In my last post, I talked about how the Government’s decision to restrict entry into capitated models of care and into Family Health Teams was an unreasonable targeting of young family physicians and their patients. Today I want to explore how two more unilateral decisions by the Government will have a negative impact in new Family doctors and will prevent them from entering team based care.
The Government has removed all rostering fees, except for patients who have complex medical needs and has ended a program called Income Stabilzation or IS except in ‘high needs areas’.
Why were rostering fees introduced?
They were introduced 10 years ago at a time when well over a million people in Ontario did not have a family doctor. Rostering fees were introduced to encourage family doctors to accept more new patients and to encourage new graduates to enter Patient Enrollment Models or PEMs.
At the time few new grads were making a commitment to have a traditional family practice. The fees were very succesful and now most new grads set up comprehensive family pratcices within 3 years of finishing their post graduate training.
The fees help with finding the capital necessary to set up an office. Equipment, leasehold improvements and other up front costs are very expensive for new physicians who on average have over $100 thousand dollars in student debt and young families.
And by the way, because of a growing population with more complex needs, we still have 900 thousand unattached patients in Ontario. So the need has not gone away.
Income stabilization is meant to help transition new physicians into capitated practice.
When physicians enter fee for service, they can generate an income right away. Every new patient they see, every patient they see for a colleauge generates a fee. But in capitation, there is no fee. The patient enters the practice and the physician starts to recieve an average daily fee of under 50 cents per day. Once a physician has 1000 or so patients on her roster, that’s fine but in the initial months of practice, while the numbers slowly creep up, the physician does not generate enough income to even cover the cost of practice.
Income stabilization is a monthly payment made to new physicians in capitated practice so that they have an income while their practices grow. There is an accountability built in to ensure that the new physician just doesn’t sit around, collecting the fee without working. There is a monthy roster target that needs to be met in order for the IS payments to continue.
Without Income Stabilization and without new patient rostering fees, it will be very difficult for new Family Medicine grads to enter non-fee for service practice. But as we saw yesterday, the Government is OK with that. They are limiting the number and lcoation of new grads who can enter capitation anyway.
This triple shot at new grads, limiting entry into capiation and Family Health Teams, eliminating rosterng fees and ending Income Stabilization is a clear indication that the government wants to go back to the bad old days of fee for service-a model they pretend to dislike.
Scott Douglas Wooder, MD
Next I’ll talk about the missed oppurtunity to reform the system