FIX BILLING STRUCTURE, RECRUITMENT AND RETENTION, SAY DOCTORS
Physicians in Nova Scotia and Newfoundland and Labrador have diagnosed some causes and possible solutions to their healthcare woes.
According to the Canadian Institute of Health Information, Nova Scotian doctors are among the lowest paid in Canada and are the lowest paid in Atlantic Canada.
Tim Holland of Doctors Nova Scotia believes the billing system used in the province has made it harder for the region to retain family physicians.
"Anecdotally we hear all the time from physicians who cite compensation as a major issue for leaving Nova Scotia to other areas," Holland said.
Nova Scotia uses a fee-for-service model of billing, which provides physicians with compensation for each service they provide.
“Fee-for-service is good because it incentivizes volume. But it's also bad because it incentivizes volume," Holland said.
"It sets up practices to do the one-problem-one-visit family medicine"
The billing system does not incentivize doctors to collaborate with other health professionals or to focus on preventative care, Holland said.
Holland believes the province should use a blended capitation model of billing, which mixes fee-for-service and capitation.
Capitation billing provides compensation for a physician’s total roster of patients, based on the expected care they will receive.
Ontario physicians currently use the blended capitation model and New Brunswick, British Columbia and Alberta have recently moved to this model as well.
"With the blended capitation model, if you can keep them healthy, you have the incentive to access that mental health social worker, because that helps keep them healthy and frees up time to do other things," Holland said.
Prince Edward Island and Newfoundland and Labrador both use a fee-for-service billing model, although physicians may also be salaried.
A report released last spring by the Newfoundland and Labrador Medical Association, the Newfoundland and Labrador College of Family Physicians and the Memorial University Faculty of Medicine recommended the adoption of a blended billing system.
The report noted Newfoundland and Labrador had the highest net out-migration of family physicians among provinces in 2016. Physicians in the province also tended to be the most dissatisfied in terms of the balance between their personal life and professional commitments.
“Currently, there is no provincial physician human resource plan that identifies the appropriate number and placement of family physicians to meet the province’s current and future primary health care needs,” the report noted.
Newfoundland and Labrador Medical Association president Dr. Tracey Bridger believes the province needs to take a long-term view of recruitment and retention.
“Around the province, a lot of time and effort is spent on filling critical and immediate gaps as opposed to planning for the long-term. They're just trying to fill a position or just get locum after locum,” Bridger said.
“It was very clear to us that a more robust recruitment program, that has a coordinated system-wide design, would go a long way to address a lot of these things, especially in rural areas."
Bridger said she was unclear whether human resources staff conducted exit interviews with doctors who leave the region in order to determine the reasons for their departure. She also believes staff often prioritize finding locums over long-term, permanent physicians.
"For some people, very little is spent on actually recruiting permanent people and retaining the people they have, because they're just busy trying to recruit locums," she said.
This could be an opportunity for collaboration between health authorities throughout the Atlantic region, Bridger said. All four provinces compete with one another to attract healthcare staff.
“It would be good, say for example, even to have a [regional] locuming program,” Bridger said.
SaltWire has reached out to health authorities from all four Atlantic provinces to find out about practices undertaken to recruit and retain healthcare staff.