Doctor payments in Canada reach $25B

Physicians in Canada were paid a total of $25 billionin20142015,up from $24.1billion during the previous period, according to a new report.

The average payment per physician remained virtuallyunchanged at $339,000 nationally, theCanadian Institutefor Health Information (CIHI) said Tuesday in its annual report.

Total gross payments tophysicians representan increase of 3.7 per centover the previous year the second-lowest increase since 19992000.

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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, saidGeoffBallinger,CIHI'smanager of physician information in Ottawa.

Average payment estimates aregross amounts that in most cases include the overhead costs of runningphysician 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 centincrease over 2014.

Between 2011 and 2015, growth in the number of physicians outpaced population growth threefold.Forthe ninth year in a row, the number of Canadian physicians per populationincreased at a fast rate, to 228 physicians per 100,000 Canadians,totalling82,000 in 2015.

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

The average gross clinical payment per physician varied across the country. The average gross payment per physician was $339,000,rangingfrom $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 averageamount 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 ofCanada's physicians continue to evolve.Last year,40 per centof 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, thenumber 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, Ballingernoted.

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

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

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

"Now they're not paid that way as often and so physicians areseeing 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.