Bean the change

“Congrats on your raise, doc!” I must’ve appeared baffled as my patient went on . . . “I heard the government is giving family doctors a bunch of money; that should help, hey?”

I sighed, smiled, and explained that it was “complicated.” I was too tired to get into the conversation that the approximately $17 000 to $27 000 being given to each BC family doctor wasn’t going to stabilize the family medicine crisis. The stabilization funding, which is meant to help clinics stay open from 1 October 2022 until 1 January 2023, is a nice gesture, but it gives our patients the idea that we can be pacified with money. The fair distribution of these funds will be an interesting and unenviable process for clinic directors. Physicians within a clinic have different styles of practice, see different volumes of patients, and work a varying number of hours to provide quality patient care. The clinics will also take a well-deserved percentage of the funding for overhead.

I joined the Supporting Team Excellence with Patients Society (STEPS) community health centre (CHC)[1,2] in September 2021, and my overall experience has been very positive. I went from being a solo family practitioner to a valued member in a fee-for-service team-based care model. My patients have access to a wonderful team, including a nurse, a counselor, a social worker, a dietitian, a respiratory therapist, an occupational therapist, a pharmacist, medical office assistants, and urgent care physicians. My laptop is no longer an accessory appendage, and there haven’t been many sightings of me peeking over my Lenovo at family gatherings. My physical and mental well-being directly correlate with the care that I provide to my patients, and the CHC rescued me when I was on the brink of burning out. The connection I have with my team calls on me to reciprocate when others need support, ensuring the greater well-being and health of our team.

Although the CHC model is working well and remains a key strategy for stabilizing primary care in BC, the issue remains that I have 2200 patients, many of whom are very complex. These patients wait up to 8 weeks for a regular appointment. While urgent-care appointments are a great concept, they are taken up quickly as we no longer have any walk-in clinics in Kamloops. STEPS is working on a CHC and urgent primary care clinic combination proposal to increase access to urgent care, which cannot come fast enough. Timely access to care is of the utmost importance to me, and to my patients.

There are physician payment proposals for CHCs offering $265 000 to $295 000 annually with $75 000 for overhead for 1680 hours worked. The $75 000 offered won’t cover most physicians’ overhead, which is on average 35.5% of gross earnings. A regular patient visit with a family physician, after paying overhead, amounts to approximately $20/visit, pre-tax. The government is recognizing that we need payment models that address rising business costs as well as the complexities of providing longitudinal care to our patients.

In many of the proposed group contracts, a full-time equivalent physician is expected to manage a panel of 1250 attached patients of average complexity.[3] If I optimized my patient panel, approximately 1000 of my patients would be orphaned. This won’t happen because I, like most family physicians, have a moral and ethical obligation to my patients. Ideally, I need another doctor to take over some of my patients so I can cope with the ongoing burden of charting, complex billing, reports, meetings, forms, forms, and more forms! The real issue is that we need more family physicians. Currently in the Thompson Health Region, approximately 39% of our population is not attached to a primary care provider.

Doctors of BC has posted results from the 2021 benchmark member engagement survey,[4] which had a response rate of 12%. The survey brought forth key issues affecting primary care medicine and realization of the crisis we are in. Our Doctors of BC president, Dr Ramneek Dosanjh, and her team are making a genuine effort to communicate with primary care providers. She will be meeting with our STEPS CHC via Zoom and will be collaborating, in person, with the medical community in Kamloops.

The family medicine crisis has received significant media attention, and family physicians are finally starting to be recognized as specialists of primary care. We must continue to advocate for equality and collaborate to maintain our diversity and autonomy.

One of my colleagues gave me the book The Coffee Bean,[5] which offers a simple lesson in creating positive change. The authors liken a stressful environment to a pot of hot water, hypothesizing that we can soften and weaken in it like a carrot, harden like an egg, or transform the environment like a coffee bean. Like the coffee bean, let’s all be active participants in the positive transformation we are seeking in our medical system.
—Jeevyn K. Chahal, MD

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References

1.    Supporting Team Excellence with Patients Society. Accessed 20 September 2022. https://stepshealth.ca.

2.    Chahal J. Quest for Superdoc, version 2.0. BCMJ 2022;64:103.

3.    Doctors of BC. Group contract for practicing full service family physicians. Accessed 20 September 2022. www.doctorsofbc.ca/managing-your-practice/compensation/contract-offerings/group-contract-practicing-full-service-family-physicians.

4.    Doctors of BC. Benchmark member survey 2021. Accessed 20 September 2022. www.doctorsofbc.ca/sites/default/files/what_we_heard_report_benchmark_member_survey_2021.pdf.

5.    Gordon J, West D. The coffee bean. Hoboken, NJ: John Wiley & Sons, Inc.; 2019.