February 27, 2014

Four new In-patient Care incentives have been successfully rolled-out across BC since their April 1, 2013 introduction, with support from the province’s 33 divisions of family practice.

Network incentives for both assigned and unassigned patients, as well as unassigned patient and enhanced clinical fees, were introduced in response to a concerning trend – physicians relinquishing hospital privileges at a rate of three per cent annually. With a third fewer family physicians caring for their own and unattached patients than a decade earlier, province-wide consultations were undertaken to learn why so many physicians were choosing to walk away.

"We heard two issues loud and clear,” says GPSC In-patient Care program co-chair Dr Brian Winsby. “First, providing hospital care wasn’t financially feasible and second, working in hospitals presented a variety of logistical challenges, from a lack of parking to the remote location of a computer that could access lab results.”

As family physicians are a vital component to delivering quality in-patient care, particularly in small and medium-sized communities, addressing physicians’ concerns became a key priority for the GPSC. While Dr Winsby and In-patient Care program co-chair Darcy Eyres worked toward establishing the incentives, they also met with some divisions to explore other ways to make the system sustainable.

“Things were getting close to a crisis point for us,” says Dr Tom Rimmer, chair of the Cowichan Valley Division. “Several doctors had given up their privileges, adding to the load for Doctor of the Day which led to more doctors to opting out of the service.

“Darcy and Brian met with us to start looking at non-financial ways to improve some of the ‘hassle factors’. That was good, but when they introduced the incentives, it changed the whole tone of things. It really showed our work was valued.” Today, the Cowichan Valley Division has not only slowed attrition, it has attracted three physicians back to its roster.

Encouraged by the positive changes that have already taken place, Cowichan physicians continue to work toward addressing other local non-financial areas for improvement. Terrie Crawford, executive director of the South Okanagan Similkameen Division of Family Practice, echoes Dr Rimmer’s experience on physicians’ reception of the new incentives.

“Both the incentives and the way they were introduced showed physicians how much they’re respected,” says Crawford. “There are three hospitals in our area and one, Penticton Regional, had a fantastic hospital care program that 100 per cent of eligible physicians were part of. We were concerned the new system might force us to change what we were doing, but there was complete respect for what was happening at a local level.

“Enabling communities to decide how they wanted to implement the network program made it possible to keep our model intact and build on our success. We’re thrilled.” Flexibility to adapt to local needs was built into the network incentives, says Eyres. “The GPSC recognizes networks will vary from community to community. The primary goal of the incentives is to help bring family physicians’ in-patient care earnings on par with office-based fees.”

The additional compensation has proved important to offering sustainable in-patient care for two reasons. “It’s not just about the money,” explains Crawford. “That’s important, but perhaps even more so is what it represents. It says to physicians ‘we value you and the work you do.’ Physicians care deeply about supporting patients. It’s good for them to know how much they’re appreciated.”