British Columbia

Low fees have B.C. doctors thinking twice about providing assisted dying

Medically assisted dying has been legal in Canada for over a year, but some B.C. doctors are questioning whether they can afford to continue to provide the service.

'We're being paid 50% of what we would doing routine office work. So it's difficult to justify continuing'

B.C. doctors who provide medical aid in dying say they are not being compensated fairly by the provincial medical system. (Radio-Canada)

Medically assisted dying has been legal in Canada for over a year, but one B.C. doctor says he can no longer afford to offer the service, because the costs involved are much greater than the $200 payout from the provincial medical services plan.

In a letter, Dr. Jesse Pewarchuk calls the situation "economically untenable" while outlining a number of steps a physician must follow in the medical assistance in dying (MAID) procedure. 

According to the Victoria doctor, the work typically takes 3½ hours to complete.

"It is a sad statement about how B.C. treats its most vulnerable and chooses to allocate funding that there is money for payment of seven-figure average incomes to certain physician specialties, but grossly inadequate payments to support the provision of this constitutionally guaranteed service, such that after expenses remuneration of a MAID provider is roughly $25 per hour," he wrote.

A revised fee schedule proposes paying doctors slightly more: $40 per 15 minutes, to a maximum of 90 minutes.

But the Canadian Association of MAID Assessors and Providers (CAMAP) says it still doesn't come close to adequately covering a doctor's expenses in what is a complex and often emotional procedure.

'Just inadequate'

"These are important and delicate conversations that need to happen without any pressure," said CAMAP president Dr. Stefanie Green. "To tell me that I need to limit my time to 90 minutes, and do it for that kind of fee, is just inadequate.

"For those of us who are family physicians, to do this work we're being paid the equivalent of 50 per cent of what we would doing routine office work. So it's difficult to justify continuing."

Green said B.C. could look to the Prairie provinces for an example of a model that is fairer for doctors. 

"We know that in places like Alberta, Manitoba and even Saskatchewan [doctors are] being paid a time-based fee. They're paid for the work it takes to do the job properly and that's really all we are asking for," she said.

Barrier to access

According to Green, a number of B.C. doctors began providing assisted dying soon after it became legal in June 2016 "as a matter of good faith" and because they believed in the idea.

At first there was no way of being compensated, because the passing of the legislation predated the creation of the fee schedule for the services.

Now she believes fewer doctors will choose to offer assisted dying, something that will effectively create a barrier to access for vulnerable patients.

"There's no doubt. It's difficult to get providers to sign on to do the work with this kind of payment scheme," she said.

Green said her group has been asking to meet with ministry officials to discuss the issue for months. 

"I think there might be a misunderstanding of the work that's involved," she said.

"We'd like a review of what the work actually entails and reasonable compensation. No one is asking for anything more than that."