Cutbacks keep Halifax clinic from taking new patients

Doctors in a pioneering Halifax collaborative care clinic have a problem with the way the province funds their work, and they say it's keeping them from taking on more patients.

Duffus Medical Centre posted a message on its answering machine recently that said, "Due to recent government cutbacks, we are unable to accept any new patients."

The clinic, which opened in 2006, sees doctors collaborate with a nurse, a social worker, a pediatric mental health worker and a physiotherapist to treat patients.

Alternative payment program

Variations of that collaborative care model are what the province sees as the future of family medicine.

But the clinic is funded through an alternative payment program — which means a lump-sum payment, regardless of how many patients it sees. And that's where the problem comes in, said Dr. Andrea McDonald, one of the physicians at the clinic.

"Since 2006 there hasn't been any appreciable increase in the amount of money we've been given," she said. "And we know that costs increase — everybody has experience with increasing costs."

Computer subsidy cut

The Department of Health and Wellness recently ended a subsidy for computers used in electronic medical records, but it still requires clinics to upgrade its computers every three years for the EMRs, said McDonald.

On top of that, the new contract doctors signed with the province this year eliminates a lump-sum incentive for dealing with patients who have complex, time-consuming illnesses.

The incentive is now a billing code, so doctors who work under fee-for-service can still bill for it, but that is not available to doctors who work under an alternative payment plan.

Extra patients cost more

"I, myself, am going to see a $10,000 loss in the first year because of that contract," McDonald said.

Given how difficult it is to find a doctor in the Halifax area, the clinic constantly gets calls from people begging to be taken on as a patient.

But under the alternate payment plan, Duffus doesn't make any more money for additional patients. And in fact, it costs more money for supplies and administration for extra patients.

That's the reason they felt they had to post the message, said McDonald.

Pressures on doctors not uncommon

Dr. Rick Gibson, family practice chief for the Health Authority's central zone, said the pressures the doctors at Duffus face are not uncommon.

"I think it's important to understand that when doctors are paid, the payment includes an allocation to cover overhead, and that's true whether you're on an alternate payment plan, as they are, or fee-for-service, as I am," he said.

"So in some respects we are all in the situation where, if your costs increase, and the negotiated increase with the government doesn't keep pace, then our income will go down."

He said all doctors face a decision at some point in their career, when they feel they have taken on as many patients as they can handle, and they need to say enough.

Sustainable model needed

Dr. Bharti Verma, another physician at Duffus Medical Centre, believes it's a little different under the alternative payment plan, because the collaborative care model makes it possible to see more patients comfortably. The financial pressures are the limiting factor though.

"Having practiced as a collaborative care provider, I do not want to go back to fee-for service," she said. "But I am at the end of my career. What will happen to the young doctors who are coming into practice now?"

McDonald said the province needs a long-term, sustainable model to finance collaborative care clinics.

"I think that the government should look to set up collaborative care clinics where they are responsible for the administration, the day-to-day management ... and then bring the physicians in and do what is our job, and that is to provide primary health care to our patients," she said.

"It shouldn't be up to us to fund the cost of administering primary health care in Nova Scotia."

There are collaborative care practices in Nova Scotia where the province pays for all of the administrative costs, said Lynn Edwards, senior director of primary care for the Health Authority.

"We've been looking at all of those models, to determine what is the most sustainable way, so we'll continue those conversations," she said.