The findings from the Canadian Institute for Health Information, which compiled billing and compensation information from all 10 provinces, found Alberta doctors, on average, received gross payments of almost $350,000 in 2010-11 — the most recent year of which statistics are available.
That ranks just ahead of Ontario doctors’ compensation of $340,000, but was 14-per-cent higher than the national average of $307,000.
It’s the second year in a row Alberta physicians have led the country. The previous three years they ranked second in Canada, said Walter Feeney, CIHI’s program lead for the database.
He noted the figures are gross payments and do not take into account taxes or any overhead physicians may incur, such as office rent, staff costs and utilities.
The study also found that Alberta was part of a trend in which the growth in physician compensation across the country slowed somewhat in 2010-11. The province’s doctors saw average gross payments increase by 2.8 per cent from the previous year, slightly below the national average of 3.1 per cent.
Feeney suggested the study’s data could play a role in the ongoing negotiations between the Alberta government and the Alberta Medical Association, in which compensation is one of the major issues in dispute.
“It’s basically intended to be a tool to be used in those negotiations, to say here’s what the national picture looks like,” he said. “It’s intended to be useful for either or both sides.”
AMA president Dr. Michael Giuffre said he has no concerns that the high pay earned by Alberta doctors will colour how the public views the current negotiations. He said most doctors pay overhead costs equal to between 40 and 60 per cent of their gross compensation. Whatever is left is then taxed at a rate of 40 per cent.
“So when people do the math, they go, ‘Well if I went to school for 10 or 12 years and delayed my income that length of time, that’s not fantastically high income. It’s actually quite reasonable income for the amount of education and amount of responsibility doctors have,’ ” Giuffre said. “That’s why it’s never been in the court of public opinion against the doctors.”
Health Minister Fred Horne said its common knowledge in health circles that Alberta physicians are generally the best paid in the country, which has been a deliberate strategy of the province to attract and retain the best doctors.
“We certainly don’t make any apologies for leading the country in this regard.”
He said the province currently spends $3.4 billion, or 22 per cent of the health budget, on physician compensation, but that some adjustments need to be made to ensure money is going to the right areas.
As an example, he said 20 per cent of Albertans report having no access to a family doctor, psychiatrists are in short supply, and the province has only 20 geriatricians at a time when the population is aging.
“These three areas are among the lowest paid in the physician workforce in Alberta and what we need to be doing is using the fee structure as a way to provide an incentive to get more of those physicians in place for the future,” Horne said.
As the CIHI report notes, doctors are typically paid in one of two ways. The most common system is a fee-for-service model, in which doctors bill the government a set rate each time they perform a particular service.
But the report indicates a shift has started across Canada in recent years toward more “alternative payment programs,” in which doctors could be paid a salary, an hourly wage, or a sum determined by how many patients are registered with their practice.
Alberta lags behind the rest of the country in this change, as about 85 per cent of the money paid to doctors in Alberta is still delivered through fee-for-service, the report says.
Both Horne and Giuffre said the current negotiations include discussions about adopting more alternative payment methods. Paying a physician a salary or by the hour might allow them to spend more time with patients rather than racing to rack up as many service fees as possible, they said.
However, there are some concerns such a model may prove inefficient and leave patients waiting longer to see a doctor.
Giuffre said his organization is calling for a system that allows some choice of compensation that’s appropriate for a doctor’s field.
“With palliative care physicians, they might spend half a day with one family, so that type of doctor would not fit into a fee for service model. Or transplant surgeons. It frees up such people to provide optimal care.”
Alberta’s doctors have been without a contract since March 2011, but the dispute turned particularly bitter late in 2012 after the province announced it was moving ahead with a four-year fee package.
The $463-million package included a 2.5-per-cent increase and cost-of-living increases over three years, but also reduced funding for some specialties. Doctors said it would mean $210 million in cuts over the next five years.
It’s unclear if the province now plans to reduce its offer, after announcing earlier this month that “tough choices” would have to be made as a result of lower-than-expected energy revenues.
The province and the AMA had previously set a deadline of Feb. 28 to reach a deal, but that has now been pushed back since the government has delayed its budget announcement until March 7.
Original Article
Source: edmonton journal
Author: Keith Gerein
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