Payment model impact on the resilience of rural communitiesExploratory study

• Published in: Canadian family physician 2024-11, Vol.70 (11/12), p.719
• Main Authors: Barbour, Luke, Venkataraman, Maya, Bland, Alexandra, de Waal, Anna, Fischer, Jordie, Hari, Kishore, Grzybowski, Stefan
• Format: Article
• Language: English
• Subjects: Payment systems; Physicians; Rural areas; Rural health care
• ISSN: 0008-350X; 1715-5258
• DOI: 10.46747/cfp.701112719

Objective To explore rural physician perspectives on how remuneration impacted their experiences of contributing to community resilience during the COVID-19 pandemic. Design Exploratory, qualitative subanalysis. Setting Twenty-two rural communities in 4 Canadian provinces. Participants Family physicians, other health care professionals, and patients in rural communities in British Columbia, Alberta, Saskatchewan, and Ontario. Methods Semistructured, virtual interviews conducted between November 2021 and February 2022 were included in the subanalysis. Interviews were audiorecorded, transcribed, coded, and analyzed thematically. Main findings Participants expressed working under an alternative payment plan (APP) model facilitated greater engagement in their communities and said they were generally fairly compensated for nonclinical duties. Increased time allotted to each patient re-centred care priorities to meet the long-term needs of the community. Finally, APP physicians stated their systems of care supported their own wellness throughout the pandemic. Conclusion Findings suggest physicians working in an APP model felt they had increased ability to engage with the community and contribute to its resilience. The flexibility of APPs may allow for more physician involvement in community sustainability that is not directly related to patient care. Rural communities are small systems of care and vary based on local geographic and social characteristics. Recently, the impacts of the COVID-19 pandemic put increased pressure on health care infrastructure and support systems. These challenges revealed which communities have the strategies necessary to cope with these changes and which do not. A community's susceptibility to change can be measured by resilience, which is defined as the process and capacity of a community to prepare for, mitigate, and respond and adapt to a stressor.1 In the rural context, community resilience is multifactorial and includes a diverse economy, access to resources, optimism, strong leadership, and social support. Health care workers play an important role in resilience, as they can bring vocational expertise, are often trusted by the community, and may possess strong leadership skills. These are 3 important components of social capital to enhance resilience.2 Many physicians acknowledge the importance of advocacy and engaging with communities and recognize community involvement as an essential factor attracting physicians to rural pra