Only some physicians pay fees years after policy implemented; health department points to previous government
A provincial government directive to health authorities to start charging rent to doctors is still not being followed consistently across the province three years after it was issued — and according to a small town mayor, that’s making it difficult to recruit and retain doctors in rural areas.
The four regional health authorities — Eastern, Western, Central and Labrador-Grenfell — were directed to charge fee-for-services physicians who use space inside health authority facilities $2,400 a month, according to a Western Health memo obtained by CBC News.
But emailed statements from health authority spokespeople show a patchwork of systems across the regions, with some adhering precisely and others straying from the directive.
Central Health charges all physicians $2,400 a month for overhead operating costs, while Labrador-Grenfell Health charges doctors a flat fee but would not say what the rate was.
We’ve had a very difficult time over the years to attract physicians here on any long-term basis.
– Fogo Island Mayor Wayne Collins
Western Health charges doctors “rent which is based on market value of the space they are using,” according to a spokesperson.
Eastern Health, the province’s largest health authority, said in an email “some fee-for-service physicians with Eastern Health pay an overhead fee for some of the costs related to running their offices,” but no doctors “are paying rent for the physical space itself at this time.”
Another email from an Eastern Health spokesperson said the policy had not been fully implemented and the health authority was reviewing it.
Fogo petition
In December, hundreds of people on Fogo Island signed a petition asking Central Health not to implement overhead fees for the two doctors practicing on the island of 2,300 people.
Central Health didn’t adopt the fees immediately in 2016, a spokesperson said, recognizing the need to remain competitive in “hard-to-recruit areas.”
Fogo Island Mayor Wayne Collins understands just how difficult it is to attract physicians to his tiny community. He and others feared doctors would leave when the fees were phased in last year.
“We’ve had a very difficult time over the years to attract physicians here on any long term basis,” he said.
“Those fees should be waived.”
Not in the contract
The Newfoundland and Labrador Medical Association (NLMA) came out against overhead fees when they were introduced in 2016. President Tracey Bridger says the group’s position hasn’t changed.
“We felt that it was not what the physicians had agreed to in their contracts,” she said.
“The right way to do it is with negotiation and not just making a unilateral decision and saying ‘take it or leave it’ because some people might leave.”
CBC News made several requests over a seven-day period for an interview with Health Minister John Haggie, but department staff he said he was not available.
In an emailed statement, the health department said “the previous government provided direction to charge overhead fees” before the Liberals came to power in 2015.
How can we get doctors to particular areas? What can we do to make their lives good so that they’ll stay?
– Tracey Bridger, NLMA
However, documents obtained by CBC News suggest 2016, the first year the Liberals tabled a budget, was also the first year such fees were collected.
A Central Health memo from Dr. Jeff Cole, vice president of medical services, addressed to Central Health physicians and dated April 18, 2016, cites the provincial budget as the reason for changes to physician benefits, including rental fees.
A similar memo from Western Health’s vice president of medical services, Dr. Dennis Rashleigh, was sent to physicians on April 19, 2016.
‘They’re passing the buck’
David Brazil, the Progressive Conservative health critic, said he didn’t recall a directive coming from his government. Steve Kent, the health minister in the previous PC government, also denied the claim.
“They’re just passing the buck,” Brazil said, adding that even if the PCs had introduced the fees, the Liberals have had nearly four years to cut them.
“They have the ability to look at something and say if it’s not in line with their policies.”
The health critic said he believes the policy of charging overhead fees runs counter to the province’s need to attract and retain doctors.
“If we start imposing more restrictions when we know other jurisdictions are making offers to lure professionals away, then we’re going to have some challenges.”
It’s a sentiment echoed by the NLMA’s Bridger, who said the issue points to a bigger problem for a cash-strapped province with an aging population.
“How can we get doctors to particular areas? What can we do to make their lives good so that they’ll stay?” she said.
“I think these are the things that we really need to think about.”
