Funding incentive faces criticism from doctors
Alberta plan to limit cash to physicians with 500-plus patients `a mistake': AMA
A provincial effort to attach strings to $50 million in federal funds to incentivize family doctors to take on more patients may have backfired this week.
Would-be recipients of the transitional funding program aimed at helping family practice doctors swamped by escalating costs are discovering panel size matters to Alberta Health.
The province's decision to limit the cash lump sums only to doctors with more than 500 patients isn't sitting well with doctors with smaller patient loads — or the Alberta Medical Association.
Instead of granting the funds on a per-patient scale, only doctors with more than 500 patients in their panel would receive $24,000.
Doctors with more than 1,500 patients would get $40,000.
By that calculation, an Edmonton doctor with 1,480 patients on their panel is just 20 patients shy of the dividing line between a $24,000 cheque and a $40,000 cheque.
An Edmonton clinic owner with more than a dozen doctors working in the building called the arbitrary hard cut-off number “ridiculous.”
“I think basically, what they intend to do is to create a monetary incentive for everybody to have at least 500 patients on the panel,” he said.
Had the province gone with a panel size of 200, as requested by the AMA, and paid proportionately, it would have captured almost everyone.
“The response from Alberta Health was, typically, `No,' with no explanation,” the doctor said.
“No `this is why we feel it needs to be done this way.' It's just, `We're doing it this way.'”
The pay scheme punishes family doctors who divide their living between, say, a smaller patient panel and working in the ER or in hospitals or in surgical support, he said.
INCENTIVE OR MISTAKE?
In an era when 750,000 Albertans are without a personal family physician, the province believes the hard cut-off is a good idea.
“We want to support the physicians that are prioritizing their time serving more patients and support them in hiring additional staff and resources to alleviate some administrative work,” said a statement Health Minister Adriana Lagrange issued Wednesday.
“Patient access is a constant issue we hear from Albertans — incentivizing physicians to manage a certain panel size promotes the adoption of more patients accepted by physicians.
Dr. Sarah Bates, acting president of the AMA'S section of family medicine, called Lagrange's decision “a mistake” in a letter Tuesday.
“It was the AMA'S and the sections' firm belief that all physicians providing comprehensive care to a significant patient panel should have been recognized and supported through this program,” Bates said, adding the AMA'S proposal to Lagrange included panels as small as 200.
“Despite our extensive and repeated attempts, we were overruled by Alberta Health,” she said.
CONFUSION AMONG DOCTORS
A sticking point for some physicians managing larger practices is how individual doctors use the infusion of money.
One doctor who asked not to be named said some doctors in clinics who typically give a percentage of their gross income to the clinic to cover overhead aren't supporting the clinic anymore.
“The issue, though, is that it stabilizes doctors but it doesn't stabilize clinics because ultimately those clinics that are underwater as a result of this arrangement, or as a result of being underfunded, are still going to remain underfunded. And they're going to continue to shut down,” he said.
“But either way, everybody feels hard done by this. The physicians are feeling they've been chronically underpaid for years. Clinic owners have been subsidizing operations by funding the shortfalls out of their own pockets.
“As much as the intent was for this money to stabilize clinics, the end result, because of the way it's being distributed, could actually be massively destabilizing to clinics.
“And when that clinic does shut down, it's going to raise some uncomfortable questions like, `We just gave you all this money. How is it that you're still shutting down?'”
EVERY PANEL MATTERS
Bates said language in the “declaration” to be signed by physicians applying to the transitional funding program appears to restrict utilization of the funds, creating confusion with members.
“It is my belief that these funds should be used on a `go forward' basis to offset overhead costs to individual physicians — this is reflected in the term `transitional,'” she said.
“It is the stated intention of Alberta Health that the transitional funding program be seen as bridging support until a more appropriate compensation model is in place for physician comprehensive care in the community,” she said, estimating up to 3,000 Alberta physicians will see funding from the pot.
Bates is concerned the panel size issue could also impact the Physician Comprehensive Compensation Model the province and the AMA have hammered out but have yet to ratify after months of meetings and a draft sitting on desks.
“It is imperative that we let the minister and Alberta Health know that the current panel size requirements do not recognize the culture, diversity and complexity of community-based comprehensive care,” she said, calling excluding smaller panels “short-sighted.”
AMA president Dr. Paul Parks said many members are very concerned that they are ineligible for the transitional funding program.
“There are many reasons that smaller panels exist, from geographic location, to patient complexity, to unique demographic factors of the patient population being cared for. Some small panels exist today because the physician was unable to financially sustain full-time comprehensive care and therefore had to reduce their practice to part-time while shifting to provide other services,” he said.
“Despite our best efforts, we could not persuade government to lower the threshold for eligibility. This was their decision.”