Quebec is promising that everyone in the province will have a family doctor by 2016, a promise which some believe will be difficult to keep.

On Monday, Health Minister Yves Bolduc said 75 per cent of Quebecers already have a regular doctor. He sees that proportion growing to 90 per cent in four years, the remainder being those who choose not to have a doctor.

Dr. Bolduc said the province will reap the benefits of admissions to medical school being increased from 400 to 825 students a year since 2003. Of these, half pick a career in family medicine, he told Canadian Press. In addition, older doctors are staying in the workforce. “Only one in five stops at age 65,” he said.

Furthermore, Dr. Bolduc sees access to care improving with more groupes de médecine de famille (GMFs) being formed. These are Quebec’s version of multidiscliplinary practices that are being implemented in all parts of the country. Quebec has accredited 245 GMFs on its way to ultimately having 300 in place. “I sign one of them a week,” he told CP.

However, the association representing general practitioners in Quebec (FMOQ) believes Dr. Bolduc is being too optimistic in his calculations and much more will have to be done. FMOQ President Louis Godin said that, by the health ministry’s own figures, the province was short 1,129 GPs in 2010 -- only a slight improvement from the year before. HE

Washington -- Fourteen states and the District of Columbia cut Medicaid physician pay for fiscal year 2011, down from 20 states in fiscal 2010. But continuing state budget deficits could lead to more new fee cuts than those already adopted for fiscal 2012, according to the Kaiser Family Foundation.

The foundation's 11th annual survey of state Medicaid programs concluded that continued Medicaid budget pressure on many states led them to expand cost-saving measures in 2011 and 2012. These moves included increasing enrollment in Medicaid managed care, reducing or ending optional benefits such as dental care, tightening prescription drug formularies, and enacting or hiking co-payments, according to the Kaiser report, released on Oct. 27.

However, reducing Medicaid fees to doctors and other health professionals was the most common cost-saving option enacted by states, according to the report. Twenty-two states adopted Medicaid physician fee cuts in fiscal 2011 or 2012, said Vernon K. Smith, PhD, report co-author and managing principal of Health Management Associates, a research and consulting firm.

In total, 39 states reduced Medicaid fees for physicians, hospitals or others caring for Medicaid enrollees in fiscal 2011. In fiscal 2012, 46 states adopted rate cuts, according to the report.

Not all states cut Medicaid physician pay. Six states actually increased Medicaid doctor fees in fiscal 2011. Alaska raised rates for fiscal 2012. Also in fiscal 2011, 33 states were able to expand Medicaid eligibility, and 22 states did so for 2012. These expansions were possible in part because of funding from the 2009 federal stimulus package and the health system reform law.

Read the full article at:
http://www.ama-assn.org/amednews/2011/11/07/gvl11107.htm

Thanks to Doug Trapp, amednews staff. Posted Nov. 7, 2011.

Doctors have ratified a new four-year agreement with the Manitoba government that will help recruit and retain more physicians in communities across the province and support the government’s plan to ensure all Manitobans have access to a family doctor by 2015, Premier Greg Selinger announced last Friday.

Funding for medical services is being increased by $125 million over four years and the contract includes a 10.6 per cent fee increase over the contract term, according to a joint news release from the government and Doctors Manitoba.

Among new fee tariffs are those for chronic disease management. This will “enable doctors to spend more time with patients who need it most,” the news release says.

There are also incentives to recruit and retain physicians in critical areas of practice including intensive-care specialists, pathologists, diagnostic specialists, as well as physicians working in remote locations.

The government’s Physician Retention Fund is being boosted by 66 per cent, and newly-recruited physicians will be required to participate in the Family Doctor Connection Program, a publicly-accessible registry of doctors accepting new patients.

The contract contains a commitment for the government and doctors to work together on provincial priorities such as implementing primary care networks and creating medical “homes” for patient-centred care.

The new contract was ratified by doctors on October 4 which was Election Day in the province. However, no further information on what is said to be a 1,000-page agreement is being provided. Attempts by the Winnipeg Free Press to obtain a copy were refused by the government and Doctors Manitoba. HE

The Victoria Times-Colonist (Aug. 18) says “The public needs proper answers to questions about the death of a baby during childbirth at Victoria General Hospital” last week. It has been suggested the death could have been prevented if an anesthesiologist had been available sooner for an emergency caesarean section.

Dr. Sue Ferreira, an anesthesiologist at the Vancouver Island Health Authority (VIHA) who is in the process of moving to Edmonton, has called for a coroner’s inquest to determine whether the delay in getting the woman into surgery was a contributing factor in the death. VIHA is conducting a review of the case, which is standard procedure, but the Times-Colonist says an “independent, public review is required,” noting that there have been unresolved concerns raised over the past number of months about anesthesiology services.

VIHA acknowledges the need for a dedicated anesthesiologist in its high-risk obstetrical unit but it has been encumbered by a stand-off between health authorities and the B.C. Anesthesiologists’ Society over the budget for such services. The Society has warned that patient safety is at risk if the money is not made available, but it has been cautioned by the B.C. Medical Association about raising public fears as a negotiating tactic.

The Ontario government has negotiated reduced fees for ophthalmology and screening endoscopy services with the Ontario Medical Association. There is also a new payment model for methadone that reduces unnecessary tests.

The lowered fees for ophthalmology will impact what specialists can charge for cataract removals. The Globe and Mail reported last month that both Ontario and British Columbia were after lower fees in this area given technological improvements which make the procedure more routine. Eight-of-20 Ontario doctors who had more than $2 million in billings in 2009-10 were ophthalmologists.

The fee changes in Ontario, added to those announced earlier this year, will result in $223 million in savings to be reinvested in front-line care. The OMA is in the last year of a four-year agreement with the government which expires at the end of next March.

More information at www.health.gov.on.ca/en/news/release/2011/aug/nr_20110812_1.aspx. HE

Medical residents in Quebec are poised to strike in the next few weeks if there is no resolution to their stalled contract talks. The union representing the 3,000 residents (FMRQ) says the government’s latest contract offer does not close the 25 per cent wage gap that exists between Quebec residents and their colleagues in other provinces. Since July, residents have suspended teaching activities of medical students. (Montreal Gazette, Aug. 27)

As of October 1, Ontario nurse practitioners will be able to offer more services. Since 1998, NPs in the province have been authorized to diagnose and treat common illnesses and injuries and order diagnostic tests for their patients. The new regulations expand their authority to carry out additional care acts and treatment procedures such as setting or casting bone fractures and open prescribing of medications. NPs will have the authority to prescribe medication as appropriate for client care and not be restricted to a specific list of drugs (except for controlled substances). More information at www.npao.org

An estimated two million Ontarians are now seeing a naturopathic doctor, a survey commissioned by the Canadian College of Naturopathic Medicine has found. The survey, conducted in August 2011, found that 72 per cent of Ontarians who are familiar with naturopathic medicine view the practice positively. Almost half of those treated by naturopathic doctors report that naturopathic medicine has helped reduce their use of prescription drugs. Furthermore, 4-in-10 report fewer visits to their family doctors and 3-in-10 say they have had fewer visits to hospital. Fully 41 per cent of respondents say they are likely to see a naturopathic doctor in the next few years, and over half of these are anticipating a visit within the next 12 months. News release at www.ccnm.edu/ontarians_say

Physicians are concerned about a new Ontario policy that may get them more involved in alternative medicine, the CBC reports. The College of Physicians and Surgeons of Ontario is drafting a policy which aims to prevent unsafe or ineffective alternative or complementary therapies being provided by physicians. But it also does not want to stop patients from getting so-called “non-allopathic” therapies that are safe and effective. The Canadian Medical Association, in a response to the draft, says it is concerned that that the policy “appears to require of physicians a high level of knowledge regarding [alternative medicine], and a high level of acceptance for its routine incorporation.” More information on the College’s consultation on the draft policy at www.cpso.on.ca/policies/consultations/default.aspx?id=4310. (cbc.ca)

British Columbia’s Northern Medical Program is under fire. The program provides funding to train medical students in northern communities in the hope they will set up practices there upon graduation. However, the CBC has reported that only five out of the first class of 24 graduates in 2008 started a practice in rural areas. The government has invested $100 million in the program since it was started in 2004 and NDP Health Critic Mike Farnsworth is wondering why students are not being asked to sign return-service contracts. (cbc.ca, Sept. 21)