Throughout negotiations, the goal was to stabilize family medicine. Without good access to primary care, the effects are being felt across the system. Stabilizing specialty services to support patient care in rural communities around the province was also a priority.
This contract makes significant investments in initiatives that will help stabilize primary care in Nova Scotia and work to make office-based practice more sustainable for all physicians.
It is anticipated that, as a result of the new Physician Agreement and C/AFP Agreement, the total annual investment in physician services will grow by at least $180 million over four years.
Investments for all physicians
- 10% across-the-board increase: Spread over four years (3% in years 1 and 2, 2% in years 3 and 4), retroactive to April 1, 2023.
- Better parental leave benefits: An increase from $1,500 per week for 17 weeks to $2,000 per week for 26 weeks, with the option for physicians to spread the benefit over 52 weeks if they wish to do so.
- Succession planning: A commitment and clear process to support better succession planning as physicians begin to move into retirement (also known as TIP-TOP, or Transition into Practice – Transition out of Practice).
- Travel/redeployment expenses: When a physician is asked by a health authority to travel to another hospital in the province more than one hour away, the physician will have their expenses reimbursed.
- Physician wellness: The Professional Support Program budget will be increased by April 2024 to support a trained intake worker to respond to and triage initial calls to the program, and will also help provide better, funded access to counselling and psychological services. The funding will also support increased upstream wellness supports such as Balint groups and mindfulness workshops. A working group will be struck to better coordinate and enhance physician wellness initiatives in Nova Scotia.
Supports for most physicians (family medicine and non-C/AFP specialties)
- Locum program enhancements: To have a replacement physician fill in when a physician is sick or on leave, increased rates and now expanded to include family physicians in Zone 4 – Central.
- Teaching future generations of doctors: Increased remuneration for physicians prepared to serve as preceptors and assessors for the physicians of tomorrow.
- Asynchronous virtual care: Physician-to-physician consult fee codes will include not just telephone but also face-to-face and secure email discussions between colleagues.
Family medicine investments
- Longitudinal Family Medicine (LFM) payment model: A new payment model that aims to provide stable, equitable funding for physicians who provide longitudinal family medicine, with a particular focus on access and attachment. The LFM model offers competitive compensation and enhanced accountability, through a blended payment that is calculated based on hours worked, services delivered and panel size.
- The LFM replaces the alternative payment plan (APP) model and is also available to fee-for-service physicians if they choose to convert to the new model.
- Annual earnings projected to increase by up to $65,000 or more in new model.
- Overhead/attachment support: A new annual payment for fee-for-service family doctors who provide longitudinal family medicine to help them with their overhead costs. The payment is $20 per rostered patient up to a maximum of 2,000 patients.
- New fee codes, invisible work: For some of the “invisible unpaid work” family physicians do, so these services can be measured and remunerated appropriately (such as complex patients, new patient intake visits, patient-specific consults and telephone prescription renewals).
- Funding to hire allied health-care providers: To support team-based care, this pilot project is for all family physicians to allow them to bill for services of the provider to help offset the cost of hiring them.
- After-hours care: All family physicians, including those in walk-in clinics, can now bill evening and weekend rates (25% GPEW premium without the requirement to bill ME=CARE) when providing primary care services.
- Long-term care: Recognizing the complexity of care required, rates for LTC will be increased and streamlined.
- Family medicine specialists: The APP rate for family physicians with a Certificate of Added Competence (CAC) in geriatrics, palliative medicine or addictions medicine will increase to $310,000. The APP rate for family physicians practising in geriatrics, palliative, addictions, FP oncology or FP psychiatry (but without a CAC) will increase to align with the FP sessional rate.
- Inpatient work: Physicians working under the Community Hospital Inpatient Program (CHIP) and the regional hospitalist model will benefit from increased facility on call rates. Digby and Hants will remain eligible to convert to the CHIP program should the physicians delivering inpatient services wish to do so.
- Primary Maternity Care: Physicians working under the Primary Maternity Care (PMC) payment model will benefit from increased facility on call rates. The PMC model will also will be available to any regional hospital (Kentville, Cape Breton, Truro, New Glasgow) that wishes to convert to this alternative payment model, if all parties are agreed it is in the best interests of the system.
- Rural practice specialist support program: New funding will help rural specialists manage the costs associated with running their practice.
- Increased facility on-call rates: Rates for regional specialists providing facility on call coverage will increase and weekday rates will now apply Monday through Thursday, with weekend rates applying on Fridays, Saturdays, Sundays and holidays.
- Enhanced FTE base for core services: An investment to create and maintain a stable complement of resources for core regional specialties to ensure a sustainable call burden, to improve the province’s ability to recruit and retain physicians, and to ensure resources to teach, assess and mentor colleagues and future physicians. This will mean at least five full-time equivalents (FTEs) for General Internal Medicine/ICU, General Surgery and Anesthesia, and four FTEs for Obstetrics/Gynecology, in each of the province’s regional hospitals. This aims to ensure a sustainable call burden, to improve the province’s ability to recruit and retain physicians, and to ensure resources to teach, assess and mentor colleagues and future physicians.
- Income stabilization: In the event of another pandemic or in situations when fee for service or hourly-paid specialists experience income loss due to factors beyond their control.
- Competitive compensation: Ensuring that regional specialists are receiving competitive compensation is crucial to both retaining and recruiting the physician resources the province needs.
- “First Through the Door” incentive program: Is an incentive program to support recruitment to core specialties in regional hospitals should a service be running significantly under-complement.
- Earn more for approved, scheduled, after-hours work in support of the surgical strategy: For after-hours work in support of the surgical strategy that has been approved by a health authority, physicians will be eligible for payment premiums at 35% for 5 p.m. to midnight Monday to Friday and 8 a.m. to 5 p.m. Saturdays, and 50% for midnight to 8 a.m. Tuesday to Friday, 5 p.m. to 8 a.m. Saturday to Monday, and 8 a.m. to midnight on holidays, respectively. Previously these premiums were only available for services required on an emergency basis.
Clinical/academic funding plan (C/AFP) physicians benefit from some of the Physician Agreement investments for all physicians (such as, across-the-board increases, more support for succession planning and travel/redeployment) as well as items negotiated in the C/AFP Agreement. C/AFP physicians will have a new process to request new physician FTEs, better deliverables reporting, enhanced support for work above and beyond the C/AFP, and an opportunity to seek increased funding for administrative supports within their departments. See the C/AFP agreement.
Physician retirement fund
The provincial government has confirmed that details about the retirement fund will be shared by March 31, 2024. Implementation will be within this government's current mandate before July 2025.
Programs continued from previous agreements
- First time audit focused on education
- Administrative burden review
- CMPA rebates
- Continuing Professional Development stipend
- EMR Funding
- GP Surgical Assist Program
- Regional Hospital Intensive Care Unit Payment Plan
- Evening and Weekend GP Office Visit Incentive
- Regional Hospitalist Model
- Chronic Disease Management Incentive Program