Informing family physician payment reform: a cross-provincial, multi-method study

Most provinces are struggling to improve access to family physicians. British Columbia, Nova Scotia, and Manitoba are implementing novel family physician payment models with the intention of enhancing the allure of family practice as a career option and reducing administrative burden, ultimately addressing long standing accessibility challenges. The models include a base hourly rate, fees per patient visit, and an annual per-patient payment. They constitute substantial changes to the level, structure and composition of remuneration for family physicians in these provinces. While they may foster the recruitment and retention of family physicians into community settings, and add support for care coordination, they may also have other unanticipated impacts on service delivery including changes to service volume and attachment of new patients that require careful study. Our multi-method, multi-province study will determine the extent to which changes to physician payment policies resulted in improvements in primary care access, and patient and clinician experiences. We will use a combination of routinely collected, population level data that capture family medicine residency uptake, interprovincial movement of family physicians, changes in service volumes, systems-level costs, and rates of patient attachment and continuity of care. We will conduct interviews with policy makers involved in the development and implementation of physician payment policies; physicians who are paid under the new models; and with patients who care experiences may have changed when their physician moved to a new payment model. This project will provide critical new data on the impact of family physician payment models on access to care, and on patient and physician experiences of care and care delivery. This is particularly important as all provinces continue to struggle with primary care accessibility and may be considering similar shifts in payment models within their own jurisdictions.