BC's new Family Practice LFP model uptake at 45 percent, why are 55 percent still cautious?

Public

Vancouver, BC - March 7, 2023

According to the DoBC Newsflash:

Doctors of BC says more than 2,000 physicians have signed up for the Longitudinal Family Practice pay scheme in the five weeks since it took effect, representing about 45 per cent of longitudinal family doctors. “That gives me great hope, and I think our entire negotiating team and the Ministry of Health some real optimism that we got the model right, because people are joining,” Doctors of BC president Dr Josh Greggain told Global News on Monday.

Is that correct? "We got the model right." At least enough for all the bureaucrats to be happy and smiling: "our entire negotiating team and the Ministry of Health". But, why are 55% of family doctors not so sure and staying with FFS, at least for now?

Did we get it right or is the LFP still in flux and going through modifications? Is the contract fixed or does it have conditions that may apply as time goes on?

Maybe the 55% of family doctors continuing to stay with FFS have reasons? It may be useful to know what their reasons and thoughts are?

Would the number remaining with FFS have been higher had the Master Agreement not continued on the path of miniscule increases to FFS and, at the same time, the promotion of unbalanced dialogue to deliberately discredit FFS.

Ironically, if the thinking behind the LFP model is even half right - that through FFS family doctors in BC have been underpaid for decades - should there not be some consideration to providing FFS the needed boost now? Even half the difference (50%) of the increased cost to the BC Government per doctor in the LFP model? Such a boost to FFS is needed to provide a more level field upon which to measure the costs and benefits of the two models.

How does the Doctors Of BC and the Association of BC Family Doctors represent the 55% of family doctors who still stand behind FFS despite continuing inadequate funding? They embrace their autonomy and trust with patients and worry, does their association listen to and represent them?

We must also understand the impact on patients, the user experience of health care delivery via these payment models. Will patients still have the choice to directly see a doctor, family physician or specialist, or are they required to first see another health provider? Possibly a Nurse Practitioner, or Physician Assistant, or more ambiguous a Clinician? Is it the same? What are patients and their supporting family members, friends and caregivers finding?

Unfortunately, neither the current FFS or the LFP model truly addresses the most important attribute of family practice, that is "longitudinal" care.

Longitudinal care is not simply seeing the same person in the same place, it is more than that and has eroded to the point of almost nonexistence.

This is why the preservation and restoration of family doctors is so critical and must be examined.

Our needs for health care span throughout our communities. Family doctors would see you in the office and also in the hospital, maybe even in the Emergency Department, or Imaging department. They might even see you in surgery or in the obstetrics delivery room, or in rehab or extended care, palliative care or at home. That's longitudinal care. Something family doctors aspired to and provided in the Boomer years. They were the glue that held things together and the hands that helped move things along.

Unfortunately, primary care and medical care has become fragmented. Some would say through deliberate neglect. Hospital visit fees paid only a quarter of an office fee, like all the other out of office and after hour fees, and they stayed that way even after all the family doctors stopped going to the hospitals, doing house-calls and being available after hours.