Nova Scotia appears to be taking
a step away from the practice of paying specialists
a straight salary in a new contract being negotiated
with Doctors Nova Scotia.
The most recent one-year deal between
the province and the roughly 140 doctors who comprise
Dalhousie University's department of medicine, including
16 specialist groups practising in the Capital district
health authority, expired on March 31.
But an agreement is taking shape
that will see doctors return to billing for individual
medical services and receiving a stipend for teaching,
research and administrative work.
A source said the pact, which would
cover three years with two three-year extension options,
will help Nova Scotia recruit physicians and allow practising
doctors more options in how they provide care.
"I think this is good for patients;
I think it's good for primary care; I think it's more
accountable and I think it gives [doctors] a lot more
flexibility," said the source, speaking on condition
of anonymity.
"All of those worries that the
family docs had about people sitting around with their
feet on the desk because they're on salary... they can
now rest assured." That perception helped drive the
change, the source said.
The most recent contract paid an
average $243,665 per full-time doctor, an increase of
2.9% over the previous agreement. The amount was meant
to compensate for all of a doctor's clinical, research,
teaching and administrative work. The actual amount
paid to individual doctors was determined within a specialist
group.
Before the introduction of so-called
alternative funding plans in the late 1990s, academic
doctors billed for medical services and were not paid
for most other work.
Modest increases in the billing
schedule and academic stipend should put this province's
specialists around the middle of the pack of teaching-physician
groups in Canada.
"It's not going to put us up with
Edmonton or Calgary, but that's not really realistic
for a province like this anyway," the source said.
COMMUNITY
BOON
The new blended approach should be a boon to specialists
who want to work outside hospitals, the source said.
Typically those doctors handle a high volume of referrals
from family doctors while those in hospitals handle
consultations on admitted patients and more acute cases.
"The old contract virtually destroyed
community-based specialities on the peninsula," the
source said. "Why would you be community based with
an overhead that could be a third of your income when
you could be hospital based with no overhead?"
Health Department spokeswoman Sherri
Aikenhead said she expects a final agreement by the
end of April. "I can say we'd be looking at more of
a blended model of payment."
About 600 of the province's roughly
2,000 physicians are on some form of alternate funding
plan.
Republished with permission from
The Halifax Herald Limited
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