.

[-JAG-]

 

 

 

The SMA fee guide is just that, a guide. It does not reflect Saskatchewan's true payment schedule. Disregard this post. My fault for poor fact-checking!

 

 

 

[-JAG-]

.

Edited February 5, 2020 by -JAG-

[The Ace of Spades]

On 1/5/2020 at 9:40 AM, -JAG- said:

Saskatchewan also shouldn’t have a problem attracting physicians in the first place.

/thread

[ArchEnemy]

On 1/5/2020 at 10:40 AM, -JAG- said:

Was Saskatchewan’s fee schedule renegotiated recently? The billing codes for almost every specialty are significantly higher than in any other province. 
 

Ex:

Family med office visit seems to be 30-45$ pretty much everywhere else in Canada but they’re 134$ in Saskatchewan (plus supplements for patients over 55)

For urology, a lot of the major surgeries (radical prostatectomy, nephrectomy, total cystectomy) hover between 1-2k in the rest of Canada but they’re 3-6k in Saskatchewan.

Even in Alberta, where every radiologist supposedly makes millions a year (see the leaked AMA report that showed that they bill nearly 10k a day on average) a chest x-ray is 30$ but it’s 97$ in Saskatchewan. Almost all other imaging is paid at a significantly higher rate as well.

Last example: Anesthesiologists in many provinces now bill for every 15 min spent in the or instead of per case. (Psychotherapy works the same way now) In most provinces the rates for both these services are 200 an hour but they’re both 400 an hour in Saskatchewan. You get the picture.

What gives? CMA data shows that Saskatchewan’s physicians to population ratio is well within the norm for most specialties, so they don’t need to pay these rates to fill in for a huge shortage or anything like that. There are actually a greater number of family doctors in Sk relative to its population than is most other provinces. Saskatchewan also shouldn’t have a problem attracting physicians in the first place. Is life so bad there compared to
the other prairie provinces that they have to pay doctors 2-4x as much as they could make anywhere else in the country in order to retain them. Or is there something that I’m not seeing... Daily patient limit like in BC? Job shortage due to new grads flocking there? (a quick visit to saskdocs confirms that there are plenty of open positions in fm, IM, psych, anesthesia, but some are not FFS)

Searched for this everywhere online hoping for answers but couldn’t find anything, hoping that you guys could help me out.

*On most compensation surveys, such as this one from 2016 (http://www.canadianhealthcarenetwork.ca/files/2018/03/20-years-compensation-chart.pdf#page220) Sk billing is normal, but one would expect fm docs to make more than 300k at 134$/visit (I know this doesn’t include follow-ups, counselling, well baby care, etc. but those are very well compensated as well)

 

 

Perhaps SK physicians value something other than money. I have never been to SK, but from speaking to the few friends who have lived there most of their life, they tend to be less materialistic overall. Cost of living is significantly lower too compared to GTA, Vancouver or even Calgary.

Besides, once you make over a certain amount of money, your marginal tax rate is so high that you are paying more than 50% tax on your next dollar. If I knew that I was only keeping 47c of the next dollar, the incentive to work harder isn't as compelling. 

[medigeek]

1 hour ago, ArchEnemy said:

Perhaps SK physicians value something other than money. I have never been to SK, but from speaking to the few friends who have lived there most of their life, they tend to be less materialistic overall. Cost of living is significantly lower too compared to GTA, Vancouver or even Calgary.

Besides, once you make over a certain amount of money, your marginal tax rate is so high that you are paying more than 50% tax on your next dollar. If I knew that I was only keeping 47c of the next dollar, the incentive to work harder isn't as compelling. 

It goes into your corporation. You're not getting a salary. 

[ArchEnemy]

2 minutes ago, medigeek said:

It goes into your corporation. You're not getting a salary. 

Not every physician is incorporated (or chooses to). Even with a corporation, the physician is receiving a salary/dividend from their corporation, of which that amount is subjected to taxes at a rate identical to any other Canadian. 

Sure, incorporation allows one to defer income that they do not need, but this also means that the physician had worked the extra hours for money that they will likely not be able to gain access to until a later date (most likely retirement). Some may be willing to delay gratification, but not all. 

[blueoval177]

On 1/5/2020 at 9:40 AM, -JAG- said:

Was Saskatchewan’s fee schedule renegotiated recently? The billing codes for almost every specialty are significantly higher than in any other province. 
 

Ex:

Family med office visit seems to be 30-45$ pretty much everywhere else in Canada but they’re 134$ in Saskatchewan (plus supplements for patients over 55)

For urology, a lot of the major surgeries (radical prostatectomy, nephrectomy, total cystectomy) hover between 1-2k in the rest of Canada but they’re 3-6k in Saskatchewan.

Even in Alberta, where every radiologist supposedly makes millions a year (see the leaked AMA report that showed that they bill nearly 10k a day on average) a chest x-ray is 30$ but it’s 97$ in Saskatchewan. Almost all other imaging is paid at a significantly higher rate as well.

Last example: Anesthesiologists in many provinces now bill for every 15 min spent in the or instead of per case. (Psychotherapy works the same way now) In most provinces the rates for both these services are 200 an hour but they’re both 400 an hour in Saskatchewan. You get the picture.

What gives? CMA data shows that Saskatchewan’s physicians to population ratio is well within the norm for most specialties, so they don’t need to pay these rates to fill in for a huge shortage or anything like that. There are actually a greater number of family doctors in Sk relative to its population than is most other provinces. Saskatchewan also shouldn’t have a problem attracting physicians in the first place. Is life so bad there compared to
the other prairie provinces that they have to pay doctors 2-4x as much as they could make anywhere else in the country in order to retain them. Or is there something that I’m not seeing... Daily patient limit like in BC? Job shortage due to new grads flocking there? (a quick visit to saskdocs confirms that there are plenty of open positions in fm, IM, psych, anesthesia, but some are not FFS)

Searched for this everywhere online hoping for answers but couldn’t find anything, hoping that you guys could help me out.

*On most compensation surveys, such as this one from 2016 (http://www.canadianhealthcarenetwork.ca/files/2018/03/20-years-compensation-chart.pdf#page220) Sk billing is normal, but one would expect fm docs to make more than 300k at 134$/visit (I know this doesn’t include follow-ups, counselling, well baby care, etc. but those are very well compensated as well)

 

 

 

Common visit code is a 5B which is $70, full physical 3B is $134. Both well compensated as next door it is 40 and 100 respectively. SK Chronic management perks more aggressive as well. I did not see limits on daily visits for FM. Perhaps this helps to allow for more time per visit.

I have some speculation. There may be a retention issue going on where they can't keep docs for more than 1-3 years. I see it plenty where we get staff, specialists or GP's, that get recruited and leave. Some smaller communities are revolving doors. There is generally an age cohort set to retire and they may be posturing to be financially very competitive. Its complex why people stay and go with many factors at play. Prairie provinces generally have to dangle a carrot for high end fields in contrast to GTA/Van, but have a lower cost of living (if you can handle the winters). 

Hard to say how long it will last if they are paying that much better, especially given the cutbacks and atmosphere in Alberta next door. Not exactly "booming" economically in Western Canada either. Interesting nonetheless.

 

[BigM]

Just briefly glancing over the psychiatry billing codes, saying that they are double what Ontario pays wouldn't be far off.

[Raptors905]

They make way more. If you looks t ICU a day 1 is 1k vs 330 in Ontario. 
 

I guess the key is that it’s Sask. Not a lot of people want to live out there so they need to keep docs happy. It’s not like the GTA where docs are begging for table scraps. 

[LostLamb]

Agree with Raptor905.  You work long and hard and you delay gratification for so long, so you’ll want to have access to those perks of what you’ve worked for...not everyone is ready to give up on it any longer. Unless you’re connected to Sask or need the extra pay that badly, it’s not enticing enough. And for those who’ll move for the money, like said above—most will work for a set period to pay back debt and then move out.

[NLengr]

On 1/25/2020 at 9:28 PM, Raptors905 said:

 
 

I guess the key is that it’s Sask. Not a lot of people want to live out there so they need to keep docs happy. It’s not like the GTA where docs are begging for table scraps. 

Sask also has a pretty strong economy so relative to other provinces, they can afford to pay more to attract and keep people. 

[1029384756md]

Hate to break it to you but the fee schedule you posted here is from the SMA which says what physicians should be compensated. If you look through the fee schedule from the provincial government it's comparable to ontario: https://www.ehealthsask.ca/services/resources/establish-operate-practice/Pages/Physicians.aspx

 

[-JAG-]

On 1/31/2020 at 12:56 PM, 1029384756md said:

Hate to break it to you but the fee schedule you posted here is from the SMA which says what physicians should be compensated. If you look through the fee schedule from the provincial government it's comparable to ontario: https://www.ehealthsask.ca/services/resources/establish-operate-practice/Pages/Physicians.aspx

 

Makes sense, no one could be that good at negotiating envelopes. Will update main post for future viewers. I have to admit that some of the numbers were far too good to be true!