Changing preferences for method of payment.

In the past several years, there has been a significant push to change the way physicians are remunerated. In Canada, governments have been trying to implement alternative payment plans as they try to escape traditional fee-for-service (FFS) models. However, actual physician preference for remuneration has not been adequately described. In this brief report, data from the 2004 National Physician Survey (NPS) were analysed to determine physician preference for type of remuneration. Methods The NPS is a comprehensive questionnaire distributed to medical students, residents and physicians across Canada. Data were extracted from the NPS and entered into a spreadsheet. Results from the following question were studied: If you had a choice, how would you prefer to be paid for your services as a physicians? (FFS only, salary only, capitation only, sessional/hourly only, service contract only). Data were categorized by age ( 65 yr), and compared using chisquare analyses. Results Survey data were extracted from 20,272 of 59,399 practising physicians (response rate of 34%). This included 1829 aged <35, 5294 aged 35-44, 6622 aged 45-54, 4461 aged 55-64, and 2066 aged 65 or older. There were differences in the preferred method of remuneration for physicians by age. Older physicians tended to have a greater preference for FFS compared to younger physicians. For example, 48.5% of physicians age 65 and older preferred FFS remuneration compared with only 19.4% of physicians under age 35 (P<0.01). The majority (58.6%) of younger physicians preferred payments (i.e., a mixture of FFS and salary based compensation), while only 32.5% of physicians age ≥65 preferred a blended method of remuneration (P<0.01). Pure salary, capitation, contract and per diem remunerative schemes were not a popular method of remuneration in any age group studied. Conclusions In 1998, the Ministry of Health and Long Term Care in Ontario instituted primary care reform initiatives which included incentives to physicians to join group practice entities, such as family health integration networks, through which alternative methods of remuneration would be adopted. It was hoped that physicians would shy away from FFS billing to any of a variety of more predictable alternative methods of compensation. 1 It is argued that alternative payment plans, such as capitation or salary-based remuneration, allow health policy administrators and governmental bodies to more easily predict and contain health-care costs, while offering patients better access to care. 2 However, much less attention has been given to actual physician preference for compensation. It is important to understand physician preference as this directly impacts the potential success of any payment program.