August 1, 2018
Re: “Weighing the value of family physicians,” comment, July 29.
[Excerpts] 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.
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.
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.
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.
Dr. Perry R.W. Kendall served as B.C.’s provincial health officer.
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