Just read this today. Big problem all over North America


Victoria spends big to attract family MDs
$442 million allocated to make field more appealing
Pamela Fayerman, Vancouver Sun
Published: Tuesday, May 29, 2007
The provincial government will spend $422 million over the next four years on financial incentives to make family medicine more rewarding and appealing for doctors.
The initiative is being undertaken to make a dent in the more than 400,000 patients in B.C. who don't have a primary doctor, to improve care of patients with chronic diseases, and to reduce hospital admissions.
B.C. Medical Association president Dr. Margaret MacDiarmid called the agreement a "watershed" milestone in primary care reform and praised its numerous features, including one that will reward young doctors who agree to move to remote areas that need their services. They will qualify for bonuses of up to $100,000 over three years, which includes $40,000 in help to pay off medical school student loans.
Details of the family medicine transformation plan are contained in a 36-page report to be released today. It sets out the goals for the medical system overhaul, and is partially based on the stunning statistic that a third of the province's population -- 1.3 million people -- have chronic conditions such as diabetes, heart or lung disease and they consume 80 per cent of the combined budgets of hospitals, the Medical Services Plan and PharmaCare.
For example, chronic obstructive pulmonary disease, a lung disease often caused by smoking, is the leading reason for hospital admissions via the emergency department. Last year, there were more than 7,000 such admissions.
"By concentrating on individuals who use the system most often, we can improve their quality of care, their overall health and well-being and reduce pressures and costs across the health system," said Health Minister George Abbott.
"We've got two waves coming at us -- aging baby boomers and the increase in chronic diseases. It will be impossible to manage the demand for care without these changes," he said in an interview.
Abbott added that those with chronic diseases are generally middle aged and older so demographic projections for the province -- which anticipate a 120-per-cent growth in the numbers of people over the age of 60 in the next two decades -- are daunting. It is projected that the prevalence rate of those with chronic conditions (now 34 per cent) could increase by 58 per cent in the next 25 years, driving up medical costs by at least 80 per cent, according to a new health ministry analysis.
Included in the changes to primary health care are these provisions:
- Family doctors will be given a "prevention-incentive payment" of $100 per patient (up to a maximum of $3,000 a year) to conduct cardiac risk assessments of patients who are unaware of their risk profile for cardiovascular disease.
- Numerous practice redesign components will be put in place to improve patient outcomes and result in better career satisfaction for family doctors who want to more closely follow patients but feel too rushed and pressured by office overhead costs to do so. A recent international survey found that Canadians were most likely to end up going to emergency departments because they couldn't get a same-day appointment with a family doctor. Doctors are now being instructed to change their appointment booking systems so they can fit in urgent patients. MacDiarmid said business case model studies have found that earnings can actually increase up to 20 per cent because with fewer appointments, there are fewer patient no-shows and urgent care patients also tend not to be long appointments
Since only about half of diabetes patients get the full realm of medical care that is recommended, doctors who treat such complex cases will receive an annual payment of $125 for each such patient, as long as the doctor can document they are following clinical practice guidelines which specify how to treat and monitor such patients. The $125 bonus is also extended to patients with congestive heart failure and hypertension. One of the ways doctors will improve care of diabetes patients is by ensuring they order a blood test at least twice a year called the A1C, which indicates how well blood glucose levels have been managed in the previous months.
- Doctors will receive a fee of $40 for every 15 minutes they talk with frail elderly, palliative and institutionalized (hospital, long-term care) patients and their families. The fee is being introduced to encourage doctors to take a more active role in such cases. About two-thirds of B.C. residents die in hospital even though surveys show that the majority say they would prefer to die at home. Doctors have traditionally stayed away from such meetings because it wasn't worth their while to spend the time required or because they couldn't leave their offices.
- In the area of maternity care, doctors will receive a $1,500 quarterly payment if they continue delivering a certain number of babies.
There are about 4,600 family doctors -- also known as general practitioners -- in B.C.
The document was developed in partnership among the health ministry, health authorities across the province, the B.C. Medical Association and other organizations with a vested interest in health care.
Abbott said he is convinced the changes will improve care of patients with chronic diseases and will improve job satisfaction for family doctors, which will help with recruitment and retention.
According to a survey by Statistics Canada, 7.7 per cent of B.C. residents (316,000) said they didn't have a family doctor because they hadn't bothered to look for one and another 2.9 per cent (101,700) had not been able to find one.
MacDiarmid concedes it is shocking that so many B.C. residents haven't bothered to find a family doctor.
"Fear and denial are powerful coping skills. However, they're not good skills when you are talking about health," she said.