The move away from fee-for-service care
CMAJ 2000;162:316
A recent CMAJ article asked if fee-for-service is on the way out in Ontario [full article].1 The answer is uncertain but probably should be Yes. The detailed arguments appear in the 50-page document that the article cited (www.cfpc.ca/ocfp), which is easy to download but more difficult to read.
A couple of points can be stressed. Income based on capitation provides financial security, and the move away from fee-for-service payments removes disincentives to collaborative care involving nonphysicians. As well, rostering of patients promotes continuity of care.
However, 2 statements in the CMAJ article disturbed me. One was that "patients register with a single family practice that has from 7 to 30 physicians." Presumably these larger practices mean that a doctor may be on call only once a month. Although this may seem a wonderful prospect for some overstressed physicians, it makes nonsense of the notion of true continuity of care outside the office setting.
The article also stated that "physicians would be expected to see large numbers of people for very short periods (6 to 10 per hour)." How is this different from the high-volume walk-in clinics that we so rightly criticize? True patient-centred care should be reflective and thoughtful, and it can be in the Canadian context. A key reason for developing a collaborative relationship with nurses and others with expanded roles is to free up more physician time for those patients who need our medical skills. Surely we can do better than 6 minutes per patient.
Brian Dixon-Warren
Family physician
Saturna Island, BC
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Reference
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Sibbald B. Is fee-for-service on the way out for Ontario FPs? CMAJ 1999;161(7):861.
© 2000 Canadian Medical Association or its licensors
