Primary Care Crisis Event: Overview and FAQ

Question:

EMRs are tools that we use to help the patients and using them properly will affect the patient care. The prices are going up significantly and are hard to afford. Why does the government not pay for the EMR?

Response:

Doctors of BC

We agree that there needs to be simpler and fewer EMRs that talk to each other. Each individual practice having to negotiate data transfers is unacceptable. Conversations have happened.

Question:

I do not think the BC system is poorly funded. Where has the money gone? There are a lot of administrative wages. Every time we complain about anything, a pilot project is made that has already been done and no one is checking. How do we move the funding to patient care vs. an administrative person that doesn't get back to us. Why do we have so many administrative people in your system?

Responses:

Doctors of BC

The health authorities shouldn’t be where the funding goes. The government has agreed to take a look at that. There are ways the health authorities work that add to the burdens rather than supporting the systems of primary care. We need to look at what the health authorities role in primary care is. They should be supporting – not adding to the burdens.

GPSC

We have been working with Divisions and other organizations to run engagement sessions in hopes of listening to the voice of the physicians. We have heard that PCN is a burden when it should be a benefit. GPSC's role is to work on this. We are hopeful that we can make change in where the power lies in the community and the design of the system in the near future.

Question:

I would love to do community care but I do hospital now. A lot of people are scared to enter a contract because there are a number of requirements, such as numbers in your patient panel, etc. Are people aware of this issue? Would there be FFS but include paperwork? I am asking about both contracts (NTP and group).

Responses:

Doctors of BC

Even within FFS, we aren’t pure FFS. Some of the fees like the CLFP is not an actual fee. You do something, you get paid for it. Sometimes we get caught in the terminology. – Contracts – within family physician world, NTP and group contracts. Have been developed, have pros and have cons. Still not valued at the level they should be valued. They are complex and there are a lot of pages to them. There are restrictions on who can access them. However, a lot of the doctors on the contracts feel there is improvement.

BC College of Family Physicians

Worries about the debate re: contract and FFS. FP doing longitudinal care are not paid adequately but because of compensation. We need to compensate giving good quality care.

GPSC

We are looking at different ways to measure attachment while minimizing burden.

University of BC

The College is looking at panel sizes and capitation models. The patient requirements haven’t factored complexity.

Question:

Where are the specialists as to engaging with the idea that more funding needs to go to family medicine?

Response:

Doctors of BC

Within the engagement work, we have had a lot of feedback from specialists as well. They agree that support for family doctors is needed. Inequity in the specialist world exists as well and we won’t fix it all tomorrow, but shows another reason why the parallel track is needed. Rise of staffing, overhead, etc. they are also having some of these challenges.

Question:

Robust amount for overhead in family medicine - is this something that DoBC is working towards?

Response:

Doctors of BC

We are. It is one of the areas that shows flaws in the system. The MOH is sets their own bars with what they are offering their new to practice doctors. We have something that can be pushed on.

Question:

Role of health authorities in PCN. We know the struggles. In this space, PCNs were designed to support family medicine. How can we have PCN reform if there's no flexibility in the governance?

Responses:

Doctors of BC

The intent behind PCN governance was to give more of a voice to the practitioners but the opposite has happened. Let’s say we get PCN governance through this. The PCN still has from the funding from the government where certain decisions are made. That shows there is an issue and a problem. The GPSC will take leadership and the Divisions need to be a part of the leadership for representation.

BC College of Family Physicians

The PCN is PMH – PCN is not a PMH. The two are not the same. We need to do a lot of work to get our clinics to be PMHs. PCN is a building block for PMH. They are linked but not the same thing.

GPSC

This is where GPSC fits in well. We hear this from every Division. Almost all Division have this problem. All the PCN pieces need to be coordinated and integrated where patients have agency.

Question:

As a UBC instructor, we spend a half day with Med students in LTC and we only get pair $90 for a session from UBC. Even the hourly rate has not been updated for years and is much less than sessional pay. Why would anyone choose to teach - what it takes out of practice and with the current compensation? Poor pay, less offices, less family physicians willing to take learners, so who is training new family physicians? Who would want to be an underpaid, overworked small business owner?

Response:

University of BC

There is currently a pilot project funded by the Ministry of Health aimed at improving practice based teaching for family practice residents. Preceptors involved in the project receive 0.1FTE (approx. $17,500/year) to take on 2 family practice residents (each resident in their clinic for 4 months) It is a 3 year project and if we demonstrate improved recruitment and retention to these teaching clinics the MOH may fund a phase two to expand to additional clinics. UBC also needs to recognize the value of clinical education. The Faculty of Medicine is underfunded compared to other faculties of the University. There is ongoing advocacy for improved remuneration for clinical education. That noted there is poor understanding of the different costs of community based practice vs. facility based practice (ex. ambulatory specialty clinics). There is a growing understanding that in order to sustain clinical education within the community to ensure grads are work force ready, we need to transform the system to better support the clinical learning environment. We need to support the teachers.

We already know that 90% of students have no intent of working primary care. This is primarily because they don’t have the team support.

Question:

UBC - can you have a community doctor do a business class? It's difficult to negotiate with doctors that do not understand overhead.

Response:

University of BC

There are significant challenges with adding to the residency curriculum. There are so many things – like business management, point of care ultrasound, dermoscopy, cultural safety and humility, virtual care, post and long covid care, complex care, health system leadership, …The issue has become what can be removed to allow for things to be added? The other issue is that in order to preserve mental health and work life balance, residents have fewer clinical education days per year (ie; on average a resident will work 176 days per year) To address this the CFPC has proposed to extend residency. The key will be to create a very different – ie; community based, service oriented, extension to better support a transition to practice.

Question:

Can the ministry provide a MOA teaching course? I cannot keep up after I train them and they get a higher paying job.

Response:

Doctors of BC

The value of MOA has come up over and over again. The need to support the MOA, pay the MOA etc. has come out very strongly in the engagement.

Question:

It took me so long to get on a PCN group contract and I asked for help repeatedly and was not given any. There are options in the contract at the start but they were made no longer options from the MOH after I got on it. The MOH opposes our rules. Doctors of BC was nowhere to be found to help us. We only went on a contract to save our practice. Who is handling the negotiations at Doctors of BC? We don't have pensions or benefits and it is so demoralizing. Months have gone by and we need to rely on the media. Where are the negotiations? I can make $300,000 without overhead working at the hospital vs. $90,000 + 40% overhead. We should be telling the young grads this instead of trying to get them into a contract. This system needs to be more transparent. It can't take years to figure this out.

Responses:

Doctors of BC

One of the things communicated today was that we need answers for the Fall. There are too many flaws in the current system. The funder needs to change the way things are done.

GPSC

We need to change the infrastructure – community FPs carry the weight. Admin burdens are different as we are “relationship professionals” – it is a service driven and mission driven profession.We need change to happen this calendar year. We have less than 6 months to figure this out. We are going to fight like hell.

Question:

In the UK, FPs are paid higher than any other specialty. If we truly value primary care, we as a society should put our money where our mouth is and address the disparity/inequity in remuneration.

Responses:

Doctors of BC

The reality is that family medicine is the least compensated specialty that you can go to. All of you toiling in your practices, can likely make more doing other things. Yet, it’s the bedrock of the system. I don’t think we’ll get to the point where we are paid the most, but at the bare minimum, we should be paid equitabilty to other specialties. This is what Docs of BC has advocated for.

BC College of Family Physicians

There needs to be huge advance for doctors in BC. Community FPs needs to be paid at a higher rate than a hospitalists for example. Equitable is a good step forward but we need to do more than that!