Horizon ending incentive pay for Sussex, St. Stephen ER docs

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Horizon Health Network is ending targeted incentive pay for doctors working in the Sussex and St. Stephen hospital emergency rooms, according to the New Brunswick Medical Society (NBMS).

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The move, which NBMS says was made “behind closed doors” and which represents a “deliberate shift away from rural emergency services,” hasn’t been publicly announced.

But in a social media post on Thursday, Horizon did announce a “temporary change in services” at the Sussex hospital on Monday, which is the Family Day public holiday.

“From 8 a.m. to 8:30 p.m., virtual and in-person care will be available for patients presenting with urgent but non-life-threatening medical needs, while patients requiring emergency care will be transported to another facility,” Horizon’s post read.

In a call with media on Friday, a Horizon spokesperson said a doctor will be working the morning shift, but there won’t be any doctors physically on site for the afternoon/evening shift. Virtual care will be available.

NBMS and Horizon have been at loggerheads over the network’s decision to begin a one-year virtual care pilot project at the hospitals.

NBMS argues that virtual care isn’t a substitute for in-person care. While acknowledging that’s true, Horizon says it has no other choice but to try new methods of health care – and that the pilot, which began a few months ago, has been successful.

On Thursday afternoon, NBMS president Dr. Lise Babin issued a statement that suggests a much bigger push to move to virtual care in rural ERs is afoot.

“The New Brunswick Medical Society has been informed that Horizon Health Network will suspend financial incentives for in-person physician coverage at the Sussex and Charlotte County Emergency Departments, effective February 15, 2025,” the statement read.

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“For the past two quarters, these targeted incentives have played a crucial role in keeping rural emergency departments open in these communities. Similar incentives are widely used across the country to help sustain access to emergency care in rural areas.

“The impact of this decision is already being felt. The Sussex Emergency Department is anticipating its first closure on the evening of February 17, 2025, forcing patients to seek care in larger urban centres – adding strain to already overburdened hospitals and increasing risks for patients. Without a physician on-site, an emergency department is effectively closed. While virtual care has its place, it is not a substitute for in-person emergency services.

“Without immediate action to maintain these incentives, further closures are inevitable. We are engaged with affected physicians, the health authority, and the Department of Health to advocate for solutions that ensure patients in these communities continue to have access to timely emergency care.

“This decision is deeply concerning and reinforces our long-standing fears of a deliberate shift away from rural emergency services. It appears that a successful, proven measure is being removed –  potentially to justify the introduction of a virtual care pilot project that cannot replace in-person emergency care.

“Decisions that fundamentally alter access to care for rural communities must not be made behind closed doors. Our health system already faces significant challenges. We cannot afford to create new ones.”

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At the Friday media conference, Dr. Susan Brien, Horizon’s senior vice president of medical, academic and research affairs, said the network has no role in physicians’ compensation.

“Horizon does not negotiate physician compensation. Physician compensation is negotiated between Medicare, the Department of Health, and the New Brunswick Medical Society on behalf of physicians,” Brien said.

When asked why NBMS would be saying that if it wasn’t true, Brien replied: “You’ll have to ask them that question. I’m not sure why they’re making assumptions and statements.”

Asked about Brien’s comments, Babin sent another statement.

“Horizon Health Network directly administers physician remuneration for all its emergency departments across the province. Although the provincial Medicare program has set rates and fees, the Horizon Health Network has significant operational discretion which it has used in this situation,” she said. 

“The targeted incentives cancelled on February 15 were the result of an operational funding decision made by the health network to maintain in-person emergency department coverage in both those areas for the last two quarters. The incentives worked to the benefit of the health and safety of both communities. The NBMS believes they should be maintained until a longer-term solution is negotiated. 

“The NBMS has verified with the Government of New Brunswick and at no time was there a directive to cease these incentives. If the incentives were initially put in place, then removed by the health network, we fail to see how they cannot immediately be put back into place by the same authorities without further delay to ensure the health and safety of those communities.” 

Brunswick News asked the health department for comment but didn’t receive a response by deadline.

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