Carllin Man MD CCFP

@DrDMPetersMD Totally agree. I had a thyroid imaging report delayed for many months because the radiologist in Vancouver couldn't see what was done in Langley. Yikes, it's like it's 1990 (which would be 30 years behind).

This means as physicians we can make more errors, repeat tests unnecessarily, do procedures that were already discussed, prescribe toxic combinations of medications. Much if this is avoided in provinces like Alberta with netcare or connectcare across entire province.

Quote today from department head in hospital, “Alberta health care is 15 years ahead of BC health care. We don’t have any ability to share and transfer data or information that Alberta started developing 20 years ago.” Talking about inability to navigate information Silos in BC

@dockevinmcleod One thing I would like to know is how many return of service family medicine graduates there are in BC a year. How many of those signing this new contract are return to service grads that would be required to start a practice regardless?

This is government not telling the whole story. We have 19 family practice training program sites throughout BC. We graduate 174 family medicine residents per year each July. Yet 54 only sign on to work in this model? Where are the rest? These “new” docs were coming regardless.

@richardzussman How many of these are "return of service" family doctors that are required to do family practice for 3 years as part of their contract when they trained in BC?

NEW - After incentives from the province, 54 new doctors have signed contracts as of Oct. 1, 2022, to provide full-service primary care in communities throughout the province. These physicians will earn $295,457 for the first year, plus a $25,000 signing bonus. #bcpoli

@ColJacksMed @TuraEmanuela @DrRitaMc @cbcnewsbc @DrJLush @DrDMPetersMD @markroseman I agree with you, we don't need to fight eat other. It's our health system that takes advantage of all of us (doctors, nurses, etc) to do the hard work, that often is done for free. We must unite and speak together. @DoctorsOfBC must work to unite all docs!

@TuraEmanuela @DrRitaMc @cbcnewsbc @DrJLush @DrDMPetersMD @markroseman @CMan_CCFP I think it won’t end well in a zero sum game where we all fight for the same scraps. We need to start working together, thinking outside the box and helping to create a better system for FPs and specialists. ? Is how. Need gov to wake up and work with us.

❤️‍🩹🩺 The #FamilyDoctorShortage & the fee for service MD payment model Imagine a million kids not able to access schools would paying teachers/lesson/child be at the top of our idea list? No, we need MD pay models incentivizing patient access @cbcnewsbc cbc.ca/player/play/20…

@ColJacksMed @TuraEmanuela @DrRitaMc @cbcnewsbc @DrJLush @DrDMPetersMD @markroseman Just had a late night radical idea. If we fund primary care properly, the cost savings to the health system would likely be measured in the tens of millions, money that would be put back into the system to improve it for all. Wait, wait that's too radical.

@DrRitaMc @cbcnewsbc Sorry, this doesn't make sense. Many services are "fee for service"; lawyers, accountants, hair stylists... When you pay people per service, naturally they will work harder. Problem for BC family doctors is the fee is fixed at a low rate by the gov't, thus causing burn out.

@bradybouchard @markroseman How do ARP or capitation models change if a doc runs the business? My understanding is none of those models includes a non physician organization running the clinic. In the end, it's still physician run! At least that's the view from BC. Govt run clinics have been a failure here.

@markroseman There is no fixing FFS given generational trends. Doesn’t matter if it pays well or not, most new family physicians do not want to run a business, want to know they can leave without covering overhead, and want to focus on clinical care. FFS can still be an option of course.

I will say that government (and others) have done an excellent job selling the narrative that fee-for-service is at the root of the problem and MUST be replaced. Unfortunate that it’s not true. (Replacing is an option, as is fixing it… or both. Details and tradeoffs matter).

Terrible timing when government and family physicians had worked out some positive solutions. Got to love complex computer systems when things go wrong…

How many lives is excess administration costing us? → bcupcc.ca/admin/ Excess ministry and health authority admin spending in BC (vs. AB) costs $851m per year, which could provide $250k per year more for each full-service family doc. #bchealth #bcpoli

@SusanFDe @DrDMPetersMD @markroseman @BShane555 @DrJLush @JillianRatti @ChakDe8 @DrRitaMc @BCFamilyDoctors @CMan_CCFP @Docs4BC The doctors I know that worked at the UPCCs all quit. It’s not a team, admin just books, does not help with care, flow, nurses not used efficiently. Ridiculously inefficient and low volume.

@MdApplewhaite @drpaulwinston @drawolak Hit it on the nail right there. The other day I felt so terrible for thinking I have to rush telling a patient they have cancer, because we have already spent 30 minutes, and I needed to start seeing the other patients booked in. Got paid $25 for that. Sighs.

@CMan_CCFP @drpaulwinston @drawolak And this is where the moral distress comes from, With every encounter you are faced with two unpleasant possibilities. 1) provide suboptimal care 2) work basically for free

What kind of healthcare system did we design in BC? People always ask if they are allowed to bring up something else. Allowed? Every patient deserves the time they need. And yes you can, so let's inject or aspirate it now. #bcpoli @drawolak Rebooking is a waste of time and $$

@DocMcConks @drawolak @TuraEmanuela Wow that is just redicilous. No other industry would work with such unpredictable invoice payment. What can we do together to get change?

@drawolak @TuraEmanuela This occurs to specialists every pay period. Same ratio. Hold for no reason. As a surgeon, turn down your fee codes saying you didn’t do that operation, all the time. Pay you for something totally different and lower cost.

Seeing lots of BC FPs reporting on facebook that anywhere between 15-50% of their last paycheques have been witheld. No explanation given. Just "billing withheld". No information given on when we expect to see these funds. This does not help us keep practices open. #bcpoli

@JillianRatti @DrDMPetersMD @DrRitaMc @BCFamilyDoctors @DrJLush @Docs4BC Yes! Many issues in BC resulting in low numbers of CCFPs practicing family medicine. How we are paid is a big part and right now it makes no financial sense to start a family practice. Without family docs, there is no primary care, despite how hard the Gov't tries to replace us.

@DrDMPetersMD @DrRitaMc @BCFamilyDoctors @CMan_CCFP @DrJLush @Docs4BC Having just checked out this thread, I think she laid out a really good argument with lots of evidence. Of course family docs should be paid well and Dr McCracken acknowledges that. The issue of access goes well beyond GP compensation though and that is important to keep in mind.

@DrRitaMc I am deeply upset that you have zero evidence but are using an academic platform to openly disagree with time based modifiers that changed family Med in AB and specialist care in BC. Access improves when docs are paid well. @BCFamilyDoctors @CMan_CCFP @DrJLush @Docs4BC

@DrDMPetersMD @TuraEmanuela @DrRitaMc @GarethEeson "The fee-for-service time-modifier code [...] resulted in reduced ED visits and hospitalizations. It is likely that discontinuing the code would result in increased ED and hospital utilization, costing much more than removing the code would save." cjen.ca/index.php/cjen…

@TuraEmanuela @DrRitaMc @GarethEeson @CMan_CCFP I am aware. But the complex disease modifiers are far different from time based modifiers. BC gambled on disease based bonuses (lost); but Alberta gambled on paying docs for time spent for each patient as required. There was success on many fronts. Compared to pre-modifiers.

🧵 1/5 Will "time modifiers" added to family doctors fees help more people in BC access primary care? 🩺❤️‍🩹Probably not 2006-14, BC spent a BILLION $$ (!!) with incentive fees family doctors for work that typically takes more time (e.g. mental health) #bcpoli #primarycare

@DrRitaMc For me, the moral of the story is that there is no one perfect funding model. We need to strengthen the current funding model we have now, while we work together to develop other models that will encourage more family doctors to start practices. That is the end goal!

@DrRitaMc There may not be a study to back this up, and there probably will never be, but my real life experience and seeing how family doctors work different in Alberta shows me that time modifiers do affect how doctors work and how patients access care with their family doctor.

@DrRitaMc To that point, came across this study from ON: "Compared with patients in enhanced fee-for-service practices, those in capitation practices had less after-hours care and more visits to emergency departments." ncbi.nlm.nih.gov/pmc/articles/P…

@DrRitaMc Since majority of family doctors work in fee for service, adding in time modifiers now would help to retain the many family doctors that are already spending time with their patients, but not being fairly compensated for it.