Primary Care Toolkit for Family Physicians
The College of Family Physicians of Canada
A variety of remuneration models have been used to facilitate the transition of family physicians to new models of primary care, many building on the traditional fee-for-service method. There is an increasing need to learn from and to understand what is being negotiated within each province and territory. The benefits of knowledge translation in remuneration methods is significant and strengthens the ability of family physicians to advocate and negotiate more intelligently for appropriate remuneration within their jurisdictions.
When used in any combination, these remuneration methods may be referred to as "blended" funding. (See Appendix for Blended Funding Mechanism.) From the National Physician Survey 2004 (NPS 2004), it would appear that alternative methods of remuneration are receiving increasing acceptance by family physicians and in fact, a blended funding formula is currently the preferred method for remuneration in primary care. The benefits of blended funding relate to:
- The ability to maintain a degree of independence in professional practice
- Increasing opportunities to diversify in practice, especially helpful for teachers, researchers or administrators, thus improving professional satisfaction in spite of heavy workloads
- Opportunities to achieve more predictable income while still being able to realize more income if workload increases
- Less pressure to make up for lost income during holidays or CME/CPD as a result of some degree of income stability from non-FFS steady payments
- Opportunities to realize additional employment benefits that may come from other methods of payment, e.g. CME/CPD, staff or other overhead financial support
The need for more stability in income is especially important to attract and maintain family physicians in practice, considering the fluctuations that can occur with fee-for- service remuneration models, particularly during such times as vacation, continuing professional development or illness. Likewise, during such times, the cost of maintaining the business of family practice continues, e.g. overhead expenses associated with leasing, staffing, office supplies, etc., in spite of income fluctuations. Further stability in income levels is therefore welcomed by many family physicians as they seek to balance their income with changes in their own professional and personal lives.