Quebec doctors earn third-lowest salaries in Canada

MONTREAL – As provinces attempt to negotiate salaries with their physicians, both sides can now refer to a report made public Tuesday on what Canada’s family doctors and specialists earn on average.

On the up side, doctors’ salaries are going up. However, the pay is increasing at a slower pace than in previous years. That holds true for Quebec, where doctors are the third-lowest paid in the country.

And remuneration for physicians remains the third-largest source of health-care spending, behind hospitals and drugs, according to a new report by the Canadian Institute for Health Information.

Read the full report here.

The National Physician Database report is based on billing and payment information from provincial medical care plans across the country, broken down into services and specialties per province.

Physicians’ salaries in Canada – determined according to all the services they perform, including diagnostic tests, major and minor surgeries, counselling, hospital care days and phone calls – exceeded $20 billion in 2010-2011. Quebec’s portion of that was $4 billion.

CIHI reports that these payments grew on average by six per cent in 2010-2011, down from the 7.9-per-cent growth seen a year earlier in 2009-2010, and well below the 9.7-per-cent growth in 2008-2009.

By the numbers: Doctors’ fees across Canada

In Quebec, however, the payments grew by eight per cent in 2010-2011, just over eight per cent in 2009-2010, and 13.4 per cent in 2008-2009.
Explore the data: click on the tabs to switch charts.

In an effort to balance the provincial budget, the Parti Québécois government asked doctors in November to put off for as long as seven years their 9.2-per-cent average pay increase.

The national average gross clinical payment per physician last year was about $307,000. The provincial pay ranged from the highest in Alberta at $349,655 per doctor and in Ontario at $340,020. Canada’s lowest-paid physicians live in Prince Edward Island, where the average pay is $235,768, followed by Nova Scotia with $250,486, then Quebec at $253,539.

While Quebec doctors earn less, their salaries are increasing at a faster rate than the national average when viewed over the last five years, said CIHI senior analyst and report co-author Walter Feeney.

“From 2006 to 2010, we see the average payments in the country increase by about 23 per cent, whereas in Quebec, they increased by 34 per cent,” Feeney said.

The report provides a portrait of salaries in the public sector alone.

For the first time, CIHI’s report combines various types of pay, going beyond the per-service payments described above to include alternative types of payment such as flat salaries, contracts, hourly rates and financial incentives for doctors who take on more patients.

Historically, about 90 per cent of doctor’s pay in Canada was from per-service billing, which now represents 75 per cent of remuneration, Feeney explained.

In Quebec, for example, 69 per cent of total payments to family physicians were based on per-service billing, representing an average salary of $217,633. In comparison, half of all payments to family physicians in Ontario are fee-for-service, and the other half is through alternative payments. In Ontario, an average gross fee-for-service full time equivalent family doctor earns about $235,893.

“What we’ve seen over time is a shift, a faster growth rate in alternative payment than in fee-for-service. Over time, provinces have developed different contracts and plans and programs to meet their own needs to best fill physicians and provide services for their population,” Feeney said. “With these different options, we see more and more uptake by physicians.

“What it comes down to is what works best for them.”

The average per-service payment was $54, up by 5.3 per cent from last year. Family doctors billed an average of $40, a 3.6-per-cent increase, while specialists billed $74, a 6.8-per-cent increase per service.