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Doctors approve new fee agreement with B.C. government


The Doctors of B.C. president, Dr. Eric Cadesky.


Doctors of B.C. / PNG

B.C.’s physicians have voted overwhelmingly in favour of a new agreement with the B.C. government in a deal that will cost taxpayers at least $331 million over the three-year deal.

Last year, the government paid out $4.516 billion for physician services. By the end of the three-year deal that took effect on April 1, that will rise to $4.85 billion.

One of the elements of the deal is a signing bonus-like payment of $7,500 to each physician who earned over $75,000 in income in 2018, or in any of the past few years, to help offset rising overhead and other costs of running their offices.

Dr. Eric Cadesky, president of Doctors of B.C., said the sum is a one-time payment. But the help with overhead costs like lease payments doesn’t end there. In 2020, the government will give physicians — in Vancouver, Victoria and other urban areas — premiums to help offset inflationary costs like higher rents.

Doctors who have offices in Vancouver, for example, will get a five per cent increase that will be capped at a daily maximum of $60; Victoria doctors with private practices will get four per cent more with a maximum of $48 a day. And in Kelowna, Nanaimo, Kamloops, Vernon and Penticton, doctors will get three per cent more up to a daily maximum of $36.

There is no cap on this weekly “business cost premium”, so doctors who keep their offices open seven days a week could earn $420 more each week.

“A reasonably active physician in the city of Vancouver could earn an additional $13,200 annually when the BCP is implemented in 2020,” Cadesky said.

For several years, doctors in private practice have been complaining about rising costs of running offices. Cadesky said it was important to have a premium in the contract that would offer some relief. Alberta has a similar program but the premium is applied as a flat rate of 1.1 per cent across the province while in B.C., the premiums rise in communities where overhead costs are higher.

Clauses like this one clearly appealed to physicians even though only about 4,000 of the 12,000 doctors in the province voted during the ratification process. Only three per cent voted against the new deal. Doctors had sought a five year deal like the term they got under the Liberals but this government wanted to keep the deal at three years, consistent with other public service contracts.

 

Doctors will also get an additional half of one per cent more in fees in each of the three years and an assortment of other compensation payments to help with retirement plans, malpractice insurance premiums, and pay for work previously not compensated, like adding information to patient charts, writing reports, following up on lab and diagnostic tests, and maintaining electronic medical files.

The new contract is outlined in nearly 400 pages and is called the Physician Master Agreement. Cadesky said it will go a long way toward helping support family physicians who want to deliver a full spectrum of care — often referred to as cradle-to-grave patient care.

Patients should benefit because the new contract includes a commitment from the government to hire more doctors to “address growth in the workload of existing physicians (such as) emergency room physicians and medical oncologists.”

The contract also addresses some fee disparities between various medical specialists. There’s a sum of $42.73 million to shrink gaps between lower and higher paid physicians — highly paid ophthalmologists, for example, compared to geriatricians, pediatricians and psychiatrists.

The government has made good on its pledge to reduce the amount of money ophthalmologists earn doing cataract removal surgery. When negotiations began last year, the government’s starting point was a fee cut of 80 per cent, provoking a near revolt on the part of such surgeons. After many months of negotiations, the parties settled on a fee of $350, down from $425, about 18 per cent lower.

The savings — $4.7 million — are to be used to raise fees of other surgeons and specialists who are considered relatively underpaid. 

The contract also boosts government funding for things like continuing medical education, disability insurance  and rural physician funding. There are pledges by the government to consult more with doctors, including on violence prevention in health facilities, electronic medical records, and new payment models.

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Twitter: @MedicineMatters




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