Dr. Melissa Duff
There have been significant changes to primary care over the 17 years I have practiced family medicine. Yet the fee-for-service payment model has remained relatively static. Fee-for-service incentivizes seeing more patients, since we are primarily compensated by patient visits. Meanwhile, the reasons patients come to us for advice and help have expanded a lot. For example, fifty years ago people didn’t visit their family doctor for mental health concerns or to fill out forms for government services. Today, we handle a wide range of issues, from food insecurity to complex mental health problems, some of which takes inordinate amount of time to address. As science and technology expand our understanding of illnesses and the treatments available, what was once a simple and straightforward visit with a patient has become a much more lengthy and complicated conversation. The fee-for-service model often does not accurately compensate physicians for the time it takes to address these issues properly.
That’s why the new Longitudinal Family Physician (LFP) Payment Model, introduced just over a year ago, is such a needed breath of fresh air. The new payment model mixes volume-driven with time-based remuneration. A time-based payment model recognizes the increasing complexity of patient care and time required to manage it properly. Under the fee-for-service model, administrative tasks like paperwork and reviewing lab work are not compensated, contributing to doctor burnout. With the new payment model, time spent on these necessary tasks is valued and compensated, a change that has already improved morale for many family doctors. This flexibility is crucial for the success of PCNs (primary care networks), which represent a major shift in how we deliver primary care.
PCNs are already the standard for primary care in many parts of the world. PCNs allow family doctors to lead teams of health professionals, like nurses, social workers and counsellors, who help manage a patient’s care. Under a team-based care model, a patient with anxiety can see a counsellor who has more experience in therapy that I do, while I can focus on providing my expertise in managing their medications. Ultimately, this frees up my time to see more patients. Team-based primary care transforms patient outcomes, ensuring patients receive holistic, well-rounded care while still maintaining a long-term relationship with a family doctor, which improves health outcomes and saves healthcare dollars.
The new payment model is critical for the success of team-based care, since the fee-for-service model does not allow the flexibility needed for this new style of practice. Under the LFP Payment Model, family doctors can have meaningful conversations with care team members and coordinate care more effectively to address the complex needs of patients more effectively while reducing burnout among family doctors. As we move forward, embracing this model can transform our healthcare system, ensuring that both doctors and patients thrive.
Dr. Melissa Duff has been a family doctor for over 17 years.
She is currently a PCN Physician Lead in Victoria, BC.