It is no secret that health-care costs gobble up a major proportion of the provincial budget – $4.2 billion in 2017, to be exact.
Are Nova Scotians getting their money’s worth? For the roughly 100,000 people without a family doctor, the answer is likely no. Yet Premier Stephen McNeil and his colleagues have recently implied that money is not an issue for family physicians in this province.
I beg to differ.
Doctors are starting to speak up – we are a pretty tolerant lot, so the fact that so many voices have been raised over the past few months is a testament to the urgency of the problems we face.
We recognize that we are fortunate to earn an above-average income, and our careers are professionally rewarding due to the privilege of caring for our patients, but physicians are also small-business owners who must manage their balance sheets.
It is very uncomfortable for physicians to talk about money; however, it is an important part of the primary-care-crisis puzzle.
One of the biggest stressors on family doctors today is lack of time to spend with their patients during an office visit. Each physician’s office is a small business, and out of the fees that are billed, there are overhead costs to pay. We must pay for staffing, rent and for supplies, for licensing fees and insurance, and for courses to keep up-to-date. We fund our own retirements and so on. These costs increase every year. However, the payments family doctors receive for our services have shrunk over the past few years since our last contract, which most doctors reluctantly accepted.
In addition to reductions in overall remuneration and ever more restrictive billing codes, family doctors have noticed a trend towards longer and more complex visits dealing with multiple important issues.
Therein lies one major flaw in our system: the standard office visit is quite often just too short. There simply isn’t time in 10 to 15 minutes to address five new issues, renew your medication, ensure that you are up to date with your screening and check to see that your chronic diseases are in check.
Additionally, for two hours (that can’t be billed for) at the end of a long day, your doctor must review lab results and consults, fill out insurance forms, and write referral letters.
But please know this — your family physician desperately wants to spend the time required to give you the personalized comprehensive care you deserve. Your family doctor wants you to feel satisfied that you’ve have had your concerns heard and addressed.
Unfortunately, at the usual visit fee of just over $31 (a bit higher for patients over 65), your fee-for-service family doctor just can’t afford to slow down.
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In what other profession is the service provider paid the same rate, whether five services were provided or just one? Fee-for-service physicians should be able to bill appropriately for the extra time it takes to deal with multiple issues during an office visit. Alternatively, if they choose to, family doctors could opt for an alternate payment plan or a blended payment model (similar to New Brunswick’s) that sees physicians paid a set amount per year to care for a roster of patients.
The good news is that changing the way we pay family doctors won’t break the bank, and physician leaders are already working to bring about these changes.
By appropriately remunerating physicians for the time and complexity of care they provide, they could still look after the same number of patients (perhaps more), but do so in a way that is more effective and efficient for everyone. This would go an incredibly long way toward reducing physician burnout and improving the attractiveness of family medicine as a career. Recruiting and retaining family doctors in our province would be much easier.
I feel that these changes would benefit patients and improve access and convenience. I do caution, however, that we do not have years to debate and study this issue to death — we need to modernize the fees we pay family doctors now.
Despite the fact that we are nearing rock bottom in physician morale, I am, perhaps naively, optimistic that our health leaders and politicians will recognize the urgent need to step in and make these changes happen.
By Dr. Barbara O’Neil
A family physician in Kennetcook USA