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- Page navigation anchor for RE: Response to RW BellRE: Response to RW Bell
It grieves me greatly to learn that several persons have construed my piece on FFS and APP remuneration as containing a racist implication. https://twitter.com/BirinderNarang/status/1491272210895437824
Let me begin by saying that to each and every person who has felt hurt, maligned or marginalized by my words, I offer my heartfelt apology.
The specific phrase that caused so much distress referred to family physicians in our community "from another country", who, on average, tend to bill more under FFS than Canadian-born physicians. I speculated briefly that this might arise out of a more “utilitarian” (a word that I chose as reflecting pragmatism, rather than greed or bias) stance towards the system of remuneration available in this part of the world. My point was that FFS allows this to happen, while APP makes this well-nigh impossible.
My comments were focussed on billing patterns in our community, and not on race, nationality, gender, sexual orientation, age, religion, language or political affiliation – or even country of origin; that phrase was more of a descriptor for our community – which is actually located in one of the “whitest”, most conservative ridings in BC. All the physicians I referred to as being “from another country” are in fact white as well.
Nevertheless this phrase clearly sank into the hearts of some physicians or other readers who ma...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Response to Dr. RW BellRE: Response to Dr. RW Bell
We are writing to respond to a Letter from Dr. R. Warren Bell (1), which offered perspective on our recent commentary (2). We agree with Dr. Bell that system factors have a significant impact on the ways in which new-to-practice family physicians are choosing to work. We welcome his call for more robust discussion about the factors that will lead to physicians embracing longitudinal family medicine, which include issues other than payment models. In our interviews with over 90 early-career family physicians exploring the factors influencing choice of practice, prominent themes included feelings of accountability to address the needs of local communities, a motivation to provide meaningful care for patients, and a desire to work collaboratively. Payment and service delivery models were important to these physicians insofar as they supported care that was consistent with these values. We are preparing manuscripts for publication that report further on these data.
Dr. Bell’s response unfortunately makes baseless and stigmatizing assertions about physicians born outside of Canada. He describes his review of the British Columbia MSC Financial Statement (“Blue Book”) (3), which reports earnings from the BC Medical Services Plan. Using this review, he draws conclusions about the earnings of ‘Canadian-born’ versus ‘non-Canadian born’ physicians, concluding that non-Canadian born physicians take a more “utilitarian approach to the Canadian health care system” because they e...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Alternative payment models: a path forwardRE: Alternative payment models: a path forward
I read with interest the Commentary on Alternative Payment Plan models (APP) in the November CFP, and was struck by the discordance between my own field observations of attitudes towards APP and the attitudes of the early-career physicians reviewed in this article.
As a long-time (45 years) FP in BC in a solo practice (with shared coverage with other solo and paired practices through most of that time), I have been interested in APPs for decades. However the BC government, while introducing APPs nearly 2 decades ago, has made them available only to physicians in large group practices. The government has also been relatively uninterested in setting up multi-disciplinary primary care units, most of which have been organized by private societies or other community-embedded entities.
Recently this has changed, with an initiative to set up structures called Primary Care Networks, in which physicians would work alongside nurse practitioners, RNs, dieticians, physiotherapists, psychologists and other health care practitioners.
I attended a planning meeting a few weeks ago, and the first thing that the representative of the local Division of Family Practice stated was that all the physicians in our small town in south-central BC had made it clear that they would not surrender their fee-for-service (FFS) payment scheme. In fact, as the evening wore on, it was clear that this was the only point on which there was unquestioned agreement.
I believe the...
Show MoreCompeting Interests: None declared.