Comment: Family doctors need much better support

A commentary by a psychiatrist in private practice.

I collaborate with general practitioners daily, and I heartily agree with Lawrie McFarlane’s statement (“Doctors association largely to blame for underpaid GPs,” Feb. 2.) that GPs in B.C. are drastically underfunded.

This is one cause of the present GP shortage. The fee-schedule disparity between specialties (family medicine is a specialty, though with shorter residency training requirements than others) is unjustified.

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Infighting between different camps of doctors also contributes. Fixing it, however, is not so simple.

Many factors affect overall compensation.

Provincially funded residency training spots dictate supply. Some specialties require large capital investments for equipment.

Costs such as office space and staffing vary wildly. Fee schedules don’t keep up with changing technology and practice. Some specialties are simply valued more.

But the perception that all specialist physicians are paid much more than GPs isn’t accurate. Average billing in my own specialty, psychiatry, is comparable to that of family medicine. However, psychiatrists have far less overhead.

Many physicians on the lower end of the fee schedule seek positions that minimize their overhead, such as at Island Health facilities.

Could we fix this by quickly rebalancing the fee schedule? It wouldn’t work even if all parties would agree, or if the government tried to steamroll physicians, as they’re now trying next door in Alberta.

Each province sets its own fee schedule, with significant but not enormous variations between them. Were B.C. to reduce ophthalmology fees by 50 to 75 per cent, for example, an exodus of ophthalmologists would quickly ensue.

Small steps are being taken. The current Physician Master Agreement set aside a modest sum to address fee disparities between specialties and across provinces.

Another initiative will partially offset increasing overhead costs for those of us in private practice in expensive locales such as Victoria or Vancouver.

However, compensation isn’t the only factor pushing family doctors out of full-service practice. Increased workload, bureaucracy and burnout, as well as decreased autonomy and respect, all play a role.

Alternatives to traditional fee-for-service payments do exist. Many family physicians and others would welcome a salaried position with predictable hours, holidays, benefits, education, overhead and support staff.

However, the provinces have a poor track record when taking such options beyond pilot projects. They’ve realized it’s far more expensive than the present system, where all of these costs rest on individual doctors.

Our present system has truly painted us into a corner. While pharmacists, nurse practitioners and other professionals are part of the solution, reliable access to full-service family doctors remains essential.

They need much better support. Something has to change … and fast.

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