Doctor payments in Canada reach $25B

Physicians in Canada were paid a total of $25 billion in 2014–2015, up from $24.1 billion during the previous period, according to a new report.

The average payment per physician remained virtually unchanged at $339,000 nationally, the Canadian Institute for Health Information (CIHI) said Tuesday in its annual report.

Total gross payments to physicians represent an increase of 3.7 per cent over the previous year — the second-lowest increase since 1999–2000. 

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Understanding how many physicians there are and how much we pay for their services could help in allocating health-care resources, said Geoff Ballinger, CIHI's manager of physician information in Ottawa.

Average payment estimates are gross amounts that in most cases include the overhead costs of running physician practices, such as staff salaries, medical equipment and supplies, and office rent.

To put the $25 billion in total gross payments to doctors into perspective, Canada spends $18 to $20 billion a year on defence. 

In 2015, there were 82,198 physicians in Canada, representing a 2.9 per cent increase over 2014. 

Between 2011 and 2015, growth in the number of physicians outpaced population growth threefold. For the ninth year in a row, the number of Canadian physicians per population increased at a fast rate, to 228 physicians per 100,000 Canadians, totalling 82,000 in 2015.

"The good news is the number of physicians is increasing faster than the growth in the population," Ballinger said in an interview. "But there are situations and pockets in the country where perhaps there aren't enough physicians practising."

The average gross clinical payment per physician varied across the country. The average gross payment per physician was $339,000, ranging from $258,000 in Nova Scotia to $366,000 in Alberta. Ballinger said 2015 was the first year Alberta topped the country in average gross clinical payment per doctor.

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For the first time, the institute provided a breakdown of the average amount by physician speciality. For example, nationally:

• Family physicians — $271,000.
• Medical specialists — $338,000.
• Surgical specialists — $446,000.

In 2015, Nova Scotia had the most physicians per 100,000 population (261). The  provinces with the fewest physicians per 100,000 were P.E.I. (181), Saskatchewan (196) and Manitoba (204).

The demographics of Canada's physicians continue to evolve. Last year, 40 per cent of all physicians in Canada were female, up from nearly 37 per cent in 2011. 

Women represented a larger proportion of family medicine physicians (45 per cent) than specialists (35 per cent.)

More time with patients

Based on the number of MD degrees awarded by Canadian universities, the number of physicians is likely to continue to increase, the institute said. 

Younger physicians don't tend to put in the 60-hour work weeks as older physicians did, Ballinger noted. 

Historically, physicians have been remunerated mainly through fee-for-service payments. 

Over time, there has been a growing shift toward alternative payment plans, but this trend appears to have stabilized, CIHI said. 

"In terms of the way they're paid, physicians were predominantly paid on a fee for service basis in years past and this would encourage physicians to see as many patients as possible," Ballinger said.

"Now they're not paid that way as often and so physicians are seeing perhaps fewer patients but I think the prevailing view is the quality of care is perhaps a little better because they can spend more time with their patients."

On average, Canada experienced a brain gain with more physicians returning to the country than leaving. 

Currently, about a quarter of the physician workforce trained outside of Canada, which Ballinger said is down from the 1970s.