Scrapping billing numbers could ease urban family doctor shortage, minister says

New Brunswick's health minister says the elimination of physician billing numbers will help address a ballooning shortage of primary-care doctors in the province's fast-growing urban areas.

The challenge of finding family doctors for smaller communities and rural areas will be relatively easy to solve by paying them more money to practise there, Ted Flemming said Monday.

"The shortage, the wait list, in rural New Brunswick is very, very low compared to urban New Brunswick. The rural issue is just not serious in the sense of numbers."

Ofthe 32,000 New Brunswickers on waiting lists for doctors, 27,500 are in urban centres.

Fewer than 1,000 people are on waiting lists for family doctors in some northern zones, while the lists in the largest cities have passed the five-figure mark, Flemming said.

Flemming announced on the weekend that the government will abandon the billing-number system, a mechanism created in 1992 to rein in soaring health-care costs.

He made the announcement at a meeting of the New Brunswick Medical Society, which endorsed the move. The Progressive Conservative government promised the change in its throne speech last fall.

Each doctor practising in the province gets a billing number they use to invoice Medicare for the services they provide. But the individual billing number is linked to where the doctor practises, restricting their movements.

If no billing number is available in a community, a new doctor can't set up a practise there.

Bigger the place, longer the wait

Anthony Knight, the CEO of the New Brunswick Medical Society, said billing numbers in urban centres have not grown at the same pace as their populations, or their family-doctor wait lists.

"That number should align with patient needs and patient expectations in terms of their health status, the size of their communities, and the demographic changes we see in our province with the shift of people in certain communities moving to more urban centres," he said.

By eliminating the billing numbers, it will be easier to get more doctors into cities where the longest wait lists exist, Flemming said.

As an illustration, the minister pointed out that in the Bathurst-Acadian Peninsula zone of the Vitalit health authority, 932 people are on the waiting list for a family doctor fewer than the normal patient load of one physician. In the Campbellton zone, 412 are on the waiting list.

But in the Moncton area, the wait list is 10,272 people, and in Fredericton it's 11,874, Flemming said.

"Finding coverage for 412 people is an easier task than 10,300," he said.

"The demand for primary health care is in the cities. It's not in rural areas. That doesn't mean we don't need to find that [northern] position. That's not insurmountable. That's one nurse practitioner."

Concern over effect on rural communities

Some leaders in northern New Brunswick are already expressing concern about the loss of the billing numbers.

"Those numbers in my mind guaranteed positions in the regions," said Denis Savoie, the mayor of Eel River Crossing and the chair of the Regional Service Commission in the Restigouche area.

"In the current system, it was one of the tools we had to make sure doctors came to the area."

Flemming said the regional health authorities and the medical society will work toward a new system, including financial incentives, to fill the gaps in northern and rural communities.

"If you want someone to locate in certain areas, you have to give particular incentives," he said.

Knight said that without billing numbers restricting mobility, doctors based in urban centres could rotate into rural communities for short periods, perhaps for extra pay.

"We know that certain incentives do work," he said. "They help to encourage physicians to work in communities, maybe not permanently but for periods of time. They could shift in and out with a team of doctors."

That would be better than leaving a billing number vacant because a new doctor is unwilling to permanently establish themselves in that rural or northern community, he said.

New doctors are looking for work-life balance and many of them prefer an urban setting, yet billing numbers are often not available in cities, Knight said. And persuading them to practise elsewhere can be "a hard sell."

Another flaw with billing numbers is they distort the calculation of how many patients are being seen.

One doctor may have 2,000 patients while another easing toward retirement may be seeing far fewer. "I'm not saying the work is not valuable," Flemming said. "What I'm saying is a billing number does not represent the same delivery of medical service."

Into 'the deep end'

The province is aiming to have a new system in place by Dec. 15.

Knight said the new regime "may not be fully ready but there should be, I'll call it, a landing pad for anyone that's interested in establishing a practice on that date."

Flemming said he leapt into "the deep end" without a clear replacement because it's been clear for years the billing-number system was flawed and he didn't want to delay changes any longer.

"You can study and you can do this and this and this," he said. "This is something that had to be done. I had no appetite for another study and another review. It's the right decision."