Weighing the value of family physicians
Dr. W. Gifford-Jones suggests that family doctors are worth their weight in gold (column, July 22). In my case, that would come to $4,238,448. So though he could be accused of some hyperbole, I firmly agree with the tenets of his essay.
In spite of the fact that another 3,000 patients are going to be “orphaned” in Sidney in the near future, I feel some optimism for the future. I base this on: • A willingness of patients to accept a team-care approach and other changes to health-care delivery. • The strong conviction of new medical graduates that they will not be small business owners; most want to be able to practise unencumbered a profession for which they were trained at considerable expense. • An apparent positive attitude from the provincial government, with, for example, urgent-care centres.
Simply throwing more money at family practice has definitely not worked. The whole model for physician remuneration has to change to accommodate the advances in medicine. The treatment of many conditions has become so complex that a physician, regardless of education and training, cannot alone deliver safe and effective medicine.
Let me try to explain the current model of remuneration for family physicians. At the moment, the family physician is paid a gross fee for which he/she will provide medical care, as well as providing an office, staff and all the requirements of a small business.
If this model were used to pay, for example, a bank manager, the result would be very strange. Going to the bank to request a statement could end up with a hand written list of transactions. Going to negotiate a line of credit, the entire financial history would be taken by the manager, who would then go home and type a contract in the evening with the customer coming back the next day. This bank manager would also pay the salaries of his personal assistant, typist and secretaries and even the cleaning staff. The manager would provide his/her own computer and software. The manager would also pay a fee for renting his office. And this list could go on.
It sounds ridiculous, but this is the method of payments that many family physicians will not let go.
At the inception of medicare 60 years ago, the multitasking family physician’s remuneration was appropriate. This gradually became a poor fit over the past 20 or even 30 years. The result is that medicine is now delivered in an inefficient manner — and the visible result is the current lack of family physicians.
The Doctors of B.C. need a fundamental change of heart. Negotiating funding for family-practice services must be completely separate from that for the specialists.
The fee-for-service model still has much to be said for it, but the family physician, in order to practise efficiently, will need to have available the services of a stenographer, medical office assistants, a practice nurse, an in-house pharmacist, a social worker, a midwife … and the list could go on. Obviously, this is not an expense that the family physician could bear.
Also, making this practical and affordable would require the creation of efficient-size groups of physicians.
If we can disencumber the family physician from unnecessary documentation (much of it introduced over the past 17 years) and the time involved in running a small business, the productivity should increase enough to ameliorate or even obviate the family-physician shortage.