Number of doctors in Canada rising, as are payments for their services

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$22 billion paid to physicians in 2012

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September 26, 2013—The number of physicians in Canada is at an all-time high and payments by government health plans have continued to rise, reaching $22 billion in 2012, according to the Canadian Institute for Health Information (CIHI).

Canada had more than 75,000 physicians working in 2012, a 4% increase over the prior year—and growth is likely to continue for some time. A major factor for 2012’s growth is the increased number of medical graduates, which has grown every year since 2001.

Growth in the number of physicians again outpaced population growth in Canada, continuing a six-year trend. The number of physicians per 100,000 people sat at 214 in 2012.

CIHI’s data provides a comprehensive look at how the physician workforce is changing and gives a better picture of how payments for their services are also shifting.

Overall payments to physicians for provincial- and territorial-funded services increased by 9% in 2011–2012, surpassing the increases of the previous two years (6% and 8%). The average payment was around $328,000 per physician in 2011–2012, about a 5% increase over 2010–2011.

“Expenditures on physician services account for about 15% of overall health spending, but physicians also directly influence how most health care is utilized,” says Geoff Ballinger, CIHI’s manager of physician information. “Understanding the payments and activities of physicians helps us understand not only how much we pay for their services but also how health care resources are allocated.”

CIHI calculates average gross clinical payments to physicians by combining fee-for-service payments (when doctors are reimbursed for each clinical service they provide) and alternative clinical payments (such as payments by hour or remuneration for the number of patients in a physician’s practice).

Alternative payments continue to increase

Historically, Canadian physicians have received the vast majority of their clinical payments through the fee-for-service system. Recently, medical billing trends have reflected more alternative payments:

  • Fee-for-service payments represented 71% of total clinical payments in 2011–2012, with alternative payments making up the other 29%. Alternative payments were just 11% of total payments a decade ago.
  • Alternative payments have continued to increase—up 14% over the previous year—reaching more than $6 billion in 2011–2012.
  • Use of alternative payments varied considerably among physician specialties, from none to exclusively alternative payments. It also differed across jurisdictions, ranging from 14% of payments in Alberta to 47% in Nova Scotia.

Rural areas attracting more doctors

Access to physicians, both primary care physicians and specialists, is a priority for Canadians. Since 2008, the number of physicians working in rural areas specifically has increased five times faster than the rural population. There were almost 6,400 physicians practising in rural areas in 2012.

“More doctors working in rural areas may be a sign that Canadians’ access to physician services in rural areas may be improving,” says Ballinger. “Even so, it is important to ask not just how many doctors are needed but where they are most needed and in what areas of specialty.”

The National Physician Database (NPDB) contains billing information and alternative payments from medical care plans across the country. It has detailed, comparable information on physician billings and services by province and specialty.

Scott’s Medical Database (SMDB) provides a detailed picture of the supply, distribution and migration (interprovincial/-territorial and international) patterns of Canadian physicians.