Practice and payment preferences of newly practising family physicians in British Columbia

Objective: To examine the remuneration model preferences of newly practising family physicians. Design: Mixed-methods study comprising a cross-sectional, Web-based survey, as well as qualitative content analysis of answers to open-ended questions. Setting: British Columbia. Participants: University of British Columbia family practice residents who graduated between 2000 and 2009. Main outcome measures: Preferred remuneration models of newly practising physicians. Results: The survey response rate was 31% (133 of 430). Of respondents, 71% (93 of 132) preferred non-fee-forservice practice models and 86% (110 of 132) identified the payment model as very or somewhat important in their choice of future practice. Three principal themes were identified from content analysis of respondents' open-ended comments: frustrations with fee-for-service billing, which encompassed issues related to aggravations with "the business side of things" and was seen as impeding "the freedom to focus on medicine"; quality of patient care, which embraced the importance of a payment model that supported "comprehensive patient care" and "quality rather than quantity"; and freedom to choose, which supported the plurality of practice preferences among providers who strived to provide quality care for patients, "whatever model you happen to be working in."Conclusion: Newly practising physicians in British Columbia preferred alternatives to fee-for-service payment models, which were perceived as contributing to fewer frustrations with billing systems, improved quality of work life, and better quality of patient care.