I had a patient recently go to the Emergency Department (ED) for a pregnancy test! It was a very expensive pregnancy test…not for her, but for our health care system. The cost of this test came out of my pocket and yours. I reflected about how and why our patients use the ED and the unfortunate state of our health care system.
The ED has replaced general primary health care for some. It’s a costly shift. Amidst the array of reasons for this is because the general public does not have access to the primary health care providers they desperately need and want. One of the root causes is the fee-for-service remuneration of family physicians. The BC Auditor General has finally revealed the reality of this backwards system and concluded what we already know - it’s not value for service.
Every day I hear complaints from patients who go to walk-in clinics for their regular care. They have no other choice. They express frustration at not being listened to, being rushed and not getting the services they need. I see these patients going from clinic to clinic trying to find someone who will listen to them for more than five minutes. This leads to duplication of services with every visit and repeated lab work, imaging and consultations - a cost to our health care system but money in the pockets of these physicians. Where’s the motivation to change?
Patients are consistently surprised to learn that walk-in clinics are actually businesses. I explain to them that these physicians are forced to prioritize business (aka making money) over quality health care. It’s why the patient is rushed in and out. More patients = more money. The fee-for-service model does not motivate physicians to take the time to listen and educate and provide high quality care. These aren’t bad doctors, they are trying their best within an inadequate system. The general public doesn’t realize that in order for the doctor to spend the time to provide the quality care that patients need and deserve, the physician personally loses money. Patients aren’t informed of the personal costs to an individual physician that are associated with running a clinic. The care is “free” for the patient so they accept mediocre service and continue to visit the ED because their needs aren’t met. This is the reality of supporting a fee-for-service primary health care system.
We build bigger and fancier EDs and put in “fast track” areas to manage patients who are more appropriate candidates for primary care. We pay big bucks for care for these patients…dollars that could be allocated to more appropriate services. Ever wonder why nurses are no longer present in physician’s offices? It’s because the fee-for-service model does not support the more appropriate interdisciplinary care. There is no direct funding for registered nurses to see patients in primary care offices. Every patient the nurse sees would be money out of the physician’s pocket. It forces health care to be physician-centric not patient-centred.
It is with hope that I read the Auditor General’s report. Will the public and government finally realize the ridiculousness of the current model? It’s high time the public finds out what “fee-for-service” actually means and how it affects the care they get. It’s also time we stopped forcing our physicians to be business people and allow them to get back to providing good quality care within a coordinated and comprehensive multi-disciplinary health service system.
It just makes good sense!
Click here to view the BC Auditor General’s Report Oversight of Physician Services
ABOUT HANNAH VARTO, MN, NP(F)
Hannah Varto is a family nurse practitioner and an ARNBC Network Lead. She enjoys working as a part of interdisciplinary teams of health care providers. Her career focus has been primarily in the field of sexual and reproductive health, specific to women and adolescent populations. She has worked in a variety of settings including public health, youth clinics, walk-in clinics, telehealth, education, travel medicine, communicable disease and as a sexual assault nurse examiner. Hannah is on the board of directors for the McCreary Centre Society, a leading non-profit organization focusing on adolescent health research. Currently Hannah is leading the implementation of ARNBC's first community of practice - the BC Contraceptive Management Community of Practice.