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Comment: What Doctors of B.C. is doing to solve GP shortage, address pay disparity

A commentary by the president of Doctors of B.C. It is well-known that British Columbia needs more family doctors, and that there are significant shortages in Victoria and elsewhere around the province.
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A commentary by the president of Doctors of B.C.

It is well-known that British Columbia needs more family doctors, and that there are significant shortages in Victoria and elsewhere around the province. There are also concerns among many doctors who feel that their rates of pay are not equitable relative to their colleagues. Some perceive this as unfair.

These challenges are not unique to B.C. — they apply to doctors and health-care systems in every province and territory in Canada, something that Lawrie McFarlane neglected to include in his Feb. 2 column “Doctors association largely to blame for underpaid GPs.”

What is unique is the approach Doctors of B.C. is taking to help solve these long-standing challenges.

Pay disparity is a significant issue for doctors, and is addressed whenever there are negotiations with government for a new physician master agreement. The continuing challenge is to find the balance between attracting new doctors who are paid more in other provinces, and keeping the doctors we have, with the need to fairly pay all of the skilled, hardworking doctors in B.C.

Doctors of B.C. does not operate in isolation from pay structures elsewhere and must balance the needs of all doctors to ensure patients get quality care in every area of the health-care system.

This is hard to do. As Dr. David Naysmith noted in his Feb. 4 commentary, “Fee disparity is a major problem for B.C. doctors,” it is an issue we have been dealing with since the early 1990s, as have all physician associations around the country. It is a divisive issue within our membership, there are no easy solutions, but we are taking steps in the right direction.

Fee disparities among specialists are directly addressed in the master agreement. In our recent agreements with government, new funding for specialists supports larger increases for the lower-paid specialties and smaller increases for those who are paid higher. This funding is allocated by a neutral third party on the basis of submissions from all of the specialties.

When it comes to reducing fees, there is a clear process in place, one that involves both physician and government representatives in the decision-making. Government can and does seek reductions in fees when circumstances change, such as when new technology streamlines procedures.

Indeed, in relation to ophthalmology, government has sought such reductions twice in the last seven years. Each time, after an extensive review, Doctors of B.C. agreed that certain fees should be reduced.

But correcting this disparity is not the only route to greater equity or to increasing the availability of family physicians.

Doctors of B.C. is active in supporting a range of initiatives to strengthen full-service family practice through our partnership with the Ministry of Health in the general practice services committee.

One key part of the committee’s work has been to introduce incentive fees for family doctors to support them in providing longitudinal care to deal with the increasing demands of family medicine.

About three-quarters of all new GP funding negotiated with government goes directly to the committee to support fees for full-service family practice doctors.

This funding was not included in McFarlane’s compensation average for family doctors, funding that specifically compensates family doctors for taking additional time to take care of their patients who have multiple chronic conditions.

Recently, fee-for-service family physicians received a new annual payment that acknowledges the work that goes into maintaining long-term relationship-based care for a panel of patients.

In addition, a number of family physicians have told us that the current fee-for-service payment model does not support them to carry out full-service family practice, particularly if they want to work within a team of health-care professionals. Doctors of B.C. is consulting with government on new alternative payment models to better meet the needs of our doctors.

As McFarlane points out, physician issues are not all about the money. The general practice services committee also works on other initiatives and programs to support family doctors in practice. We recently polled our physicians and learned their greatest dissatisfaction centres on the huge amount of paperwork that accumulates, a lack of resources to take care of their patients who have multiple health conditions, and the feeling that they are just not valued.

Through the master agreement and the advocacy work of Doctors of B.C., we have put in place additional fees and non-monetary programs that support both family and specialist doctors, that increase available resources, reduce some of the burdens doctors can experience and ensure doctors feel valued in the work they do every day.

We are also working with government to increase team-based care, so that family physicians and other health care professionals can work together to their full scopes of practice, with patients at the centre, so that responsibilities and burdens can be shared.

The challenges in our health-care system are big and complicated. We will not reach solutions overnight; real change takes time.

Doctors of B.C. is working to support all our physicians so that they can provide the best quality care for B.C.’s patients.