The plan to pay doctors more is timely, but there are risks

There was so much to talk about in Tuesday’s budget that big chunks of it were released in the preceding days.

Arguably, the most important element was the multi-faceted boost to family physician compensation. It has several attractive features:

1. It is quick. The pay for office visits is boosted 13.5% for those over 65 and 10.6% for seniors. It can be implemented at the beginning of April.

2. It provides additional rewards to doctors who embrace today’s technologies. Those who choose to participate can use internet for records and telephone to communicate with patients. They do so in exchange for a bulk payment.

The ridiculous previous requirement to create paper documentation of the electronic work has been eliminated.

3. Established physicians are incented to add to their patient rolls and to create electronic records of who their patients are. Even together with the changes to fees for office visits, this will leave Nova Scotia family physicians at the low end of the range in Canada.

4. This creates a framework for better overall data which can lead to more informed resource planning and the ability to estimate the cost of alternative payment models.

The changes were worked out with Doctors Nova Scotia, but they are not embedded in a formal agreement. That is just as well, since many details remain to be worked out. And it makes it easier to fine tune the system.

The whole package has a rather ad hoc feel to it. It appears to have been rushed to completion so that much of the cost could be included in the accounts for the just completed fiscal year.

There are also material risks:

1. A small number of people were involved in developing the new payments for enrolments and use of technology. The government states the details of how the new payments will be handled by a trust that still needs to be set up. On the other hand they advise that the payments will be available to doctors in April.

Doctors do not yet know how the system will work or how they should make applications.

There is a good chance that there will be disappointment in timing or accuracy of payments, or expectations of doctors based on the brief press announcement will not be met.

2. Collective bargaining agreements are now in place for teachers and civil servants, but not for health care workers. They have four unions and a multitude of expired agreements with the nine former regional health authorities.

The health care workers may think that the doctor arrangements, which are well outside what has been done for other unions, represent an opportunity to break the mold that government has so far been able to impose.

On Wednesday NSGEU president Jason MacLean said that they would be seeking a strike mandate from their members. He went on to say that “the bargaining unit has been trying to reach a deal with the province for four years.”

That’s a bit rich. The employers requested a start to bargaining in the spring of 2015. This prompted no meaningful response until the employers complained to the labour board in the spring of 2016.

Dates were set but the unions kept cancelling until the employers again applied to the board, seeking conciliation which began in the second half of 2017.

Regardless, a dragged out and contentious bargaining process will not be good for health care.

3. The new payments structure exacerbates the awkward division of labour between the Department of Health and Wellness (DHW) and the health authority (NSHA).

The Minister states that the NSHA is accountable for attracting and retaining family physicians.

But DHW controls both how and how much (including recruitment incentives) the physician is paid. The NSHA had no involvement in developing the new program.

This can create the seeds for all kinds of problems. The department should be focused on policy and long-term planning for the various elements of the health care system.

During its first mandate the Liberals had many of their good ideas founder on clumsy or inept execution.

The initiatives to improve doctor pay are good ones and the choice to put them in place before the end of the current collective agreement has much to commend it, not least the much-needed positive signal to current and prospective family physicians.

There are serious risks that it will be looked back on with regret if the implementation causes as many problems as it solves.


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