At walk-in medical clinics around the province, patients are being turned away because of a government-imposed cap. Doctors practising at these clinics are paid 100 per cent of the physician fee schedule for the first 50 patients they see each day. However, after that, they get only 50 per cent of the fee rate for the next 15 patients, and nothing at all if they treat more.
The purpose behind this arrangement is simple enough. If caps are not imposed, doctors might be encouraged to run up the number of patients they see.
That could lead to poor or inadequate care, along with excessive billing.
Most of the high-billing physicians tend to be specialists, whose fee schedules are more generous.
However, some GPs have also been known to generate high numbers. For this reason, it makes sense to set an upper limit on how many patients physicians may charge for in a given day.
Unfortunately, this is at best a crude solution that creates problems of its own. It might be true that if patient limits are set, those who do get seen will receive better treatment.
But unless more GPs are trained and brought into practice, and more clinics are set up — neither of which is happening fast enough — then caps simply lead to patients being turned away.
There are reports of residents in Victoria going to several clinics and being refused admission because the facilities had capped out for the day.
The only option that leaves, if the concern is urgent, is a visit to the local emergency department — the worst use of scarce resources.
Part of the problem is that no one knows with any certainty how different payment models affect physician behaviour.
Some experts advise abandoning the fee-for-service model altogether, and going to a salaried approach. This would remove the financial incentive to see large numbers of patients, in favour of more comprehensive care and attention.
Intuitively, that seems to make sense. Yet numerous studies have failed to find definitive evidence that it does indeed improve patient care. Within both a fee-for-service arrangement and a salaried model, some doctors have been shown to provide excellent and conscientious care, while others come up short.
The deciding factor might have more to do with the training individual doctors received than with the payment system.
What, then, is to be done? The reality that stands out is we simply do not have enough GPs to serve all of the patients who need treatment.
By some estimates, B.C. needs to add about 450 new physicians annually to meet demand. In fact, only about 300 set up practice each year.
And this is a long-standing problem. In 2010, the B.C. Liberal administration of Gordon Campbell promised to provide a family doctor for every British Columbian by 2015.
But last year, the province’s health minister, Terry Lake, conceded this target had not been met, and offered no guarantee it ever would be.
Moreover, the shortfall of GPs is not confined to B.C. Canada as a whole ranks near last among 28 Organization for Economic Co-operation and Development countries in terms of access to a physician.
Part of the reason is that doctors earn much higher incomes in Canada than in many European countries. That limits how many doctors provinces can afford to train and pay.
Yet this cannot be accepted as an excuse for coming up short. Family physicians are the foundation upon which our health-care system rests.
And we are a wealthy province. Campbell’s promise should be honoured — a GP for every resident of B.C.
