STRAIT AREA: Doctors Nova Scotia (DNS) taking a closer look at how family physicians in the province are compensated for their work.
On January 6, more than 25 family doctors from throughout the province met in Dartmouth to discuss what can be done to support family medicine in Nova Scotia.
“We need some solutions as to how to help the healthcare system not only retain and recruit physicians, but also incentivise comprehensive family practice,” said Dr. Manoj Vohra, president of DNS.
A focus of the meeting was how doctors are compensated and what type of payment models have been implemented by other provinces, such as New Brunswick. Vohra said currently, doctors in Nova Scotia are compensated either through a fee-for-service model, which pays based on the number of treatments provided, or a salary model, which pays a fixed amount regardless of the number of patients a doctor sees.
“Neither system allows you to have the time that you need with patients and also get remunerated appropriately for that,” said Vohra.
“What we support is the starting of a blended payment model, which basically takes the best of both worlds.”
Vohra pointed out that Nova Scotia continues to be one of the lowest paid provinces for family physicians and among the highest taxed.
“It leaves Nova Scotia a less attractive place to be recruited unless we find models that actually promote work-lifestyle balance, provide appropriate compensation, and allow physicians to be part of the building processes of it,” said Vohra.
The next step for DNS is to meet with provincial government and the Nova Scotia Health Authority (NSHA) to bring forward its recommendations.
Doctor Michel Chiasson, a family physician in Cheticamp, did not attend the January meeting but says it is important for the payment model to balance efficiency with quality of care.
“The fee-for-service model can be very effective. The more patients a doctor sees, the more they’re going to get paid,” said Chiasson. “But that really produces a model where preventative medicine is not appreciated, where patients are not maybe given the amount of time that they require because they’re just paid per visit.”
He added that although he and many other physicians work on a salaried basis and still maintain a large caseload, the system may not always be the most efficient for tackling large volumes of patients.
“I think there has to be some investigation, so that’s what this meeting was about. It was to see what other provinces and other jurisdictions are doing and how we can find other models that will incentivize physicians to be active but also provide quality care.”
Doctor Patricia Menard, who practices in Antigonish, agrees that it is wise to examine other payment structures, but points out that other factors, such as training, also play a role in recruitment and retention.
“Rural physicians have to be able and willing to do it all,” said Menard. “If you’re working in Guysborough, you might be in your office seeing a new mom and her baby and then all of a sudden, you’re in an emergency room handling an acute stroke.”
Menard said it is important for new doctors to have exposure to rural settings during their training and believes students from rural areas should have first priority to complete their residency in their home communities.
She also believes communities need to provide up-to-date facilities that allow doctors to work together as part of a healthcare team with other professionals, such as family practice nurses.
“Many older buildings don’t have the space to accommodate teams,” said Menard. “Infrastructure can be a big part of moving a community forward in terms of healthcare.”
Despite the challenges, Menard pointed out that a lot of work is already being done to address the issues of primary care across the province.
“It’s really about everybody, including communities, DNS, NSHA, and the physicians themselves all working better together.”