Since I was on the BCMA Board of Directors about 30 years ago, little has been done to properly address the plight of full-service general practitioners. We are still unable to ensure each of them a sufficient salary in order to keep them in full-service practices and to attract new graduates into this field.
Two problems are immediately clear. One, that the old Board policy of keeping the average GP earnings at 80% of the average specialist earnings has been lost; two, our association has failed to separate GPs into two groups: those who provide full-service practice and those working in walk-in clinics in urban settings.
I propose a solution.
Our association has been successful with the two programs it has implemented in paying bonuses to practitioners—namely, the Northern and Isolation Allowances and the Retention Fees (even if these are sometimes paid to doctors who want to be in these locations to ski, fish, etc.).
Let us have an urban full-service GP retention fee paid to all those GPs who earn 20% or more of their income from fees other than 0100 or 0120; i.e., for seeing the elderly and the very young, obstetrics, hospital and nursing home visits, and minor surgical procedures.
How much should this fee be? Consider the fact that several GPs on the North Shore have abandoned their practices to become hospitalists in Lions Gate Hospital for a salary of $175000 for a 48-week work year. Forty percent of our fees pay for our overhead. The hospitalists have no overhead, so a full-service GP should be paid $291000 for 48 weeks or $315000 for a full year. The fee might also be based on the full-service GP receiving 80% of what the average specialist earns (I don’t know the figures for this). Judging from my family practice, a bonus of about $50000 per year would be entirely reasonable.
|Garry R. Jenkins, MD