way to create less stress, better care

Current fee-for-service model pays doctors per patient regardless of how long they spend with them

B.C. is now compensating family doctors for the extra time they need to spend on some patients with COVID-19. It’s one small step toward a time-based payment model many doctors would like to see expanded to all patient visits.

The new compensation system, known as a time modifier, came into effect on July 1 and recognizes the fact that prescribing medications for treating COVID-19 can be complex and time intensive. Usually, family doctors in B.C. are paid about $32 per patient they see, regardless of how long it takes. The new time modifier, though, let’s them charge $43.50 for up to four 15-minute assessments a day for patients who qualify for COVID-19 treatment.

“It’s great, but what about the rest of our patients that need more of our time?” Dr. Maryam Zeineddin, a West Vancouver family doctor and one of the chief negotiators for Doctors of BC working with the government on reform, told Black Press Media.

It’s a sentiment numerous family doctors around the province have voiced since the time modifier came into effect. What about the those with cancer, the people who just miscarried, the patients who got diagnosed with diabetes? Those people are also deserving of more time, doctors say.

The problem with the current fee-for-service system, according to family doctors, is that the only way they can keep their clinic’s doors open and pay themselves a salary is by seeing as many patients as fast as possible. Family doctors are paid about $32 per patient visit, but Doctors of BC estimates 30 to 35 per cent of that goes to overhead costs.

Sidney-based family doctor Dr. Laura Asplin said this results in three options for someone in her position: pump through as many patients as possible with the risk of providing lower quality care, provide as much time as needed to each patient and subsist on almost no income, or work unpaid hours at home and risk burnout.

“Most doctors, because we do care about patients being taken care of properly, choose option three of being overworked,” Asplin said.

What many doctors would like to see is a model that compensates them based on the time they spend with a patient. This is the case in Alberta, where family doctors are paid a base fee for the first 15 minutes of a visit and then an extra amount for every 10 minutes afterward.

Dr. Carllin Man, who practised in Alberta before moving to Burnaby, said that model results in better care for patients and lower stress for doctors. More time spent in preventative care means less time spent in the emergency room, Man said, pointing to a 2018 study from the University of Alberta that found just that. Long-term, a greater investment in family doctors could mean health-care savings for B.C., Man figures.

Zeineddin echoed Man’s thoughts, adding that when family doctor’s time is valued – through a time-based payment model or otherwise – it means they can provide care with equity instead of equality.

In her role as chief negotiator for Doctors of BC, Zeineddin said she’s pushing for a system in which having a family doctor isn’t just a privilege, but a right. Doctors of BC estimates close to one million British Columbians are currently living without a family doctor.

The Ministry of Health declined to comment on whether implementing a time-based payment model more broadly is on the table, but noted it is in discussions with Doctors of BC about changes in general.

READ ALSO: Chilliwack doctor says government needs to re-think how family physicians are paid

READ ALSO: B.C. family doctor shortage sparks hundreds to rally in Victoria


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About the Author: Jane Skrypnek

I'm a provincial reporter for Black Press Media.
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