Re: “Weighing the value of family physicians,” comment, July 29.
Although I suggest that Dr. Chris Pengilly’s description that family physicians are paid a gross fee to provide medical care is perhaps not the best way to characterize the dominant fee-for-service model, I agree wholeheartedly with his critique of this payment mechanism as a highly inefficient way of delivering care to individuals with multiple complex chronic health conditions.
We have known for 20 to 30 years that complex primary care is delivered more effectively, and more efficaciously, with more satisfied patients and more satisfied physicians, through team-based group practices with allied and complementary health-care professionals and appropriate practice supports.
In B.C., we are facing the prospect of significant numbers of family practitioners entering the retirement-aged cohort. Pengilly is one such. The outcome will likely be even more British Columbians who are unable to find a primary-care attachment.
We also see that these retiring physicians are unable to sell their practices and recruit successors. As Pengilly notes, most newly graduating family-medicine specialists do not, on the whole, wish to be small-business owners. They would prefer alternative ways of being remunerated; they would also prefer to work in team-based practices.
I also agree that the Doctors of B.C. (formerly the B.C. Medical Association) needs a fundamental change of heart.
While being engaged with government in attempts to reform primary care and meet population health needs, they are still, as Pengilly notes, wedded to the fee-for-service payment model, which rewards piecework and impedes appropriate complex chronic care.
I therefore propose a modest solution to assist in the long-delayed transition to full-service primary care. A solution in which no physician is forced into a payment system that she or he might find distasteful, that rewards anticipatory team-based care for individuals with chronic care needs and that optimizes the skill sets of other health-care professionals.
Government and the Doctors of B.C. should get together to agree that the fee-for-service dollars that are “freed up” as older family practitioners retire should be “retired” from the fee-for-service “pot” and redirected to a variety of alternative payment plans that can be used to support new family-practice specialist graduates and ancillary health-care professionals entering the primary-care arena.
This reallocation could be close to cost-neutral for government, be politically acceptable to the body that represents physicians, be better for British Columbians and, as Pengilly suggests, “the productivity should increase enough to ameliorate or even obviate the family-physician shortage.”
Dr. Perry R.W. Kendall served as B.C.’s provincial health officer.
