“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.
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 firstname.lastname@example.org or on Twitter @juliaoftoronto