Canada is facing difficulties recruiting medical graduates to practice family medicine, and the range of services offered by the current supply of general practitioners (GPs) is shrinking. Poor working conditions, a consequence of existing remuneration systems, are contributing to the dwindling supply of comprehensive primary care services, and the current system of remuneration creates inefficiencies in the delivery of primary health care.

Payment is Powerful explores various ways to improve primary care practice and increase GPs’ practice revenue without resorting to additional public funding. For example, GPs could bill patients more aggressively for services they now deliver at low cost or free of charge but that are uninsured by provincial governments. Under the fee-for-service approach, physicians simply charge the patient directly for the service provided. Under flat-rate billing, GPs charge the patient an annual rate in exchange for the delivery of uninsured services, including such popular ones as telephone, e-mail, and fax prescription renewals. And under hourly billing, physicians simply set an hourly rate for services, taking account of the kind of service provided, the physician’s experience and expertise, and the cost of materials.

GPs could also make better use of associated primary care staff, such as nurse practitioners, and they could join multidisciplinary practice settings, such as primary care cooperatives. For patients, cooperatives offer “one-stop shopping” of an array of services across disciplines and specialties. For physicians, cooperatives offer improved benefits and increased revenue, as well as the possibility of a more challenging professional environment and relief from burdensome administrative duties.

Finally, GPs could develop skills in lucrative primary care subspecialties, both insured and uninsured, that pay higher hourly rates than the normal menu of primary care services. Such services include plastic surgery, travel immunization, and weight loss and diet counselling.

All these options have the potential to improve the efficiency of Canada’s health care system. By making better use of their time and delegating more tasks to non-physicians, GPs could spend more time on primary health care and other services Canadians demand. By following proper business practices in billing patients for uninsured services, GPs could increase their compensation, which, in turn, would attract more doctors to family medicine. By joining a cooperative, physicians could lighten administrative and other burdens, interact more efficiently and effectively with their colleagues, and offer patients a multiplicity of services. For Canadians generally, the result would be  much-needed better access to primary care, fewer emergency room visits, shorter waiting times, and better preventative care. The savings from these positive results could then be put to better use elsewhere in the health care system.