William Osler Health Centre doctors (L-R) Andrew Healey, Susan Lavery ,Alexandra McMillan posed the in ICU in Brampton June 26, 2014. According to a new report, pay increases for doctors have slowed down in Canada.J.P. MOCZULSKI/The Globe and Mail
The amount of public money doled out to doctors across Canada is growing at the slowest pace since at least the late 1990s, a development that suggests some provinces are succeeding in curbing physician pay increases.
Total payouts to doctors topped $22.8-billion in 2012-13, up 3.5 per cent from the previous year, the smallest annual uptick since national data on doctors' paycheques began to be published in 1999-2000. What's more, the average salary doctors earned before covering their office expenses – $328,000 – has barely budged, a departure from past increases in the neighbourhood of 4 or 5 per cent a year or more.
The latest peek into doctors' wallets is courtesy of the Canadian Institute for Health Information, which released its yearly study of the physician work force on Tuesday.
The new president of the Canadian Medical Association said the slowdown in pay increases comes after a handful of provinces, including Ontario and Alberta, took tough stands in their contract talks with doctors.
Settlements have "been far more modest in the last two or three years," said Chris Simpson, a Kingston cardiologist who represents doctors across the country, but not as their bargaining agent. Doctors' contracts are negotiated at the provincial level.
"I think it's likely a reflection of the fact that a lot of the provincial governments have really been trying to put the brakes on health-care spending," he added.
The new edition of CIHI's work-force report is the first to feature data from the year after Canada's most populous province essentially froze the total amount of money it makes available annually for physician pay, after a bitter standoff with the Ontario Medical Association.
In 2012-13, the total amount Ontario paid to all its doctors rose 1.7 per cent; in the three years previous the increases were 9.6 per cent, 5.4 per cent and 6.2 per cent. Average gross pay for Ontario physicians actually fell by 1.3 per cent to $370,731 from $375,543.
Only Manitoba saw an actual decrease in the total it paid out to physicians, a drop of 0.6 per cent. The largest increases were in Saskatchewan, where the total payout rose 9.1 per cent and average gross payments to individual doctors rose 6.6 per cent.
Hugh Grant, an economist at the University of Winnipeg who co-authored a report on physician pay published last year, pointed out that reining in physician pay alone will not stop health-care spending from gobbling up more and more of provincial budgets as the population ages.
Payments to doctors account for, on average, about 15 per cent of health-care budgets, he said.
"You might say, 'Why are you worrying about constraining costs in this group that's only costing 15 per cent?'" Prof. Grant said. "But it's the fact that that's the gateway to getting a drug prescription or getting admitted to hospital. You have to control the amount of services being provided by physicians because if they increase the level of services it means pressure on drugs and other things down the road."
Of course, one of the reasons provinces might pay out more in total is because they are paying more doctors to care for more patients. Indeed, the report revealed that in 2012-13, Canada had more physicians than ever before – 77,674 – up 3.4 per cent from the previous year, a figure that is growing three times faster than the Canadian population.
The reasons for the increase? Canada is opening up more medical-school slots, licensing more foreign-trained doctors and losing fewer MDs to other countries. The brain drain has become a modest brain gain: Canada saw a net increase of 40 doctors in 2012-13.
"The paradox is that we also are not seeing significant change in the number of Canadians who are reporting that they are still having challenges finding a regular doctor," said Geoff Ballinger, CIHI's manager for physician information.
Mr. Ballinger said that provinces are moving toward "alternative pay schemes," which compensate doctors for things such as adding patients to their rosters or achieving health-care targets instead of simply seeing patients on a fee-for-service basis.
That, coupled with the fact that younger doctors tend to work fewer hours than their older counterparts, could help explain why a rise in the number of doctors does not equal fewer patients searching for a primary-care physician, he said.