‘We have bills to pay:’ Sask. doctor talks clinic ownership pressures’

With Saskatoon’s loss of a doctor’s office last week amid its ongoing physician shortage, a family physician shared that clinic owners are trudging through their own problems trying to keep the lights on each day for patients in need.

Adam Ogieglo is a part-owner of Lakeside Medical Clinic.

After Broadway Family Physicians closed its office last week, Ogieglo said clinics are businesses that, like all industries, are touched by inflation pressures.

The cost of supplies — like food and gas — is on the rise as owners like Ogieglo work to also keep pace with paying staff a fair and livable wage. With it common for doctors to be the owners of various clinics, Ogieglo shared the fees doctors pay each year to professional organizations like the Canadian Medical Association are also increasing.

“On the flip side, we don’t regularly get raises that kind of deal with those pressures,” Ogieglo shared.

How doctors are paid varies by country and even province, but Saskatchewan’s payment method for doctors is one that Ogieglo said requires change.

With two years of COVID-19 stresses under their belts and now the high volumes of need plaguing not just clinics but hospital emergency rooms, Ogieglo said change is needed in this area to address shortcomings elsewhere.

“Definitely, a lot of my day-to-day stresses are not on the medicine side of things,” he said.

Being both a physician and operating on the business side of the industry does complicate things. Ogieglo said being part of the ownership of the clinic means more meetings and decisions that the average doctor wouldn’t need to concern themselves with in the course of their day-to-day work.

Ogieglo said there are often questions that need answering — like whether a particular piece of machinery or technology should be purchased, who should supply a clinic and whether more staff should be hired — that he wouldn’t have to think about if he were only seeing patients.

While Lakeside does have a general manager to help with their day-to-day business concerns, there’s also the balance of running a profitable business with meeting the needs of patients in Saskatoon and the province.

 After-hours

Ogieglo said Lakeside is one clinic that provides after-hours services that aren’t fairly compensated.

“We’re the only clinic that’s open past 8 p.m. on weekdays (and) we’re the only clinic that’s open past 4 p.m. on weekends in the city of Saskatoon that I’m aware of,” Ogieglo said.

While that might be a godsend for the mother with a child who needs to be seen late at night or the employee who can’t afford to take time off work, it means doctors are spending their weekends and evenings at work instead of at home with their families.

“All these pressures add up with time,” Ogieglo said. “Our physicians are working longer hours than other clinics and so that alone is a recruiting impediment.”

The province has offered a 10 per cent premium to doctors after 7 p.m. on weekdays and on weekends and statutory holidays. But Ogieglio said that works out to only about $4 a patient — an additional $16 an hour if a doctor sees a new patient every 15 minutes.

“There aren’t a lot of physicians that are jumping at the opportunity,” Ogieglo explained.

The small additional payment isn’t enough to entice doctors to enlist for those weekend and evening hours. Lakeside is often at a disadvantage, too, when a clinic that has reduced its hours is hiring doctors to fill a position that only requires normal weekday work hours, compared to having to pitch in for even the occasional weekend, evening or holiday.

“Our clinic is potentially looking at reducing after-hours offerings in the near future unless that situation changes,” Ogieglo said, noting other clinics have also reduced their hours.

It leaves doctors wrestling with wondering what after-hours care in a city like Saskatoon will look like in the near future. Will clinics be open at all in later hours or will that demand need to transition onto the shoulders of hospitals and ERs already bursting at the seams?

The payment scheme also leaves physicians feeling penalized if they dedicate more time to a patient with a more complex case that only pays half as much for the same amount of time several less-complex patients would have taken.

“I think a fair payment model wouldn’t have you penalized by seeing a complex patient,” Ogieglo stated.

“Raises” only come every few years when doctors’ rates are negotiated by their professional organizations. Unless those go up, physicians cannot bill more, even though that cost isn’t one patients themselves have to pay.

Ogieglo said it means the only real way for physicians or clinics to make up for higher costs is to see a higher volume of patients. And while there’s no shortage of patients to be seen, doctors in the province and across the country are already battling high rates of burnout while continuing to manage amid a country-wide health-care worker shortage.

How to  change the “funny system” of payment for doctors,  in Ogieglo’s eyes, is a big question and one being looked at by professional organizations, the Ministry of Health and the Saskatchewan Health Authority.

Ogieglo would like to see the model that was recently implemented in B.C. used here. It’s one that compensates physicians for paperwork hours in addition to the times they see patients — work that usually goes unpaid.

The physician said he could see that change also doing a lot to help persuade newer graduates interested in opening up a clinic to pursue more office-based primary care work.

Knowing that another clinic in Saskatoon has recently closed, Ogieglo said it does come with some concern.

“Any clinic has to make payroll,” he said. “We have bills to pay, we have payroll to make, we have staff that we are supporting.

“These are difficult times for a lot of businesses.”

The hiring crunch

Currently, Lakeside Medical Clinic is only at 75 per cent capacity in terms of employed physicians.

“We are working to actively recruit more doctors and it seems to be a taller and taller order these days,” he said.

The University of Saskatchewan does have a medical school but that alone doesn’t guarantee physicians. Ogieglo said some graduates of the program do move away each year and not every graduate chooses to work in primary care or to open a practice.

However, Ogieglo said there are things that could be done to encourage students to consider primary care more seriously.

“We’re scaring people — very capable people — away from doing the work that needs to be done,” he shared, adding fewer students have been choosing family medicine, leaving spots in that area of the program unfilled without the proper number of doctors being trained.

To potential future doctors, Ogieglo said while family medicine is busy and can require a lot of hours, the work never stops being rewarding.

“Anything can come in, head to toe, young or old, you are making a difference in people’s eyes,” he said.

Having worked one evening a week for his whole 11-year career at Lakeside, Ogieglo said he wouldn’t trade the opportunity to help the mother with the crying infant at 9 p.m., even though it means time away from his family.

While Ogieglo can find it hard to talk about the financial side of medical care, he said the challenging topic isn’t really something people need to be familiar with.

“People don’t need to understand necessarily how I’m paid,” he said. “The model is broken. We need government to be at the table working to fix the problem so the people can have access to care when they need it.”

Ogieglo feels such action would go a long way towards solving the crisis seen in hospitals and emergency rooms currently as people are desperate for are amid a shortage of physicians.

“You have to fix the foundation of medicine first and that’s primary care,” he said.