Last summer, Manitoba’s physicians approved a new historic Physician Services Agreement (PSA) with the Manitoba government, which features a record $268 million in increased funding over four years for physician practices to help stabilize medical services and support physician recruitment and retention. 

“The new Physician Services Agreement offers a significant increase in funding for medical services across the province, and that should mean better access to physician care for patients,” Doctors Manitoba President Dr. Michael Boroditsky said at the time.

The new agreement not only includes annual increases to keep remuneration and funding for physician practices competitive with other provinces, it also includes new models for both specialists and family physicians to support their practices in new ways.

For physicians and patients, some of the greatest benefits include: 

• Increased funding for specialty and hospital services to help attract more physician coverage.
• A game-changing new funding model for longitudinal family medicine, called Family Medicine Plus, blends existing volume-based payments with funding for patient panels, patient complexity, and time-based payment for indirect clinical services.
• New rural and northern retention and recruitment incentives and additional funding to help stabilize physician coverage in rural hospitals and remote First Nations communities.
• Making virtual visits a permanent part of Manitoba’s medical coverage, following their temporary introduction during the pandemic. 

Physicians strongly supported the new Agreement, recognizing it is worth 10 times as much as the one that preceded it. Existing physicians see the potential to finally address the physician shortage in Manitoba.

Dr. Chukwuma Abara, representative for the Northern Medical District, applauded a new premium for physicians working in remote communities. ​“The new differential will help to recognize those physicians who have been committed to remote First Nations and other northern communities, it will help to attract more doctors to these underserved populations.”

A new rural and northern retention fund is also being welcomed. ​“Finally, there is official recognition and value for the continued service we offer in small town Manitoba,” exclaimed Dr. Selena Papetti, a family physician representing the Eastern Medical District.

For Dr. Alexis Botkin, a community-based dermatologist in Winnipeg representing the Victoria Hospital Medical District, she sees the potential of a new tariff for medical specialists serving patients with complex medical needs. ​“This one new tariff will support specialists care for those patients who need ongoing monitoring and follow-up.”

There is also support for hospital-based specialists, including increases designed to help attract more doctors to provide hospital care.

The PSA includes a big change for family physicians too, with a new funding model for longitudinal family practice called Family Medicine Plus.

Doctors Manitoba heard from many specialists who were happy to see primary care access as a priority. Dr. Anthony Battad, an internal medicine specialist and representative for the St. Boniface Medical District, echoed this. ​“I’m relieved to see this Agreement finally putting value on primary care. This will translate into better care for patients, including helping to keep some of them out of hospital.”

“I’m excited about a new era for family medicine in Manitoba,” explained Dr. Candace Bradshaw, Past President and a family physician in Winnipeg. ​“Until now, family doctors relied primarily on piecemeal funding for each patient visit that left doctors and patients feeling rushed. FM+ is giving me hope. After years of chronic burnout, I feel the joy in practicing medicine again, knowing I’m able to spend more time with my patients and provide them with quality care.”

“Family medicine now means more in Manitoba,” she added.

Dr. Edin Tunovic summed it up concisely: ​“It’s really a game changer for family physicians.”

Dr. Kurt Skakum, a psychiatrist and President of UMG, pointed out that the PSA ​“strikes a balance between family physicians and specialists we don’t often see.”

The feeling of hope and optimism among both family physicians and specialists is recognized by medical learners too.

Medical Student Taylor Nimchonok explained ​“it’s been a tough few years for doctors and students, and morale has been really low. Now, students are noticing your hope and excitement. It’s a complete shift in attitude and energy. We see it and we feel it.”

About three quarters of physicians routinely offer virtual visits to patients, but the existing funding system had two major issues: it was temporary and could be canceled at any time by the government, and doctors were required to meticulously track and document start and stop times for each visit. Under the new PSA, virtual visits are now permanent in Manitoba, removing uncertainty about whether or not this new way of caring for patients would continue to be funded. The unnecessary and excessive documentation requirement is also removed, saving physicians an estimated 45,500 hours per year in administrative burden.

“Virtual visits have really changed by practice and made my services more accessible and convenient for my patients, so I’m very pleased to see virtual now recognized officially as part of patients’ Manitoba Health coverage,” said President-Elect Dr. Randy Guzman, a vascular surgeon at St. Boniface Hospital.

The PSA also introduces remuneration models to support communication between physicians and with other providers.

“As physicians, we should be collaborating more with each other and other providers to serve our patients,” said Dr. Nichelle Desilets, a rural family physician and Representative for the Assiniboine Medical District. ​“I am really happy to see new models that recognize and fund that patient-focused collaboration.”

Physicians agree the new PSA has a lot to offer, though Doctors Manitoba will not display a mission accomplished banner.

“While there is a lot to celebrate in this Physician Services Agreement – it is the largest ever for Manitoba – no physician group got everything they needed,” acknowledged Dr. Boroditsky. ​“After years of fiscal restraint, health system changes and a pandemic, there is a large accumulation of issues and concerns that physicians still need to see addressed. There is still more to press for.”

He pointed to some specific physician groups with ongoing shortages that still require attention, such as certain specialty groups such as geriatric medicine, hospitalists, and those working in remote First Nations communities.

Many physician groups, including community- and hospital-based specialist and family physicians, had hoped to see more progress on expanding team-based care models in physician practices. Some fees or funding models are in desperate need of modernization.

Luckily, under the new PSA, a Joint Physician Services Agreement Committee is set up to facilitate consideration and resolution of many issues between the typical four-year negotiations cycle.

The biggest and most complicated parts of the Agreement were implemented on October 1, 2023 and April 1, 2024. Two percent funding increases will follow on April 1 of 2025 and 2026. The Doctors Manitoba Practice Advice team is support members through these changes, and is always available to answer physician questions.