‘Nova Scotia is waiting’
Family doctors developing blended payment model
About 25 family doctors from around Nova Scotia met in Dartmouth on Saturday to begin developing a blended payment model that will be pitched to the provincial government as the way of the future.
“I think most family doctors and patients in Nova Scotia recognize the current payment models for family doctors don’t work,” Dr. Tim Holland, president-elect of Doctors Nova Scotia, said during a break in meetings. “Fee-for-service is based on a 15-minute appointment, and you just can’t attend to the complexity of patient needs in 15 minutes. We’re looking at shifting to a blended model that’s more focused on capitation, where the family physician is paid for the patients themselves. Whether they deal with them in the office, by phone or by email, they’re overall focused on that patient.
“This capitation model is going to be one of the cores of this new blended model we’re working towards.”
Dr. Manoj Vohra, president of Doctors Nova Scotia, said Saturday’s session involved “family physician leaders” from different parts of the province.
He said the results of the meeting will be shared with the provincial Health Department and the Nova Scotia health authority in an effort to kick start talks on a new payment model within the month.
“Nova Scotia is waiting,” Vohra said. “I urge the health authority and the Department of Health to ... move forward on this as soon as possible.”
Vohra said other provinces have adapted over the past two
decades and introduced different compensation models for family doctors. Meanwhile, Nova Scotia is finding it increasingly difficult to recruit and keep family physicians.
More than 90,000 Nova Scotians do not have a family doctor and more than 40,000 people are on a wait list, Doctors Nova Scotia said.
“The basic foundation of our health-care system ... is family practice,” Vohra said. “What we have to do now is try to make sure that we have the right payment models in place, so that patients can get the access and they can get to see family physicians when they need to.”
Holland, who will become president of the medical association in June, said New Brunswick has worked with physicians to create a more appealing payment model for family doctors.
“Many residents who train in Nova Scotia end up signing (to practise) in New Brunswick,” Holland said. “What we want to do is replicate those successes in New Brunswick in Nova Scotia to be able to create appropriate recruitment and retention here to meet the needs of Nova Scotia patients.
“In discussions with one
of our colleagues from New Brunswick today, he was telling a story about three physicians from Nova Scotia that recently signed (to work) in New Brunswick. But this is an ongoing issue. Nova Scotia physicians are leaving to go to Alberta, to B.C., to Ontario, to New Brunswick. We need to stem the tide of losing our family doctors and also be able to recruit our new residents into Nova Scotia.”
Holland said the payment model defines the structure of how primary health care is delivered in Nova Scotia.
“This not just dollars and cents, but how we deliver care, the autonomy that family physicians have, the ability to engage with their patients in a way that’s most meaningful to their patients,” he said. “Let me say unequivocally, this is not about more money. It’s about making the money that’s there work better for patients.”
Asked to comment on morale among family doctors, Holland said: “Family physicians in Nova Scotia are burnt out. They feel disrespected and they feel like they are not listened to. However, as you can see today, they still want change, they’re still optimistic and they still have hope.”