Where in Canada do doctors make the most money?

We don’t know. And neither does Don Drummond.

by Julia Belluz

Giovanni Orlando/Flickr

“Since Ontario’s doctors are now the best paid in the country, it is reasonable to set a goal of allowing no increase in total compensation.”—Don Drummond, Commission on the Reform of Ontario’s Public Services 

The dust has settled from last week’s Drummond report, which landed with both a thud (its 500 pages outlined suggested incisions to public sector spending) and a whimper (commentators said the economist’s policy recommendations about health care were the same tired ones we’ve heard for decades, and that the report was nothing more than a well-timed exercise in political theatre by Ontario’s McGuinty government.)

Still, at least one disputatious question lingered: How richly are Ontario physicians compensated?

At a time when the Ministry of Health is entering fee-deal talks with the province’s doctors, Drummond’s suggestion that “Ontario’s doctors are now the best paid in the country” peeved the Ontario Medical Association, which sits across the table from the government in the negotiations.

OMA president Dr. Stewart Kennedy said Drummond was off. “CIHI (the Canadian Institute for Health Information) states the average gross payment for a family doctor in Ontario ranks eighth out of 10 provinces and is below the national average,” he retorted in a statement.

Really?

It looks like Kennedy got that figure from this report (table A.6.1). To get a better handle on the data, Science-ish called Michael Hunt, director of pharmaceuticals and health workforce information at CIHI. Hunt explained that the report Kennedy referred to is a little more nuanced than it seemed in his statement. CIHI used fee-for-service compensation to compare the provinces, since it is still the most widely used payment model across Canada (over 70 per cent of doctors are paid this way).

However, CIHI’s data doesn’t capture all the other ways in which doctors are compensated. If it did, Hunt said it “would change what those numbers look like.” A growing number of physicians in Canada are paid through alternative payment schemes, which according to Health Canada, include salaries or blended payments, such as fee-for-service plus targeted incentives for providing certain services (e.g. managing chronic diseases like diabetes). By 2009, some 73 per cent of total clinical payments were fee-for-service while about 27 per cent were made through alternative plans. Keep in mind, the proportion of fee-for-service payments to physicians differs from province to province. In 2008-2009, 74 per cent of Newfoundland doctors were paid fee-for-service, compared to 85 per cent in B.C. and 52 per cent in Ontario.

“In Ontario,” explained Hunt, “the family medicine sector has significant funding from Alternate Payment Plans. Thus it’s difficult to assign rankings from our data.” For this reason, CIHI recommends proceeding with caution when using their numbers to rank payments.

So where do doctors make the most in Canada?

Beyond CIHI’s data it seems we don’t have the numbers for net physician income across the provinces, which would be appropriate for the kind of ranking both Drummond and Kennedy undertook for their opposite political ends. (After Drummond’s report, the McGuinty government confirmed Ontario’s doctors won’t see a pay raise anytime soon.)

Science-ish tried to get the source behind Drummond’s claim (it did not appear in his report). Drummond pointed Science-ish to the Ministry of Health. Two spokespeople got back noting the limitations of CIHI’s data, and suggesting that a recent report by ICES on physician compensation in Ontario showed that “Ontario is well ahead of other provinces in terms of total physician compensation.” That report, however, does not provide evidence of this, and when pressed, the Ministry could not offer more by way of an explanation.

The College of Physicians and Surgeons of Ontario, as well as Dr. Irfan Dhalla, one of the authors of the ICES report, also could not say where Drummond’s statement about Ontario’s doctors being tops came from.

Rick Glazier, a senior scientist at ICES who studies physician compensation, confirmed Science-ish’s suspicions. “We don’t have this data and I am not aware of a data source.” He went on: “It’s actually shocking that we don’t know. This is an enormous public expense running into many billions of dollars and the fact that it’s not accounted for and can’t be compared across jurisdictions is pretty telling that no one is minding the store. Shouldn’t we as tax payers know where the dollars are being spent?”

Science-ish is a joint project of Maclean’s, The Medical Post, and the McMaster Health Forum. Julia Belluz is the associate editor at The Medical Post. Got a tip? Seen something that’s Science-ish? Message her at julia.belluz@medicalpost.rogers.com or on Twitter @juliaoftoronto




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Where in Canada do doctors make the most money?

  1. “Shouldn’t we as tax payers know where the dollars are being spent?”

    Damn straight! Given that such a comparison would need to find some fair and impartial way to assess the various compensation models across all jurisdictions, it seems like something a federal body would want to look into; you know, maybe the folks under the Minsister of Health, or Stats Can. But since that would mean actually gathering accurate, meaningful statistics, we’ll likely have to wait for a change of government…

  2. I am in the business of brokering doctors to third party payers.  At least in the GTA they are making an astonishing income.  Depending on specialty 250000 to 600000 annually for what amounts to 8-20 hours a week of work on top of their typical week.  The government needs to open their eyes and stop letting the OMA walk all over them.  I remember in 2002 before the payment structure was changed for the MD’s nobody was dying on the streets and enough Mercedes still got sold.  In europe in most jurisdictions the average salary in our terms is 75-80,000 dollars a year for the average MD.  In the past, the extra school and extra time needed a higher degree of compensation for the missed opportunity cost.  What the government needs to look at is how many University bound students need a masters these days to be competitive and unemployment is 8.6% in the GTA.  Let capitalism rule and stop subsidizing there lifestyle.  Believe me they do well enough for the time and money they invested.  Its 2012 in a ultra competitive environment…..such is life; and they will……

    • The guys making 600K are likely dermatologists as they are a top money earner.  Internal medicine specialists are one of the bottom earners in the specialties.  I am interested in what you said about working “8 to 20 hours a week ON TOP OF THEIR TYPICAL WEEK” .  So what you are saying is that these physicians are working 48 to 60 hours a week, if their “typical week” was 40 hours long.  I have a relative who is a specialist in a big city.  He works 24 hours every 5 days in addition to working his regular 40 hour week.  He was in one of those low paying specialties and because it did not generate much fee for service and therefore not many interested candidates, they started paying people in the specialty a salary.  This doctor not only sees patients in the hospital but he trains medical students and residents.  It took him 12 years of university and residency to obtain his specialty, twice the time it takes to get a master’s degree and I am not sure but I am not aware of any master’s degree that involves saving lives.
      Another physician I know is a pediatric heart specialist.  It took him 17 years to obtain his specialty.  He did his residency in three different countries around the globe and operates on newborn premies with bad hearts.  You want to pay him $80K?  How would he ever pay off his education debt?

      • @Healthcare Insider – I’m with you, especially on your last comment.

        Residents get paid very little. The longer you are a resident, the more you are specialized, but those are years that you are barely making an income, let alone paying off debt.

        • Yes, when my family member was a resident he worked 300 hours a month and made $25K a year…..when he wasn’t working, he was studying and trying to catch up on his sleep.  People have no idea what the life of some physicians is like, especially those who work nights in the hospital…brutal!

    • Yup… You guessed it, I’m an MD. And it will be a cold day in hell before you ever broker me out to anybody, buddy! Also, why don’t you go to medical school, tow the line until your nuts are down on the floor and then see how many years you have left to make your nest egg before you keel over from a stroke. You have an increasingly strident patient population who learn from House that all doctors are jackasses, but that we can wake the dead… And there’s the US next door, with all the temptations. Which is, by the way, what I did.
      I miss Canada because of the respect, but not jerks like a parasite who lives off doctors and then writes about them with contempt. That respect goes a long ways towards offsetting the earnings gap; at the same time, a Manhattan hot dog vendor with sufficient initiative will make as much as the average Canadian internal medicine doctor. And they don’t have the national health care system and the nurses and everybody else telling them what to do. And they don’t deal with people at the most difficult times of their lives. And they probably will even get away with the occasional bout of gastroenteritis for undercooking those hot dogs, while your doctor only needs to slip a little to kill you.

      So a word of advice: next time you decide to be a smartass, you should go back to high school and see if you can get the grades to get into med school. And next time your appendix bursts, see if you can just do it yourself. After all, if it’s so easy, if anybody can do it, you should be able to.
      Shame on you buddy. But you know what, next time you pop into my ER, I’ll just endure all the invective about how spoiled we are (I work 90 hours a week, on the average, thank you) and will still do the right thing by ya. Because it’s clear that when someone’s as ignorant as you are, they aren’t in their right mind.

    • They deserve what they earn and more. Lets say there was only 1 doctor that could do cardiac surgery. Every person in the world would give tens of thousands of dollars for him to operate on them because if they don’t they will die. A persons life is worth much more than the small amount doctors get paid to save the patient. Obviously, people can not afford to pay tens of thousands of dollars, so the government implemented a system to help those who are unable to afford it. Doctors are the top students in their class. They are those exceptional students who gave 110% during high school and university. These were the kids in class who didn’t party and they spent most of there time working instead of socializing and ‘living’.There grades are generally speaking higher than the grades for workers in any other profession. They were in University for around 12 years, and they only start getting paid when they are around 30. Now to make matters worse, they have long hours, they must deal with life and death situations constantly, and they have ridiculously high taxes that take away around 40-46% of there money. A doctor that makes 250,000 will only end up with around 154,000 after taxes. Now that doctor has to worry about paying off his massive amount of student loans, buying a house, car, furniture, electric bills, etc. If he wants to send his children to private school (which he may also have to do because of religious value) than thats more money added to the massive debt.

      So your saying that the top of the top who worked there hardest everyday, and have to endure 12 years of additional school, and they had much less fun and partying as kids, should be paid LESS? Why? Do you not find that ethically wrong? These people save your life, and you want them to sink into more debt? The result of this will be that the smartest students wont become doctors, which will result inadequate doctors doing life and death procedures. Is that what you want? To have a brain surgeon who was getting low 80′s in school, instead of the students getting 97?

  3. Since we don’t have complete data sets and competent analysis or interpretation, what do we know?? for example, is regional or local cost-of-living being factored in?

    • That’s a good point! If a doc practices in Toronto, it’s going to cost them a lot more to live there than a small town in New Brunswick, so they’re probably going to get paid more. 

  4. Don Drummond is a Genius!

    Sometimes you just can’t see the forest for the trees! Mr Drummond is a genius, not because he has given us the solutions to the province’s deficit problem but because he identified the areas that need to be addressed.  It’s up to us to cultivate the ground-work he has done and plant the solution seeds!

    One of the problem areas Mr Drummond identified for us involves the revenue sharing agreements with the horse racing industry. Millions and millions of dollars have been paid to the race track operators and the Ontario race horse breeders over the past 10 or so years under the OLG Slots at Racetrack agreements.  The 2010 payments totaled $334 million alone. Half of that goes to the track owners and operators and half goes to the horse people.

    The horse people use those funds to improve the breeding stock in the province and support race purses to attract quality breeders to the tracks.  This side of the current formula supports 55,000 jobs (according to the HLT Report on Horse Racing) in Ontario and generates tons of tax revenues and spending for and in the province.  It would be like shooting yourself in the foot to tamper with this part of the arrangement so leave it alone. The industry derives its income from three sources: wagering on horse races, the sale of Ontario-bred racehorses and slot revenue. The Ontario Horse Racing Industry Association (OHRIA) manages the use of the slot revenues.

    The second part of the formula involves payments to the track owners and operators.  These payments to the 17 Slot at Track partners totaled $169 million in 2010 and many millions in previous years. The agreements anticipated that improvements would be made to racetrack infrastructures, they did not specifically require improvements to be made and benchmarks and controls were not put in place by OLG to ensure that this would happen. Most track operators did initially make improvement to their racing facilities to accommodate the slots, some more than others. With some exceptions, much of these millions of dollars paid to the track operators simply evaporated and most certainly have not been used to improve the facilities.

    Maybe Don Drummond saw this loop-hole in the Slots at Track program or maybe not but this is where a change and a new solution should be found; a solution that will NOT affect the revenue to the horse owners.

    Here is my solution to the later problem!  Transfer the ownership of the racetracks to OLG so that 50% of this subsidy or whatever you want to call it goes back to the government to help pay down the province’s staggering deficit. There is more!  Close some of the 17 racetracks and build Super-tracks with full service casinos at geographically disbursed locations, like Woodbine, Mohawk, Ajax Down, Fort Erie, Rideau and Sudbury. Oh, did I forget some of the tracks? Yes, because we need to eliminate some to consolidate.

    Now for the bite that will hurt the most but will help both the horse people and the industry. Close the Windsor, Sarnia, Dresden, Clinton and Western Fair tracks and add a Super-track to the Dealtown Casino Initiative where the government already owns a 250 acre parcel of prime real estate and where they already have a 650,000 sq ft resort facility that can be transformed into the Dealtown Casino Racetrack and Retirement Village AT NO COST TO ONTARIO TAXPAYERS! The casino and racetrack will be paid for by one of the major gaming and hospitality developers, like Penn National or Delaware North who have impressive track records in both racetracks and casinos, or partners like Paragon Gaming of Las Vegas or Donald Trump who both have solid track records in Canada.

    Thank you Mr Drummond for identifying the problem!  Now it’s time to implement the solutions!

    By Brian Keenan, Chairman of the Dealtown Casino Initiative

    http://briankeenan.point2agent.com/blogs/dealtowncasino/default.aspx

    • You might want to use some of that horse track & casino money to put into mental health to pay for addictions counselling for gambling addicts and their families who are often left homeless when they lose everything at the track and in the casino.

      • The health care comunity is under paid, period. Our hospital system is top heavy get rid of the bureacrats and pay our doctors, nurses, emts what they are worth they are more valuble than the politician looking to cut the medical professionals pay and augment their own. Loose the bad spending go with a positive impact on the public first. Our good health professionals deserve it.

  5. Our docs SHOULD be paid well!! They take care of one of our most important assets – our health and lives.  They have to pay for years of university, and go through years of residency training (in which they might make 30K a year).  Docs don’t make these incomes straight out of med school,  these are incomes of well-established physicians.  I would much rather our physicians to be well reimbursed than to have underpaid physicians who feel undervalued, or are poached to the US. My question is why are CEOs of hospital systems making MORE than these doctors?? Compared to the CEOs, the docs are the ones with the occupational health risks, and the ones saving lives. 

  6. What a stupid article.  The author starts with a question; “Where in Canada do doctors make the most money?” Then she wastes an entire article to tell us, “We don’t know.”  Gee, Julia, thanks for the (non) information.

      I can hear Mr. Hand in Fast Times at Ridgemont High saying, “Will I graduate today?  Gee, Mr. Spicoli, I don’t know.”

  7. They deserve what they earn and more. Lets say there was only 1 doctor that could do cardiac surgery. Every person in the world would give tens of thousands of dollars for him to operate on them because if they don’t they will die. A persons life is worth much more than the small amount doctors get paid to save the patient. Obviously, people can not afford to pay tens of thousands of dollars, so the government implemented a system to help those who are unable to afford it. Doctors are the top students in their class. They are those exceptional students who gave 110% during high school and university. These were the kids in class who didn’t party and they spent most of there time working instead of socializing and ‘living’.There grades are generally speaking higher than the grades for workers in any other profession. They were in University for around 12 years, and they only start getting paid when they are around 30. Now to make matters worse, they have long hours, they must deal with life and death situations constantly, and they have ridiculously high taxes that take away around 40-46% of there money. A doctor that makes 250,000 will only end up with around 154,000 after taxes. Now that doctor has to worry about paying off his massive amount of student loans, buying a house, car, furniture, electric bills, etc. If he wants to send his children to private school (which he may also have to do because of religious value) than thats more money added to the massive debt.

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