Carllin Man MD CCFP

Family Doctor in New Westminster. We need time modifiers to modernize our fee for service billing system. Feel free to DM! #everyonedeservesafamilydoctor

[Carllin Man MD CCFP @CMan_CCFP]

@DrDMPetersMD Totally agree. I had a thyroid imaging report delayed for many months because the radiologist in Vancouver couldn't see what was done in Langley.

Yikes, it's like it's 1990 (which would be 30 years behind).

[Carllin Man MD CCFP @CMan_CCFP]

@dockevinmcleod One thing I would like to know is how many return of service family medicine graduates there are in BC a year.

How many of those signing this new contract are return to service grads that would be required to start a practice regardless?

[Carllin Man MD CCFP @CMan_CCFP]

@richardzussman How many of these are "return of service" family doctors that are required to do family practice for 3 years as part of their contract when they trained in BC?

[Carllin Man MD CCFP @CMan_CCFP]

@ColJacksMed @TuraEmanuela @DrRitaMc @cbcnewsbc @DrJLush @DrDMPetersMD @markroseman I agree with you, we don't need to fight eat other. It's our health system that takes advantage of all of us (doctors, nurses, etc) to do the hard work, that often is done for free. We must unite and speak together.

@DoctorsOfBC must work to unite all docs!

[Carllin Man MD CCFP @CMan_CCFP]

@ColJacksMed @TuraEmanuela @DrRitaMc @cbcnewsbc @DrJLush @DrDMPetersMD @markroseman Just had a late night radical idea. If we fund primary care properly, the cost savings to the health system would likely be measured in the tens of millions, money that would be put back into the system to improve it for all. Wait, wait that's too radical.

[Carllin Man MD CCFP @CMan_CCFP]

@DrRitaMc @cbcnewsbc Sorry, this doesn't make sense. Many services are "fee for service"; lawyers, accountants, hair stylists...

When you pay people per service, naturally they will work harder.

Problem for BC family doctors is the fee is fixed at a low rate by the gov't, thus causing burn out.

[Carllin Man MD CCFP @CMan_CCFP]

@bradybouchard @markroseman How do ARP or capitation models change if a doc runs the business? My understanding is none of those models includes a non physician organization running the clinic. In the end, it's still physician run! At least that's the view from BC. Govt run clinics have been a failure here.

[Kevin Mcleod @dockevinmcleod]

Terrible timing when government and family physicians had worked out some positive solutions. Got to love complex computer systems when things go wrong…

[Mark Roseman @markroseman]

How many lives is excess administration costing us?
→ https://t.co/wnCe6Xbemp

Excess ministry and health authority admin spending in BC (vs. AB) costs $851m per year, which could provide $250k per year more for each full-service family doc.

#bchealth #bcpoli

[Paul Winston MD - Restoring Movement is the goal. @drpaulwinston]

@SusanFDe @DrDMPetersMD @markroseman @BShane555 @DrJLush @JillianRatti @ChakDe8 @DrRitaMc @BCFamilyDoctors @CMan_CCFP @Docs4BC The doctors I know that worked at the UPCCs all quit. It’s not a team, admin just books, does not help with care, flow, nurses not used efficiently. Ridiculously inefficient and low volume.

[Carllin Man MD CCFP @CMan_CCFP]

@MdApplewhaite @drpaulwinston @drawolak Hit it on the nail right there. The other day I felt so terrible for thinking I have to rush telling a patient they have cancer, because we have already spent 30 minutes, and I needed to start seeing the other patients booked in. Got paid $25 for that. Sighs.

[Carllin Man MD CCFP @CMan_CCFP]

@DocMcConks @drawolak @TuraEmanuela Wow that is just redicilous. No other industry would work with such unpredictable invoice payment. What can we do together to get change?

[Carllin Man MD CCFP @CMan_CCFP]

@JillianRatti @DrDMPetersMD @DrRitaMc @BCFamilyDoctors @DrJLush @Docs4BC Yes! Many issues in BC resulting in low numbers of CCFPs practicing family medicine.

How we are paid is a big part and right now it makes no financial sense to start a family practice. Without family docs, there is no primary care, despite how hard the Gov't tries to replace us.

[Carllin Man MD CCFP @CMan_CCFP]

@DrDMPetersMD @TuraEmanuela @DrRitaMc @GarethEeson "The fee-for-service time-modifier code [...] resulted in reduced ED visits and hospitalizations. It is likely that discontinuing the code would result in increased ED and hospital utilization, costing much more than removing the code would save."

https://t.co/aAEy4UtUg1

[Carllin Man MD CCFP @CMan_CCFP]

@DrRitaMc For me, the moral of the story is that there is no one perfect funding model.

We need to strengthen the current funding model we have now, while we work together to develop other models that will encourage more family doctors to start practices. That is the end goal!

[Carllin Man MD CCFP @CMan_CCFP]

@DrRitaMc There may not be a study to back this up, and there probably will never be, but my real life experience and seeing how family doctors work different in Alberta shows me that time modifiers do affect how doctors work and how patients access care with their family doctor.

[Carllin Man MD CCFP @CMan_CCFP]

@DrRitaMc To that point, came across this study from ON:

"Compared with patients in enhanced fee-for-service practices, those in capitation practices had less after-hours care and more visits to emergency departments."

https://t.co/slRyiyjqww

[Carllin Man MD CCFP @CMan_CCFP]

@DrRitaMc Since majority of family doctors work in fee for service, adding in time modifiers now would help to retain the many family doctors that are already spending time with their patients, but not being fairly compensated for it.