LFP Payment Model a "game changer" for family physician

Apr 8, 2024

Dr Leo Dai’s workday doesn’t end when his Burnaby clinic closes.

The family physician works late into the night poring over lab reports and updating patient charts. For nine years—before the Longitudinal Family Physician (LFP) Payment Model came into effect in February 2023 —he did that paperwork for free because he couldn’t bill for it.

Now, thanks to the LFP model, he is paid for everything he does to care for his 2,000-patient panel, including patient visits, care coordination, and required paperwork. 

“I practiced under fee-for-service for quite a long time and LFP was quite refreshing,” says Dr Dai, currently serving as the Board Chair of the Burnaby Division Family Practice. “Changing over to LFP did not really give me the opportunity to spend more time or expand my panel because I was already at full capacity. But what LFP did for me, is it really compensated me for all the work I was already doing for free.” 

Read more about the LFP Payment Model:

The new LFP Payment Model came in response to an urgent need to retain and attract family physicians in community longitudinal practice by compensating them appropriately for the work they do. 

Dr Dai says the model is working. The program meant his clinic was able to recruit five full-time equivalents of family doctors, resulting in expanded cross-coverage and same-day appointments for his patients, who are mostly Chinese speaking. If he’s busy, patients who need urgent care are more likely now to get care from another doctor on the day they need it.

Many of the new physicians came from other provinces like Alberta — as well as two from the United States.

“After the LFP came out, BC became the most attractive place for family doctors,” Dr Dai says. “We were able to recruit quite a few doctors who started in longitudinal care, and they wouldn’t have done so if not for the LFP model.

“Since LFP gave us more FTEs (full-time equivalents), it increased our ability to cross cover. We tried to make same-day appointments available even before LFP, but LFP definitely made it easier,” he says.

Dr Dai says the model allows new physicians in his clinic to chart their own course in terms of patient loads and work-life balance. This, in turn, means more quality care for patients.

“They have that time to really get to know their patients, to build their panels and to review those old records,” he says. 

“It’s very different for doctors new to practice because now they have the choice to not see patients as quickly as I have been. They have the option to really take their time and provide quality care. Not saying my practice is not quality care, I’m just so used to going at a certain pace,” he says.

For Dr Dai, who has an established practice, the model has translated into a pay boost, compensating him for everything he does in a day while covering the rising costs of running a practice.

In the past, he would have had to see more than three patients per hour to sustain his overhead. This was tough because besides patient visits, Dr Dai is the medical director of his group practice, dealing with patient complaints, college requirements, supervising provisionally licensed physicians, and medical teaching. 

When he previously brought in a student, Dr Dai says he would lose money because he had to book fewer patients. Now he gets paid at least $130 per hour regardless of the number of patients he sees while teaching. 

“We don’t get much of a stipend having learners around so it was a bit of a pay cut for doing work we enjoy doing and I feel we should be doing. And it’s nice the longitudinal fee code does compensate for that teaching,” Dr Dai says.

The new time fee codes also kick in for mental health visits. Under the old model, Dr Dai would spend up to two hours with a patient “who needs to be listened to and needs the time,” but could only bill $50 for a counselling visit. The LFP model means he receives $25 per visit and $130 per hour. 

“That’s a huge difference if I need to spend that time,” he says.

Dr Dai says he expects the LFP model will make it easier for him to slow down when he’s ready. But some of his colleagues are finding they do not want to leave.

“It is a game changer,” says Dr Dai. “Interestingly, in our practice we have a few physicians nearing retirement, and they told us that because of the LFP they want to work a bit longer.”