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Patients of two clinics in Greater Victoria are being asked to pay monthly or annual subscription fees to access the services of the family doctor on staff, a model that has alarmed proponents for the public health-care system.

The Victoria area is among the hardest hit with the family doctor shortage. Starting Nov. 1, Beta Therapeutics said it will be accepting patients willing to pay $110 per month per person. The clinic notes on its website that the primary care services are carried out by licensed medical practitioners who are unenrolled in British Columbia’s medical services plan (MSP).

“We’re not advocates for the widespread privatization of health care in B.C.,” Samantha Rocha, director of the clinic, said in an interview Wednesday.

“The goal of the clinic has always been to be offering the most accessible health care. And so at the moment, this is the way to do it.”

Ms. Rocha said Beta Therapeutics has been brewing the idea of launching family medicine service since the spring of 2020. The goal had always been to be a publicly funded medical clinic, but settled on a private-pay model because of the state of family medicine in B.C. She said it was easier for the clinic to attract physicians who wanted to work under the subscription model, rather than the province’s fee-for-service model, because of their concerns about covering overhead costs and achieving work-life balance.

Ms. Rocha didn’t provide the number of patients who have signed up, but said the physician, Dan Cutfeet, has filled 80 per cent of the spaces he had available.

Physicians practising in British Columbia can either “de-enroll” or “opt-out” from MSP, the Ministry of Health said in a statement.

Those who “opt out” are limited to charging patients directly the same fees proscribed by MSP. It is then up to the patient to seek reimbursement from MSP.

Services provided by a physician who is not enrolled with MSP or whose enrolment has been cancelled by MSP are not insured and will not be reimbursed by MSP. However, “de-enrolled” physicians may not charge for the provision of an insured service any amount that is more than the rate payable by MSP if they were enrolled.

The ministry said only seven B.C. doctors have voluntarily de-enrolled from MSP, amounting to about 0.1 per cent of physicians. Two physicians have opted-out status. A ministry statement said the government is “not concerned de-enrollment from MSP poses a risk to our public health-care system at this time.”

However, the ministry said the Medical Services Commission, which manages the provincial medical services plan and ensures physicians are abiding by the Medicare Protection Act, is aware of the two clinics and looking into the matter.

Shortage of family doctors puts B.C. government on defensive

About one million British Columbians are without a family physician.

A second clinic, Perpetual Health Centre, has issued a notice to its patients, saying the facility’s family physician and owner, Perpetua Nkechi Nwosu, has de-enrolled from MSP, effective on Nov. 1.

The clinic, which will prioritize seniors and women, will bill patients privately an annual fee of $1,500 for the care provided by Dr. Nwosu. Children under 10 years old will be seen at no cost if parents are registered with the practice

Dr. Nwosu wasn’t available for an interview.

However, in a lengthy statement she posted on social media on Aug. 7, she said she was harassed, abused and threatened by members of the community, after Victoria’s Capital Daily reported Dr. Nwosu told her patients, in a letter, that she’s starting a “retainership service” of $125 per month. The physician said the retainer will help cover building costs, salaries, materials, software and more.

“I am not going to create a two-tier system, I want to have the ability to be present for people when they need a physician for their physical and mental health. I want to do this with the best possible team realizing I wouldn’t offer what I have on my own. It was the goal of the retainership, no patient was going to be left behind and a good number of my patients are happy to be part of it,” her post reads.

Ayendri Riddell, campaigner at the BC Health Coalition, said annual subscription fees are not a solution to the primary health care crisis but a part of the problem.

“We already have a two-tier system dividing people who have a regular primary care provider or place of care and people patching together services through walk-in clinics or other options,” she said in an e-mail. ”I’m genuinely concerned that clinics like those being established in Victoria (combined with a broader range of clinics that require some form of private payment) further entrench this gap based on ability to pay.”

Doctors of BC, a voluntary association representing 14,000 physicians, referred to the ministry’s comments, saying the option has not posed a risk to the integrity of the public health care system in the past.

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