Nfld. & Labrador

Patchwork of rental fees for N.L. doctors hampers recruitment: critics

After three years, a directive to health authorities to start charging rent to doctors is still not being followed consistently across the province.

Only some physicians pay fees years after policy implemented; health department points to previous government

Fee-for-service physicians in N.L. who have offices in health authority facilities may or may not be charged, depending on which region they're in. (Melissa Oakley/CBC)

A provincial government directive to health authorities to start charging rent to doctors is still not being followed consistently across the province three years after it was issued — and according to a small town mayor, that's making it difficult to recruit and retain doctors in rural areas.

The four regional health authorities — Eastern, Western, Central and Labrador-Grenfell — were directed to charge fee-for-services physicians who use space inside health authority facilities $2,400 a month, according to a Western Health memo obtained by CBC News.

But emailed statements from health authority spokespeople show a patchwork of systems across the regions, with some adhering precisely and others straying from the directive.

Central Health charges all physicians $2,400 a month for overhead operating costs, while Labrador-Grenfell Health charges doctors a flat fee but would not say what the rate was.

We've had a very difficult time over the years to attract physicians here on any long-term basis.- Fogo  Island Mayor Wayne Collins

Western Health charges doctors "rent which is based on market value of the space they are using," according to a spokesperson.

Eastern Health, the province's largest health authority, said in an email "some fee-for-service physicians with Eastern Health pay an overhead fee for some of the costs related to running their offices," but no doctors "are paying rent for the physical space itself at this time."

Another email from an Eastern Health spokesperson said the policy had not been fully implemented and the health authority was reviewing it.

Fogo petition 

In December, hundreds of people on Fogo Island signed a petition asking Central Health not to implement overhead fees for the two doctors practicing on the island of 2,300 people.

Two doctors have offices in the community clinic on Fogo Island. Mayor Wayne Collins said it hasn't always been easy to convince doctors to come to the remote island. (Submitted by Kay Burns)

Central Health didn't adopt the fees immediately in 2016, a spokesperson said, recognizing the need to remain competitive in "hard-to-recruit areas."

Fogo Island Mayor Wayne Collins understands just how difficult it is to attract physicians to his tiny community. He and others feared doctors would leave when the fees were phased in last year.

"We've had a very difficult time over the years to attract physicians here on any long term basis," he said.

"Those fees should be waived."

Health minister John Haggie said he never heard concerns about the overhead fees until the petition began circulating in Fogo.

"Basically, nobody brought it to my attention," he said. "I think the bigger picture is, what was the purpose of this policy? What has it achieved?"

Not in the contract

The Newfoundland and Labrador Medical Association (NLMA) came out against overhead fees when they were introduced in 2016. President Tracey Bridger says the group's position hasn't changed.

"We felt that it was not what the physicians had agreed to in their contracts," she said.

"The right way to do it is with negotiation and not just making a unilateral decision and saying 'take it or leave it' because some people might leave."

Dr. Tracey Bridger, president of the Newfoundland and Labrador Medical Association, says overhead fees discourage doctors from starting practices in rural parts of the province. (Sherry Vivian/CBC)

Haggie acknowledges the 2016 budget addressed overhead fees, but he said a decision to implement them was made by the previous government. He said he had no reason to think it was contentious and thus no reason to change course.

How can we get doctors to particular areas? What can we do to make their lives good so that  they'll stay?- Tracey Bridger , NLMA

"To be perfectly honest, it was presented to me as part of the stuff that I had to tidy up when I came in through the door."

The minister pledged to examine the fee to figure out whether it makes sense to keep charging it and whether it's having any unintended consequences, like discouraging doctors from practicing in Newfoundland and Labrador.

Health Minister John Haggie said staff is reviewing the policy directive and trying to establish its successes and failures. (Katie Breen/CBC)

He also wants to know why Eastern and Western Health didn't implement a flat fee back in 2016 as instructed.

"That is an issue," he said.

'They're passing the buck'

David Brazil, the Progressive Conservative health critic, said he didn't recall a directive coming from his government. Steve Kent, the health minister in the previous PC government, also denied the claim.

"They're just passing the buck," Brazil said, adding that even if the PCs had introduced the fees, the Liberals have had nearly four years to cut them.

MHA David Brazil asked why the NLTA's calls for Dale Kirby's resignation went unanswered in 2016. (House of Assembly)

"They have the ability to look at something and say if it's not in line with their policies."

The health critic said he believes the policy of charging overhead fees runs counter to the province's need to attract and retain doctors.

"If we start imposing more restrictions when we know other jurisdictions are making offers to lure professionals away, then we're going to have some challenges."

It's a sentiment echoed by the NLMA's Bridger, who said the issue points to a bigger problem for a cash-strapped province with an aging population.

"How can we get doctors to particular areas? What can we do to make their lives good so that they'll stay?" she said.

"I think these are the things that we really need to think about."

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