Inform/Reform 

 In response to widespread concerns about primary care access and the need to support community-based longitudinal family practice, Canadian provinces have introduced reforms to primary care physician payment. Agreements announced in British Columbia, Nova Scotia and Manitoba introduced new models that share the structure of a base hourly rate, fees per patient visit, and an annual per-patient payment. The new payment models, although characterized by varying stated objectives, collectively strive to enhance the allure of longitudinal community-based family practice as a career option and may address longstanding disparities in pay between family physicians and other specialty-trained physicians. By fostering the recruitment and retention of family physicians into community settings, these models have the potential to enhance care access. At the same time, the models do not explicitly address other longstanding, structural issues in primary care, and may have unanticipated impacts on service delivery including changes to service volume, attachment of new patients, and health system costs that require careful study.

Objectives

This multi-method, multi-province study will determine the extent to which changes to physician remuneration policies resulted in improvements in primary care access and clinician experiences. Our objectives are to assess specific impacts on

1. Clinician experiences of care provision and practice choices

2. Recruitment to and retention in primary care

3. Patient attachment/enrolment, continuity of care, service volume and costs.

Team Members

Nominated Principal Investigator:  Lindsay Hedden

Co-Investigators & Collaborators:  Alan Katz, Ruth Lavergne, Ted McDonald, David Rudoler, Nichole Austin, Gayle Halas, Maria Mathews, Rita McCracken, Kim McGrail, Hugh Shiplett, Erin Strumpf, Steve Slade, Renee Fernandez, Luisa Montoya, Paula Keating, Cathie Carroll, Katie Malam.