The new payment model for family physicians announced by the province this week means family doctors in B.C. will be close to the highest paid in Canada, a dramatic turnaround from their status as among the lowest paid in the country.
The model, negotiated between the province and physician advocacy groups Doctors of B.C. and B.C. Family Doctors, means a full-time family physician working 1,680 hours a year, who sees 1,250 patients with cases of average complexity and has 5,000 visits from patients a year, will earn at least $385,000.
Instead of being paid $30 to $40 per visit regardless of the severity of a patient’s problem, family doctors will be paid based on time spent with patients, the number of patients seen in a day, the number of patients attached to their practice, the complexity of the patient’s issues, and their office overhead costs.
According to a national physician database compiled by the Canadian Institute for Health Information, compensation for full-time family doctors in B.C. ranked near the bottom of the list compared to other provinces.
B.C. family physicians who work full-time earned an average of $308,399 in 2019-20, the most recent figures available. That puts B.C. family doctors only ahead of their counterparts in Ontario and Newfoundland, who earn $303,656 and $290,388, respectively. This figure does not include overhead costs paid by doctors which range from 30 to 40 per cent.
Alberta had the highest compensation rates for full-time family doctors, at an average of $393,248 a year.
Alberta NDP leader Rachel Notley is urging her province’s new premier, Danielle Smith, to bring in a pay bump similar to B.C.’s to prevent Alberta doctors, currently the highest paid in the country, from being lured to B.C.
“I truly fear that Alberta doctors will look to B.C. as a place where the government has issued a very clear intent to build respect and to end chaos in health care,” Notley said during a news conference in Edmonton on Tuesday.
Premier John Horgan has been calling on Ottawa to develop a national health strategy to prevent provinces from poaching health-care workers from each other. B.C.’s resource-rich neighbour has been pushing its “Alberta Is Calling” campaign that touts high wages and low house prices in an attempt to woo skilled workers from other provinces.
But Notley said B.C.’s deal could tip the scale and draw Alberta doctors to the west coast.
Doctors of B.C. president Dr. Ramneek Dosanjh said the new payment model could attract out-of-province doctors and prevent current family doctors struggling with rising business costs from moving to more lucrative types of medicine.
Figures provided by the Ministry of Health Monday showed the average salary for a full-time family physician in B.C. in 2020-21 was $250,000.
The ministry said its figure is lower than the $308,399 calculated by the Canadian Institute for Health Information because it only includes physicians providing continuous care in the community and not family physicians providing focused or specialist care in hospitals, who are paid more. It also does not include premiums for rural doctors and on-call payments.
Rita McCracken, a Vancouver-based family doctor and assistant professor in UBC’s department of family practice, said between 30 and 70 per cent of family physicians do all or part of their work as hospitalists, which includes working in addictions treatment, emergency care or palliative care.
That means they spend less time in a traditional doctor’s office treating patients with whom they develop a long-term relationship and a deep understanding of their health needs, often called longitudinal care.
“B.C. is probably the worst in terms of the vast majority of [family doctors] choosing to supplement their regular care with these other jobs,” said McCracken, who is researching the family doctor shortage. “We have enough doctors, we just don’t have enough doctors doing the job we need them to do because the current structure of a family doctor’s job, frankly, sucks.”
There are approximately 4,120 family physicians in B.C. who self-identified as providing longitudinal care, according to the health ministry.
As of this week, 3,164 of those family doctors have received $25,000 for overhead costs as part of a $118-million program announced in August.
The new payment model for family doctors, which takes effect in February, gets rid of the current patient cap, which only pays doctors a full fee for 50 patients a day. Doctors who see more than 50 patients in a day only receive partial payment for subsequent visits.
McCracken is worried some doctors will abuse the new system by trying to see as many patients as possible in a day through shorter visits in an attempt to maximize their pay.
Dosanjh doesn’t share this concern, saying the payment model is based not only on patient visits, but time spent with a patient and the complexity of their medical issues, which she said will encourage doctors to spend time providing high-quality care.
“I really want to get away from that negative rhetoric that exists that people are going to game the system,” she said. “This is a hope to provide better-quality care and access and attachment for patients.”
The tentative physician master agreement reached between the province and Doctors of B.C. will see all doctors in B.C. receive a 13.5 per cent pay increase over three years. That pay raise, which applies to salary doctors, fee-for-service doctors, specialists and consultants, is about three times higher than the increases recently negotiated with doctors in Ontario and Alberta.
The B.C. agreement, which has yet to be ratified by doctors, would also increase funding for rural medicine programs and the after hours on-call rates for doctors.
WAGES ACROSS CANADA
How do current average wages paid to full-time family doctors in B.C. stack up against other provinces?
Alberta — $393,248
Quebec — $369,185
Manitoba — $364,852
New Brunswick — $341,161
Saskatchewan — $322,026
Prince Edward Island — $317,968
Nova Scotia — $312,420
British Columbia — $308,399
Ontario — $303,656
Newfoundland — $290,388
Source: The National Institute for Health Information’s National Physician Database. Figures are for 2019-2020, the most recent available. Figures not available for Yukon, Nunavut and Northwest Territories.