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The cost of providing physician services across Canada climbed 3.7 per cent last year to $25-billion, but payments to individual doctors have essentially flat-lined, newly published data show.
The average clinical payment to physicians was $339,000 in 2015, virtually unchanged from the previous year. This reflects the fact that provinces are increasingly taking a hard line with physicians as they try to contain costs, which has resulted in bitter labour battles, such as the one continuing with Ontario doctors.
Geoff Ballinger, CIHI's (Canadian Institute for Health Information) manager of physician information, cautioned, however, that this number does not represent salaries.
"It's important to realize that the 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," he said.
(While CIHI does not collect data on overhead costs, an earlier study in Ontario found that average overhead is about 26 per cent of payments, though that varies widely depending on specialty. The highest billers tend to be specialists who do procedures like cataract removal that require expensive equipment.)
Average clinical payments vary considerably between provinces, from a low of $268,000 in Nova Scotia to a high of $366,000 in Alberta.
And payments vary even more broadly based on physicians' specialties. CIHI data show that general practitioners receive, on average, payments of $271,000, compared with $338,000 for specialists and $446,000 for surgical specialists.
For the first time, the CIHI data include both fee-for-service payments and so-called alternative payments.
In Canada, about 70 per cent of physician payments are billed on a fee-for-service basis, meaning doctors are remunerated for specific medical acts based on negotiated fee schedules. Increasingly, physicians are paid salaries, with capitation arrangements (where they are paid a set amount per patient annually), or with a blend of payment methods.
The 3.7-per-cent increase in total physician services spending is the lowest year-over-year hike in 15 years, another indication that provinces are trying to keep a lid on spending.
Yet, the number of physicians continues to increase. The number of doctors licensed to practise in Canada grew 2.4 per cent from 2014 to 2015.
The growth in physician numbers has outpaced population growth threefold since 2011, according to CIHI.
But, again, there are important regional differences. The physician work force grew 5 per cent in both Alberta and Saskatchewan, but it shrank by 3 per cent in New Brunswick and 2 per cent in Newfoundland and Labrador.
There are now 82,198 licensed physicians in the country – more than there have ever been, in absolute numbers or per capita, and that trend will likely continue for the foreseeable future.
Canada's 17 medical schools graduated 2,817 new MDs last year. The number of graduates has jumped 12 per cent in the past five years.
One of the most noteworthy trends revealed in the CIHI data is the rise in female physicians. From 2011-15, there was a 23.7-per-cent increase in female practitioners, compared with 7.3 per cent for males.
Almost 45 per cent of family doctors and 35 per cent of specialists in Canada are women.
Mr. Ballinger said collecting this sort of data is important for fashioning sound public policies. "Understanding the supply, payments and activities of physicians across the country helps us to understand not only how many physicians there are and how much we pay for their services, but also how health-care resources are allocated," he said.
André Picard