Alleviating Canada’s Acute Shortage of Family Doctors

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In British Columbia this week, the provincial government took a bold, and costly, step that it hopes will help recruit family doctors for about 1 million people. Adrian Dix, the minister of health, outlined a new plan that could see a typical family doctor’s gross income rise by 135,000 Canadian dollars a year, to about 385,000 dollars.

It’s a problem that resonates in other provinces. This week I’ve been in Nova Scotia for an upcoming climate article. In casual conversations, the province’s shortage of family physicians kept coming up.

Nova Scotia’s latest monthly tally, released in mid-October, showed that 110,640 people, or 11 percent of the population, were on the wait list for a family doctor.

Nova Scotia and British Columbia are not alone. The recently re-elected Coalition Avenir Québec government dropped its promise to ensure that everyone has a family doctor. More than 800,000 Quebecers are without one. In Ontario, the provincial advocacy group for family physicians estimates that 1.8 million residents do not have a family doctor and another 1.7 million people are under the care of physicians older than 65 who are nearing retirement.

The desperation to secure a physician pushed Janet Mort in British Columbia to drastic measures. She took out an ad in a local newspaper in search of a physician to fill her 82-year-old husband’s prescriptions after his physician retired, as reported by Global News. Her strategy was successful.

For others, the process to find a family doctor has meant working the phones to call individual clinics or to join growing provincial wait lists. Those who turn to the services of walk-in family doctors find longer wait room times and no continuity of care. And some people add to the congestion in overburdened hospital emergency departments.

While British Columbia’s new plan would increase the income of family physicians, it’s not a simple raise. Rather than just increase payments, the province is completely changing how family doctors bill the government. Under the current fee-for-service model, physicians in British Columbia and most provinces are paid about 30 to 40 Canadian dollars each time they see a patient, regardless of how much time they spend or how complex the patient’s medical issues.

The system was first set up to end a strike by doctors in 1962 after Saskatchewan became the first province to introduce public health care. But critics say it encourages medical students to seek out other specialties where the government’s fees better reflect the time and skill needed for treatments and that bring higher earnings generally.

Under British Columbia’s new plan, a physician’s income will increase depending on a number of factors, including how much time a doctor spends with a patient, how many patients the doctor sees each day, the number of patients in their practice and the complexity of the patient’s medical condition. The new system will also pay for some of the costs of running and staffing offices, a move that address a longstanding grievance of many family doctors.

In an interview with The Vancouver Sun, Dr. Ramneek Dosanjh, president of Doctors of B.C., described the new system as “a seismic shift.” The province estimates that it will increase health care costs by 708 million Canadian dollars in its first three years.

Even Mr. Dix, however, acknowledged that the new payment system is unlikely to completely resolve the family physician shortage.

I spoke with Katherine Stringer, the head of the Department of Family Medicine at Dalhousie University in Halifax, about the department’s efforts to increase the number of family doctors in Nova Scotia.

One step has been designing a program that makes sure that students spend part or all of their two-year family medicine residencies in smaller communities throughout the province rather than just in Halifax, a move that she said has often led to new family doctors staying where they trained.

She also acknowledged that while family doctors are in effect small business owners, the training they receive on how to run their business while in medical school is “very rudimentary.”

As a result, Dr. Stringer said, for many new doctors “it’s a very stressful first year.” Emulating a strategy used for new technology companies, the medical school has brought in mentors to help new doctors find their way. Dalhousie is also working with the province on establishing teams to set up all of the patient record compiling needed for a new practice.

But Dr. Stringer said the key to making family medicine more attractive will be a further shift toward a model where patients deal with a group practice of physicians rather than a single doctor. Such arrangements better spread workloads, allowing doctors to share office expenses and cut administrative chores.

“We’re able to free up a doctor’s time and hence able to accept more patients,” Dr. Stringer said.

Dalhousie is in the process of converting its two clinics in Halifax to collaborative practices, she said, and aims to be able to serve 3,500 more patients.

“The future of family medicine in Canada has to be team-based,” Dr. Stringer said. “We can realize efficiencies and focus the care so that patients receive the care from the right health care provider at the right time.”

This week’s Trans Canada section was compiled by Vjosa Isai, a reporter-researcher for The New York Times who is based in Toronto.

A native of Windsor, Ontario, Ian Austen was educated in Toronto, lives in Ottawa and has reported about Canada for The New York Times for the past 16 years. Follow him on Twitter at @ianrausten.

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