"MD perks causing health costs to soar"

[Guest Ian Wong]

Here's an interesting article from the Globe and Mail, which details some of the information regarding physician salaries, Ontario wage caps, signing bonuses, etc. It was printed on Jan 5, 2002. I'll include both the URL, and I think I'll Copy and Paste it here too, in case the original URL is deleted (I'm not sure if the G & M saves their old articles:

 

Ian

UBC, Med 3

 

www.globeandmail.com/serv...w=1&start_

 

MD perks causing health costs to soar

By LISA PRIEST

INVESTIGATIONS UNIT

 

Saturday, January 5, 2002 – Page A1

 

Canada is so starved for doctors that signing benefits, $60,000 annual bonuses and double-digit fee increases are being dangled, with bidding wars erupting between provinces.

 

Be they fledgling family doctors or specialists with years of experience, most provinces are trying to find ways to seduce all types of physicians to their cities and towns.

 

No other health-care workers receive these kinds of bonuses and perks, and some worry it is putting pressure on a health-care system already stressed by rising costs.

 

"We're stuck with paying our doctors very large sums of money," said Gordon Guyatt, spokesman for socially concerned physicians in the Medical Reform Group.

 

"That is certainly one of the major drivers in terms of health-care costs. The government policies of trying to constrain expenditures of physicians have just gone out the window," Dr. Guyatt said.

 

In British Columbia, doctors working in remote and rural areas are offered annual staying bonuses of up to $60,000. Alberta has seen an average 22-per-cent fee increase over two years, while Manitoba holds out signing benefits of up to $15,000. Nova Scotia offers "debt-reduction packages."

 

In Ontario, more doctors are being exempted from government-imposed caps on how much individual physicians can bill.

The province claws back money once a financial ceiling is hit.

 

Documents obtained under the Freedom of Information and Protection of Privacy Act, reveal 471 Ontario doctors were exempt from such a threshold in the fiscal year 1999-2000, including an anesthetist who topped the list by billing more than $1.5-million in professional fees that year.

 

Those same documents show a family doctor billed $652,830 and an orthopedic surgeon billed $745,431. One internal-medicine specialist billed more than $1-million, while four others in that specialty billed just shy of that amount.

 

Family doctors who are not granted exemptions see their earnings clawed back after billing $340,000; for specialists, it was $420,000 in fiscal 2000-2001. The clawback rises as billings increase, according to Ontario health-ministry spokesman John Letherby.

 

Nationwide, physicians are the third-most expensive part of the health-care system. In 1999, physicians ranked behind hospitals and drugs respectively, costing $12.2-billion out of the $89.5-billion health-care system, according to figures from the Canadian Institute for Health Information.

 

Whatever doctors bill, it is important to note that this does not represent take-home pay. Out of their billings, doctors pay their overhead costs and other expenses.

 

In Ontario, the number of doctors exempt from billing thresholds has been increasing over the past few years, largely because the physicians are working in areas of high demand.

 

According to Dr. Guyatt: "Anybody who complains or threatens is liable to be exempt."

 

While many industries are laying off workers or giving modest pay increases, hospitals worldwide are clamouring for all kinds of doctors, making it a boom time for the 58,000 licensed physicians in Canada.

 

"Physicians are what I would call an international commodity," said Henry Haddad, president of the Canadian Medical Association. "A lot of countries in the world are looking for physicians. . . . There's really an international market for them."

 

But pediatric neurosurgeon Vivek Mehta of the University Hospital in Edmonton, said he is not convinced the current seller's market is necessarily a good thing.

 

"Offering the moon in Alberta, I don't think is good for the country, so I have mixed feelings," said Dr. Mehta, who moved there from Nova Scotia. "You wouldn't have this problem if there was parity."

 

Thoracic surgeon Timothy Winton packed up his five children and physician wife and moved to Edmonton from Toronto. But he did that to run a department and because of the innovative approach the province offered -- not for the pay.

 

"I'm trying to build programs that will be good for patients and good for the system at the same time," said Dr. Winton, section head of thoracic surgery for the Capital Health Authority. "I'm interested in innovation in health-care delivery and research."

 

Liver-transplant surgeon Vivian McAlister moved from Halifax to London, Ont., without even checking what the pay was, largely because he wanted to be in a centre that "could keep up with the rest of the world."

 

"It turns out it's less well-paying than in Nova Scotia," he said.

 

Still, the perks for doctors are many.

 

If a physician's spouse is also a doctor, all the better -- a job will be found for her or him, too. Have children? No problem -- employers will work out a reasonable on-call schedule.

 

Looking for a home? No worries, they can help with that, as well. And of course, there will be continuing medical education, a chance to move up in departments and many research opportunities.

 

"We're all fighting over a very finite resource," said Frank Peters, physician recruiter in Nova Scotia. "There are doctors needed everywhere."

 

Indeed, provincial governments are hiring recruiters to find doctors, attract them to the province, then dream up further incentives to keep them.

 

"My job is to recruit people to Nova Scotia who will stay and raise a family, not just to move on in two or three years," Mr. Peters said in an interview from Halifax.

 

Bob Firnesz, executive director of the medical-services branch of Saskatchewan Health, said his province tries to compete for doctors but it is not easy.

 

"We cannot compete with Alberta and we're right next door," he said.

 

Between 1996 and 2000, more Canadian doctors migrated to British Columbia, Ontario and Alberta, according to Canadian Institute for Health Information figures, than to provinces such as Saskatchewan and Newfoundland.

 

These have lost home-grown physicians, but have attracted hundreds of others from South Africa and elsewhere.

 

While every province is trying to lure doctors, there are no figures on exactly how many more are required.

 

The Canadian Medical Association is working on a three-year project to answer such questions, but said the expansion of medical-school enrolment and the luring of international medical graduates is helping.

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