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Last Word on LFP Payment Model

The Longitudinal Family Physician (LFP) payment model officially launched in Feb/2023. Most people, including many family doctors, seem content to move on. Given this is not my fight, I doubt I'll have much more to say on it.

For a more detailed look, see my previous analysis, whose conclusions still hold true.

As a short-term or interim solution for doctors, it's not unreasonable. But that's not how it was sold. Not only by the government, but also by groups including Doctors of BC and BC Family Doctors, who helped negotiate it. This is far from the whole solution for primary care, except if you're Dix or Eby. Definitely not for patients.

By going along with the government's comms plan, the docs shot themselves in the foot. I fear my real last words will be "I told you so."

In what follows, I'll outline what was actually delivered, the gap between perception and reality, and the cost for the future.

Minimum Viable Practice

The LFP model is the minimum necessary for those practicing high-quality community-based longitudinal family medicine to continue operating. After years of gross neglect by government, it is now possible for those practicing this way to do so.

It was not viable to continue before. So this is a big accomplishment. But let's not overstate it either. If it was any weaker, it would not be sufficient. For many, it still isn't. I don't think it's out of line to refer to this as a Minimum Viable Practice (MVP) payment model for longitudinal family physicians.

Among the flaws noted in my full analysis: base hourly rate below that of a paralegal, still provides more incentives to push people through quickly rather than spend time with complex patients, targeted to a very specific practice model, not relevant or sufficient for many family doctors, many important details and administrative requirements still to be determined, and it doesn't begin to touch on infrastructure costs.

In reality, this was an okay deal for some doctors who had been grossly neglected and abused for years. It's not clear how it will make life better for patients, though it probably kept it from making life worse.

Perception

The LFP model has been sold by government and doctors' organizations, with help from a large cross-section of the media (very unfortunately further diminished recently), as "monumental" or "seismic." People are talking about it being enough to "solve" the primary care crisis. As I noted previously:

Doctors got a 55% raise! They'll make at least $385k/yr! They're now the best paid in Canada, properly rewarded for all their valuable work, and the deal will attract doctors to community practice in droves!

The perception was — by design — astounding. The reality is very different.

The messaging preys on the public's overall unfamiliarity with physician compensation. Specifically, it leaves the following perception:

the government gave doctors everything they asked for (so not minimum viable, but everything)
they received a 50%+ wage increase, beyond the realm of any collective agreement (achieved in one example scenario, but this was not an increase but exchanging one model for another)
they are now paid what most people would consider an unfathomably large annual salary (there is little public talk of overhead or gross vs. net)
they are equally well compensated for their admin time as clinical time (admin time bills at below gross paralegal billing rates, and directly compensating admin time is only one way to support it)
this will attract enough doctors for everyone (and remember, they have everything they need)

Something like 1000 docs signed on at first — that's great! But just like always, it's one cherry-picked statistic. We're not going to actually measure what effect that has on patients.

Future Costs

What happens in two years, when most people still don't have a family doctor, wait lists are horrendous, and the crisis is just as bad as today?

Who will get the blame? The doctors who got everything they asked for and are making outrageous salaries? Or the government who bent over backwards to give them what they asked for?

The doctors screwed up on this one. It may well be that the LFP model that was negotiated was the best deal that was possible right now. That's fine.

But to go along with the propaganda circus and promoting it as the best thing that ever could have happened is incredibly short-sighted.

They could have grudgingly accepted it, saying their members were willing to make sacrifices in order to begin the process of saving primary care in BC.

Instead, they gave up all future leverage. It was an incredibly poor strategic move. They set themselves up as the scapegoats, and turned the government from villain to saviour. They're left in no position to do anything but kowtow to governments, whether its the necessary improvements to the LFP model, the continued expansion of UPCCs, or power grabs like the Health Professions Act.

The government got what it wanted. The docs sacrificed any future improvement for a minimum viable practice model. Patients got screwed.

We squandered the best chance we had to fix primary care, and traded it for more of the same.

The crisis continues.

Remember, I told you so.