JULY 30, 2007


NB incentive has unintended consequences

For retiring docs, $150 new-patient bonus makes finding a replacement difficult

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 fashion would.

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 obviously rankles.

"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.



back to top of page




© Parkhurst Publishing Privacy Statement
Legal Terms of Use
Site created by Spin Design T.