Overview

Remuneration

Remuneration for family physicians being paid through the publicly funded health system has been traditionally provided through fee-for-service (FFS). Remuneration is negotiated between provincial / territorial (PT) governments and their respective PT medical associations. Nevertheless, family physicians as members of The College of Family Physicians of Canada, members of the PT medical association sections of general practitioners / family physicians or members of special PT interest groups in family practice, have an increasingly strong voice in advocating for remuneration levels that represent the value Canadians attribute to the healthcare provided by family physicians.

How family physicians are paid is a key enabler in establishing new or revised models of primary care. Governments and health authorities should realize this if they are to be successful in primary care renewal.

Newer models of primary care are leading to newer ways to remunerate family physicians, driven by the many changes that are occurring at this level of care. For example, as preventative care takes on increasing importance in primary care, jurisdictions have become increasingly interested in ensuring that appropriate screening methods are being applied to practice populations. In some jurisdictions, this has translated into financial incentives or bonuses to support the provision of preventative health services to patients, beyond or even as a replacement to FFS remuneration. Methods of remuneration in changing primary care models should support family physicians providing comprehensive services in several areas of family practice, including home care, obstetrics, in-patient hospital care and long-term care.

At least two other drivers have affected remuneration for family physicians in primary care in more recent years. The first has been the need to compensate family physicians much better for the health services they provide, recognizing their unique value and importance, not just in primary care but also in the whole health system. Without this recognition, this country will continue to suffer from the chronic shortage of family physicians it is currently experiencing. The second driver has been the increasing need to align remuneration with the appropriate work balance of family physicians. For example, it is increasingly recognized that a significant contribution to professional satisfaction for family physicians comes from being paid to provide comprehensive care not encumbered by the requirement to see large volumes of patients to generate appropriate incomes, but rather associated with such preferences as spending more time with patients, better managing the complexities of care for different practice populations and meeting the appropriate needs of patients with chronic lifelong diseases.

The intent of this section on remuneration is not be to be prescriptive but to identify the various ways that family physicians can be remunerated to meet their patients' healthcare needs and to address their own professional and financial satisfaction. As such, no one method of remuneration or financial model of primary care is best but each requires an evaluation of the intimate details, to ensure that family physicians are being suitably remunerated for the value they bring to their patients in primary care. In fact, no payment method in primary care has been linked to better patient outcomes than any other. This kind of support may indeed require a level of expertise that is well beyond the information found in this toolkit. Family physicians and their leaders are therefore advised in most circumstances to seek both financial and legal advice before agreeing to new and revised methods of remuneration.