Family doctors saw average gross payment fall by 1% last year: CIHI

Toronto - The new Canadian Institute for Health Information (CIHI) physician numbers show just how much payment increases to doctors are slowing — or falling — as the number of doctors continue to grow faster than the population.Indeed, the number of physicians in Canada continued trending upward in 2016, with the physician rate of growth outpacing that of the population in Canada for the 10th year in a row. Between 2012 and 2016, growth in the number of physicians was almost triple that of the Canadian population.According to the there were more than 84,000 physicians in Canada last year, or 230 per 100,000 population—the highest proportion ever. Dr. Shawn WhatleyCIHI’s report "Physicians in Canada, 2016" updates information on the physician supply, payments to physicians and the services they provide to Canadians. It shows that total clinical payments to all physicians increased 3.4% over the previous year to $25.7 billion. Growth over the last few years has been almost half of the average annual growth of the past decade (6.2%).But the report also shows average gross clinical payment per physician in 2015/16 was $339,000, an increase of less than 1% from 2014/15. For most physicians, gross clinical payments cover the costs of running their practices. But nationally, the average gross clinical payment to family medicine physicians decreased by nearly 1% in 2015/16 to $275,000. The average payment to medical specialists (e.g., cardiologists, rheumatologists, neurologists) increased 1.5% to $347,000, and the average payment to surgical specialists increased 1.8% to $461,000.The long-range numbers show just how badly doctors in some provinces are being hit. Looking at the four years from 2011/12 to 2015/16, average billings per physician in Ontario fell more than 6% from $372,041 to $348,056, the Globe and Mail reported. However, other regions did better: during that four years in Quebec average annual gross billings per doctor rose more than 21%. In Manitoba during that period they were up 10% and in Alberta it was 8.8%."A combination of cut, plus unilateral action by the government, has put funding for medical services in Ontario in a difficult spot," Dr. Shawn Whatley, president of the Ontario Medical Association, told the Globe and Mail.Facts and figuresIn 2015–2016, the average gross clinical payment per physician ranged from $262,000 in Nova Scotia to $380,000 in Alberta.While the proportion of clinical payments has maintained close to a 70/30 split between fee-for-service (FFS) payments and alternative payment plan (APP) payments over the last several years, in 2015–2016, almost all physicians (97%) received some payments through FFS and more than two-thirds of physicians (69%) received some payments through APPs.In 2015–2016, FFS payments to physicians for clinical services totalled approximately $17.3 billion. Consultations and visits accounted for 72% of services and 66% of payments to physicians, while procedures accounted for the balance (28% of services and 34% of payments).In 2015–2016, the average cost per service paid to physicians was $64.05. Family physicians billed an average cost per service of $46.96, while medical and surgical specialists billed an average of $82.03 and $89.02 per service, respectively.Between 2012 and 2016, the number of female physicians increased by 21%, while the number of male physicians increased by 6.1%.The proportion of recent medical graduates (10 years or less since graduation) increased from 16.2% in 2012 to 20% in 2016.In 2016, about 54% of physicians younger than 40 were female; for physicians age 40 and older, the proportion was 36%.More physicians moved to Canada than abroad, resulting in a net gain of 58 physicians from international migration in 2016.“Although the supply of physicians and the total payments for their services continue to grow, over the last few years we’ve observed a reduction in the strength of that growth compared with earlier periods. This type of information is important, because by studying the supply, payments and activities of physicians we can better understand this critical part of the health workforce, whose decisions drive the utilization of most major categories of health care spending in this country," said Geoff Ballinger, manager of physician information for CIHI in a release. Average gross clinical payments by physician specialty, 2015–2016The average gross clinical payment to family medicine physicians in Canada was just more than $275,000, while medical specialists’ average gross payment per physician was $347,000 and surgical specialists’ average payment was $461,000. Ophthalmologists grossed the highest average payment, at $714,000, and psychiatrists grossed the lowest, at $266,000 per physician.Psychiatry: $266,000Physical medicine: $274,000Family medicine: $275,000Pediatrics: $294,000Neurology: $304,000Total physicians: $339,000Plastic surgery: $346,000Total medical specialties: $347,000Dermatology: $378,000Internal medicine: $389,000Orthopedic surgery: $398,000Obstetrics/gynecology: $398,000Anesthesia: $415,000Otolaryngology: $424,000General surgery: $435,000Urology: $457,000Total surgical specialties: $461,000Gastroenterology: $515,000Neurosurgery: $520,000Thoracic/cardiovascular surgery: $569,000Cardiology: $578,000Ophthalmology: $714,000Note: Saskatchewan, Alberta, the Northwest Territories and Nunavut are not included. Source: National Physician Database, Canadian Institute for Health Information.

Family doctors saw average gross payment fall by 1% last year: CIHI

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