Three of the biggest players in P.E.I.’s health-care system have reached an agreement that sets more flexible models for how many patients family doctors can and should handle.
Earlier this year, the Medical Society of Prince Edward Island entered mediation with the province’s Department of Health and Wellness and Health P.E.I. over new operational guidelines for family doctors’ workloads.
The three parties have now agreed on an accountability framework for longitudinal family medicine on P.E.I., according to a joint news release from the three parties Thursday morning.
“The agreed upon framework establishes clear and achievable accountability measures of productivity to support equitable workloads and to ensure transparency and consistency in how care is delivered,” the release said.
The framework offers four practice models with various panel size expectations for family doctors, “providing flexibility to ensure models fit physicians, the health system and patient needs,” the release said.
“There are also new quality indicators focused on key areas that align with Health P.E.I.’s strategic goals. These combined indicators will provide valuable insights at both the system and individual levels, supporting continuous improvement in patient care and care delivery.”
This marks a shift from earlier concerns raised by the medical society, which worried that rigid workload targets could drive family doctors away from the Island.
Last year, the three parties celebrated the signing of a new Physician Services Agreement — the province’s contract with doctors — which took effect April 1.
But tensions surfaced earlier this year when physicians represented by the medical society voiced concerns over Health P.E.I.’s new operational guide.
That document included key performance indicators, or KPIs, that set out a requirement that each family doctor see 24 patients a day, based on an average appointment being 15 minutes long.
The Medical Society of P.E.I., Health P.E.I. and the provincial government have agreed to go into mediation to resolve issues with how the latest Physician Services Agreement is being implemented. Halifax-based lawyer Bruce Outhouse has been named as the mediator, and all sides have agreed to meet with him no later than Sept. 30. CBC’s Stacey Janzer reports.
Health P.E.I. also wanted a full-time family physician to have 1,600 people on their patient roster, although CEO Melanie Fraser later insisted that was a maximum number, not a minimum as the society understood the phrasing.
Supported by the College of Family Physicians of Canada, the medical society even threatened legal action. The society had warned that the targets could push family doctors off the Island.
“This agreement reflects the shared commitment of the Department of Health and Wellness, Health P.E.I. and the Medical Society of Prince Edward Island to recruit and retain family physicians and work toward the goal of connecting every Islander to primary care,” the release said.
“This memorandum of understanding helps P.E.I. move forward in ensuring the Physician Services Agreement offers one of the most competitive physician compensation packages in Canada, along with new flexible practice options and clear accountability measures.”
‘Real stability’
Under the agreement, Health P.E.I. said doctors now have a choice between different patient roster models. Model A will include 1,600 patients, whole model B will have 1,300.
Model B will ensure patients with more complex needs are able to get the care they need, and model A would be for doctors able to see more patients in shorter time periods.
Krista Cassell, president of the P.E.I. Medical Society, said she is relieved to have an agreement in place.
“It’s been [a] protracted, very public time of unrest and instability,” she said. “That’s been very worrisome to my colleagues and their patients.”
Cassell said one of the main concerns among family physicians was not having control over some aspects of their practice.
“This process has allowed them to have a say in what a reasonable amount of work for a family physician on P.E.I. is right now,” she said.
“This agreement provides some real stability, some real certainty about expectations, a framework that’s fair and clear and transparent so that docs know how they’ll be expected to work and what they’re responsible for.”
Melanie Fraser, CEO of Health P.E.I., said the new models allow doctors who exceed the targets to qualify for bonuses.
“There are incentives for those who exceed the requirements of the model that they choose, and those incentives exist for both those who choose model A and model B,” Fraser said.
Doctors will also be evaluated for productivity and the quality of care they provide, Fraser said, and Health P.E.I. will collect more data to track what’s happening.
Dr. David Antle, a family physician in Summerside, has spoken out against the previous workload targets in the past.
Thursday, he told CBC News that this new agreement is better.
“I’m grateful to everybody involved because I do think this is a far better-off deal and situation than was being pushed on us in the summer,” he said.
“I think this gives people much more options, much more flexibility. There’s no surprises in terms of how it’s going to impact the physician’s career.”
While he said Thursday’s announcement is an important step forward, Antle said there are still concerns about whether doctors will have their voices heard.
“There’s still that unanswered question of how we’re going to be engaged as a group moving forward and how we kind of get back to a place where there’s more interaction and collaboration overall,” he said.
“I don’t think we’ve completely solved that.”
Doctors have until January to decide on patient load
Family doctors in the province will have until the end of January to decide on the number of patients they want.
Although some doctors may want to see fewer patients, that’s expected to happen gradually. Neither Health P.E.I. nor the medical society expect physicians to drop patients from their roster.
Health P.E.I. said more Islanders will be assigned to patient medical homes soon.
Cassell said many medical students from Dalhousie University who were on placements in P.E.I. last year didn’t end up staying, and that was a huge loss. She hopes this new agreement will help keep more of them here in the future.
About 37,000 people in P.E.I. are currently on the province’s patient registry waiting to be assigned to a primary-care provider.
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