An incentive introduced last year
to encourage doctors in New Brunswick to accept orphan
patients is having the reverse effect in some cases.
The incentive provides $150 to
family physicians for each new patient they take on.
It was intended to improve access to family doctors
in the province but it also appears to be making it
more difficult to find doctors to take over practices
from retiring physicians. That's because the incentive
doesn't apply in these cases. So although a replacement
doctor could conceivably be taking on as many 3,000
patients in one shot, they wouldn't receive the financial
bonuses that a doctor taking on patients in a piecemeal
The lesson seems to be that one
doctor's carrot may be another's stick.
This problem was highlighted last month when one retiring
New Brunswick family physician tried but failed to find
someone to take over his longstanding practice.
Dr Eric Christiansen, 63, of Rothesay,
last month hung up his stethoscope. Despite his efforts,
the popular MD couldn't find a doctor to take over his
practice, leaving the vast majority of his 2,500 patients
without a family physician, in a province in the throes
of a physician shortage crisis, according to the Telegraph-Journal.
The New Brunswick Medical Society (NBMS) and the provincial
government, who jointly agreed to the incentive last
year, admit the incentive wouldn't apply if a doctor
had stepped in and taken over Dr Christiansen's practice
wholesale. But both dispute the incentive's role in
retiring physicians' difficulty finding replacements.
The notion that an incentive intended to improve access
might negatively impact physician supply and recruitment
"The $150 was intended to get doctors
who were near full practices to take on new patients,"
says NBMS assistant executive directorJanet Maston.
"There are other incentives for recruitment. This wasn't
a recruitment incentive."
"We are targeting our orphan patients.
If a physician is taking over a practice then those
patients are not orphaned," adds Linda Lingley, the
Department of Health's Director of Medicare.
Asked whether patients' access
to primary care might be better served by giving incentives
to doctors to take over established practices instead
of paying doctors to enroll patients only after they
become orphaned, Ms Lingley is dismissive. "Government
does not get involved in the business aspect of fee-for-service
physicians," she says, emphasizing the distinction between
the access issue and the physician-supply question.
"The ability to assign patients from the list that the
regional health authorities manage has been an efficient
way to ensure those who have identified themselves as
orphans get a physician as soon as possible."
But Ms Lingley's laissez-faire
approach to managing the impact of the $150 incentive
points to a common misunderstanding of medical economics,
says Atlantic Institute for Market Studies analyst Brian
S Ferguson, PhD. Doctors' decision-making is affected
by financial incentives to a greater extent than many
think, according to a 2002 AIMS report. Dr Ferguson
looked at a number of Canadian and international examples
and concluded that physicians respond to market forces,
including cash bonuses, the same as any other professionals.
But that's a view not universally
shared in government circles. "Much confusion and bad
policy follows from the inability of many policy analysts
to handle the techniques of an elementary economics
course," wrote Dr Ferguson in a scathing commentary
that now appears prescient.