Dr. Paula Keating: Family physicians, team-based clinics not immune to economics

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We were surprised  a recent Telegraph Journal editorial expressed disappointment that New Brunswick physicians, or any other health-care organization for that matter, did not endorse the recently published provincial Primary Care Action Plan.

It does not seem reasonable to expect physicians, or the organization which represents them, to celebrate a plan which has no measurable objectives or targets, no associated budget, and which was never the object of any substantive consultation with the clinics or health professionals that it impacts. As we have stated prior, we agree with government on direction, but are seriously concerned about the lack of urgency and pace of change.

Our family physicians support team-based primary care. The New Brunswick Medical Society has also been a steadfast advocate for this model for the last decade. In the absence of any provincial policies at the time, physicians are the ones that led the ideation and creation of the Family Medicine New Brunswick initiative that sought to move physicians from solo to team practices. There is a strong consensus on direction for our primary care system from all health professional groups. No one needs convincing, we have known the solutions for decades.

Our bookshelves are full of government and Regional Health Authority plans that have failed to move the needle on this essential issue of access for the citizens of this province. Within the health-care system, it is well understood the reason for those repeated failures was lack of funding to fully implement the very ideas and initiatives those plans promoted. Every single time, successful pilot projects that increased care for our patients were left to flounder after elected politicians got their headlines and moved on to cut some ribbons or address the latest acute care crisis.

Money won’t solve everything. This simple but deceptive statement has been a favourite saying for armchair analysts of our health-care system. It certainly has a grain of truth to it, even if we are the least funded system in the country. Our acute care hospital system is large and complex, and it needs transformative ideas, not just increased funding. However, when it comes to primary care, which has never been the object of large-scale and sustained government investments in our province’s history, money will solve the issue.

The reality today is family physicians who take on a patient roster in a traditional family clinic, whether they are working in a team-based model or not, have the least amount of support from the system and take home the least amount of money out of all their peers. Family physicians can make more money, with less complications, in almost every other field of work. On top of that, New Brunswick physicians also earn less than our colleagues doing the same work in other provinces.

Based on very simple economics, it should not be a surprise to anyone that many of my colleagues are leaving their practices, and new medical graduates are no longer choosing family medicine. They are often passionate about primary care or have invested their whole lives in the clinics they have built. However, based on the current policies, it makes absolutely no economic sense to take on or grow a roster of patients, which is why many physicians are choosing not to do so. Those that keep going often do it at their own personal cost, taking time away from family and friends to try and respond to ever growing patient needs and expectations. The recent explosion in our patient waitlist is directly related to this stark reality.

Sometimes we overcomplicate very simple issues. If we want our family physicians, new and old, to invest in team-based practices, hire new professionals and take on new patients, we should give them every tool we possibly can and make it the most lucrative choice for them. The government of British Columbia did exactly that and got 90 per cent of family physicians to move to the new model while recruiting 700 new physicians to family practice in a single year.

The Vitalité Health Network is also doing this, and achieving success, but have been told they need to slow down their transformation due to lack of funding. They are making large scale investments in family physicians, their clinics and the teams and resources required to fundamentally change our system. They understand family physicians need earnings that reflect the challenges of taking on a large roster of patients, as well as a team, infrastructure, and accountability system that will ensure they are able to increase access to appropriate care for patients.

We have the solutions. It is time to invest in them. New Brunswick patients deserve better, and so do the physicians who care for them.

Dr. Paula Keating, is president of the  New Brunswick Medical Society