Canada has more doctors, making more money than ever
Canada has more doctors, making more money than ever - The Globe and Mail
The number of doctors in Canada and the amount they get paid by government health plans hit record highs in each of the past several years – and 2012 was no different.
Canada had more than 75,000 doctors working last year, an increase of 4 per cent over 2011, and governments paid them $22-billion for their services, about 9 per cent more than the previous year, according to new data released Thursday by the Canadian Institute for Health Information.
The data are noteworthy because they suggest the country is taking baby steps to correct what is perceived to be a shortage of physicians, and reflect a marked shift in how doctors are being paid and, thus, interacting with patients.
Where the doctors are going
The number of doctors per capita climbed in 2012 for the sixth year in a row, outpacing population growth threefold and resulting in 214 physicians for every 100,000 Canadians. That figure is expected to rise as the country continues to attract foreign-trained doctors and Canadian medical schools churn out record numbers of graduates.
Growth in the number of doctors has been highest in rural areas, where complaints about shortages and access to care have historically been most pronounced. In the past five years, the number of physicians working in rural Canada rose five times faster than the national population.
Provincially, British Columbia and Newfoundland and Labrador reported the largest increases in the number of physicians, at 5.1 and 4.6 per cent, respectively. Manitoba was the only province that did not report an increase.
Geoff Ballinger, manager of health human resources at CIHI, said the overall numbers make it tempting to shrug off the notion of a doctor shortage in Canada. But that would be premature, he noted.
For one thing, the number of physicians in rural Canada in not proportional with the rural population: While 18 per cent of Canadians, or about six million people, live in rural communities, just 8.5 per cent of the country’s 75,142 doctors served those people.
That gap may be a reason that the number of Canadians who say they do not have a regular family doctor has stagnated at about 4.4 million in recent years, according to Statistics Canada.
“It’s tempting to suspect the situation is improving . . . but we’re not seeing a change in those numbers,” Mr. Ballinger said.
Shortage or no shortage?
For many of those 4.4 million people, not having a family doctor is a choice. They are content to seek care at walk-in clinics. But nearly 800,000 reported that they did not have a place to go for regular care.
The figures do not necessarily mean a shortage of physicians, said Tom Noseworthy, a health policy professor at the University of Calgary.
“I don’t believe Canada has a problem with the number of physicians,” he said. “I think we have a substantial problem with the types and, furthermore, the distribution of doctors.”
“We’ve got a situation now where there isn’t always a good alignment between the training programs [medical schools] and what the market actually needs,” he said. “I do not believe Canada suffers from an insufficient number of physicians.”
Changes in pay
Doctors earned more last year than ever before.
The data show the average physician was paid $328,000 for clinical services last year, from a high of $376,000 in Ontario to a low of $258,000 in Nova Scotia. (Most doctors must pay their overhead – including office space and staff wages – out of their income.)
Across the country, average income was 5-per-cent higher than in the previous year.
Increasingly, though, doctors are earning their pay in ways other than the traditional fee-for-service model, in which a doctor sees a patient and bills for his or her time and expertise.
So-called alternative-payment methods have skyrocketed in recent years, and last year accounted for 28.7 per cent of the $22-billion provincial and territorial governments paid out to doctors. A decade ago, alternative payments made up just 11 per cent of physician income.
“It’s a big, big shift, and I think for the better,” said Scott Wooder, president of the Ontario Medical Association, which negotiates physicians’ pay with the province.
These alternative payments include straight salaries, compensation in which physicians are paid a fixed sum per patient on their roster, and hourly or daily wages. Sometimes remuneration is a blend of fee-for-service and an alternative payment.
Ontario doctors have been embracing alternative payments in greater numbers since the 1990s. Almost $3.4-billion, or roughly 35 per cent, of all physician income in Ontario last year was alternative payments.
Most were in the form of what is called capitation – compensation based on the number of patients on their roster, regardless of how often a patient seeks medical attention.
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Canadian socialized medicine sure is working!