While getting a haircut recently (for a price higher than the $31 average family practice fee) I was thinking about Dr David Chapman’s editorial, “Valuing time and care” [BCMJ 2022;64:197].
My 40 years as a GP began in 1967. In those days, I would bill MSA $6 for an office visit. Gold was $30 an ounce, and a full hour of work on my car at a dealership was $5. Office overheads were easily manageable, and my secretary could handle the office (and billing) with a typewriter and a telephone. MSA would increase insurance premiums as necessary to cover costs.
Now, health care policy has made MSP payments to family physicians unrealistic, and overheads have become huge. To function properly, a family practice needs a secretary, nurse, and office manager. Their salaries come out of the undervalued payments to family physicians from MSP. Rents have skyrocketed, along with the many other overhead costs.
Recently, my plumber charged $266 for a 15-minute job that needed no new parts. Asked why, the answer was “overheads.” My car dealership attaches an hour-rated fee to each service item, with a charge of well over $100/hour.
Family practice is an expensive business, but paying for those costs is hamstrung by the inability to pass them on to the customer. They have to come out of the payments from MSP, which have become limited in such a way that they are akin to a salary, without the perks of payments for sickness, holidays, or a pension.
It is no wonder that new physicians are shunning this branch of medicine.
—Anthony Walter, MD
This letter was submitted in response to “Valuing time and care.”
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