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No takers yet for $25,000 new-doctor signing bonus

New doctors concerned about expenses involved in running a practice
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A doctor's examining room. TIMES COLONIST

A new two-year contract from the province offering a $25,000 bonus has yet to attract any new family medicine residents — 175 of whom graduated from the University of B.C. last week — to sign on as a family doctor in B.C.

Dr. Ana Boskovic, representing the UBC medical residents, and Dr. Romina Moradi, representing international residents, said in a phone interview that doctors don’t want to sign the contracts only to end up abandoning their patients two years from now if they find out the system in B.C. isn’t sustainable, or the clinic, location or type of contract wasn’t a good fit.

“If we’re going to be taking these contracts to provide longitudinal care and attach a patient panel and then there’s no solutions put into place to make family medicine sustainable, what happens to these patients?” Moradi asked.

“They’re going to go right back on that waiting list, and that’s completely heartbreaking.”

There are approximately one million — or one in five — people in B.C. without a family doctor.

Health Minister Adrian Dix had hoped to scoop up 175 new grads by offering a two-year “new to practice” deal valued at $295,457, with a $25,000 signing bonus that expires on Sept. 30 and about $130,000 over five years in medical-training debt-forgiveness.

The new doctors are expected to take on about 1,250 patients over two years and to share in overhead costs for the clinic in which they work.

Boskovic said being given a three-month time limit is “very stressful.” Typically, a newly graduated medical resident might work as a locum — filling in for vacationing doctors or assisting in a variety of clinics and communities — to get a feel for where and how they want to practise long term and what type of payment scheme best suits them.

In a June 20 letter to the Health Ministry and Doctors of B.C. signed by 168 residents, Boskovic and Moradi expressed concern that the offer does not address overhead expenses — including rent, staff, utilities, supplies, licensing fees, malpractice insurance, software for charting and locum doctors to cover vacations — which can total $80,000 to $100,000 annually.

The residents asked for a meeting with the Health Ministry by June 30, but it has not yet occurred.

Asked if any contracts have been signed, the Health Ministry said Monday that residents and new physicians have reached out for more information over the last two weeks, and “we are in the process of gathering those questions and providing those clarifications.”

The majority of physicians in B.C. work under a fee-for-service model in which they are compensated per patient visit, about $32 as a base fee.

A growing number of mostly new physicians want to work on contracts and salary, which can include overhead costs. Almost all doctors want team-based care where physicians and allied health-care professionals work together.

Boskovic and Moradi say the new-to-practice contract was the only option offered to them. Typically, they would start on fee-for-service after graduation. “We have not had anything else presented to us that includes infrastructure supports or adjustments to the fee-for-service supports,” said Boskovic.

The medical residents say they still have a lot of questions, including queries about contracts in family medicine practices.

Most family resident graduates haven’t trained with a physician who has been on a contract, said Moradi, who trained in medical school in Poland. “So to have a contract presented as the sole solution presented to us took us off guard.”

About one third of the 175 family medicine residents studied internationally and are already committed to what’s called a “return of service” agreement, where, in exchange for every year the ministry funds their training, they must give back to family-medicine practice in an under-served area.

“International residents have already signed on to provide longitudinal care in communities across B.C,” said Moradi, guaranteeing one third of the graduates will work in B.C.

International family practice residents weren’t included in the signing-bonus contract in the original offer made June 15, but the province has since offered them the same agreement.

As for what’s needed to attract new family practice doctors to work in B.C, the graduates called it “the million-dollar question.”

“I would say we’re definitely feeling the weight of the need,” said Boskovic.

The residents have seen the lifelong relationships that family doctors can have with patients, which is why many have chosen the field, she said.

Boskovic, who grew up in the Lower Mainland and did her undergrad, medical school and residency at UBC, said she has seen the struggles of the family doctors who have been in practice three decades “and are struggling to keep those practices afloat.”

“So I think there needs to be options for new graduates.”

ceharnett@timescolonist.com