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Old 01-10-2004, 10:05 PM
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Default how doctors get paid

Hi, I have another question. This is one that may be best answered by posting a link with the appropriate link, since I'm sure it is discussed somewhere.

I'm looking for a detailed description of the way in which physicians receive pay in Canada. Here are my specific topics of interest:

a) how do family physicians operating outside of hospitals.. in private practice... get paid? Is it that they bill their respective provincial government for all of the services rendered?

b) how do specialists operating in hospitals get paid? In other words, these would have some teaching responsiblities in the hospitals. Are they salaried? DO they not receive pay for every patient they see?? What about for when they are on call, do they get extra pay for the time they are on call, or do they just need to do a certain amount of call for a certain period?

c) how are hospital surgeons paid?

d) how do private practice specialists get paid? Is it also fee-for service?

e) can surgeons have private practices? if so, how are they paid? where do they do their surgeries... do they have to book time in a hospital o.r., or do they have their own operating rooms???

as a concluding item... about what amount do you think the AVERAGE of each of the above make per hour... not that I am basing any decisions on this... but i would like to be informed....

:hat :smokin
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Old 01-11-2004, 10:28 AM
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Everyone is fee for service -family docs, specialists, surgeons, 'private practice' specialists etc. There are very few exceptions to this - notably pathologists (they are employees of the hospital) and emerg docs in London (they are on an 'alternative funding plan' - kind of like a salary, and paid by the same funding body that they would have billed for fee for service). The OB/Gyn department at UWO is talking about switching to an 'alternative funding program' but it hasn't happened yet.... and some family doctors have signed up for 'family health networks' which is a variation of the alternative funding plan concept but is a lot more complicated!

Physicians maintain their own offices (even surgeons) and their own secrataries, office expenses, etc....some have 'private' offices in your neighbourhood strip mall or professional building, others have their office within a hospital...but they are still not 'hospital employees'... and the only real difference between the two is the physical location of their office.

They then apply to hospitals for 'privileges' which will allow them to admit patients to that hospital and care for their patients while they are in the hospital.... Surgeons apply for OR time and usually snag a day a week if they are lucky! They then work out a 'call schedule' with the other physicians in their specialty at that hospital....when they are on call, they get to scoop up any new patients as their own and they cover their colleague's patients that are already there....they bill for anything that they do during the day.... Some hospitals offer some $$ just for being on call, but it depends on the hospital and the location and how desperate they are for doctors (ie this is usually seen in the smaller community hospital where there might not be enough going on for the doctor to bill for much during the on-call shift)

Now, large teaching hospitals are another story....many of those docs have 'academic appointments' with the university...meaning that they have some obligation to teach and/or do research in addition to their clinical duties. Some do more clinical work (and get paid fee-for-service) like everyone else not at a teaching hospital...they tend to get little to no compensation from the university for their teaching time (and this is another huge issue in medical education - pay $16 000 in tuition but nobody is actually getting paid to teach you - they are all volunteering to do it!). Others, that spend more of their time in teaching/research (60% +) usually receive compensation from the university they are attached to (ie they are employees of the university as a teacher/researcher) but they are fee-for-service for any clinical work that they do.

Physicians (and surgeons) at major teaching hospitals also have a small army of residents and medical students under them....residents are paid a salary by their respective provinical students don't get paid. The supervising consultant can bill for the patients that he/she has supervised a resident/student in treating...

Basically everything from talking to a patient on the phone to delivering a baby to doing a heart transplant has a billing code and a defined price tag attached to it.... thus the more you do, the more you make...up to the point where you hit your 'cap' (the max the government will pay you in a period of time) which varies with specialty and location in the provinice.
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Old 01-11-2004, 11:16 AM
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thanks for you insight

Basically everything from talking to a patient on the phone to delivering a baby to doing a heart transplant has a billing code and a defined price tag attached to it...
are these billing codes published for the general public?
if so, do you have the link?
if not, don't you think lay persons have the right to know?

thanks again :hat :smokin
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Old 01-11-2004, 11:31 AM
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Default This link should do it

This is available for anyone, Ontario numbers.
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Old 01-11-2004, 11:38 AM
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Default Re: This link should do it

I remember my prof telling me they were thinking of making itemized bills for each patient just to show them how much their visit was costing (not that they had to pay it). But I'm not sure what ever happened to that idea.

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Old 01-11-2004, 12:03 PM
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Default Re: This link should do it

Hi there blinknoodle,

I believe that the province of Alberta implemented a policy of that nature a while back. I know some folks who lived in Calgary back in those days and quite enjoyed receiving their physician's services statement. I'm not sure if this initiative is still in place. :rolleyes

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Old 01-11-2004, 01:08 PM
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Default Re: This link should do it


this is indeed what i was looking for... thanks :hat :smokin
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Old 01-11-2004, 01:18 PM
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Default Re: This link should do it

I remember this one patient complaining about how when they were in the US they had to pay $400 for an emergency room consult with a couple of X-rays. They then went on to go on about how great it was they didn't have to pay for that in Canada. My response was: "But excuse me, you do!"

Don't get me wrong, I'm all for the Canadian Health Care system over the American system. Heck, maybe if Howard Dean gets in the White House they'll be more like us (or wouldn't it be funny if we privatized and things flip-flopped!) But it is really, really, really annoying to have people show up in the emergency department for prescription renewals (especially if they complain about the wait while you're dealing with three people with chest pain!!) This is a horrible abuse of the system: It costs $200 to be assessed in emerg the minute you step in the door. . . to get your family doctor to do it would cost the system $17.30, $28.50 if a BP check was included or any other complaints were brought up. Same goes for a sore throat, cold, mosquito bite, mild headache, or number of other things I've seen in emerg. . .

Those of you applying to medicine and wondering what to NOT do as it could jeapordize your chances of admission. . . don't show up to emerg for ridiculous stuff like that. Emerg docs interview for med school admissions as well, and if you happen to have the emerg doc who saw you in emerg for an OCP* (ie birth control) renewal, they probably won't take you too seriously when you start talking about how important it is to manage resources wisely in the Canadian Health Care system.

*Sorry, don't mean to pick on women but I couldn't think of a prescription med more often prescribed to this age group. :\
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Old 01-12-2004, 07:35 PM
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Default re:

The office I'm working at are joining/starting an FHN. The gist (sp?) of it is that instead of fee for service they get a set amount of $ per year regardless of how many times they see the pt. There are differents rates for the various pt types (i.e. an 80 year old is worth more per year than a 16 year old). In theory they should make the same or more per year than under FFS. There are also health incentives, i.e., if you get 80% of your pts vaccinated agaist flu (or Td) you get a bonus, if you get 90% of your gals to have paps/mammos you get a bonus. If you sign on new pts you get a bonus. If you take on nutters (meant in the nicest way possible) you get a bonus, etc. In return you have to offer evening and some weekend hours and be on call sometimes. The biggest thing is that if your pts go to walk-in clinics or see other GP 'specialists' (sports med, psychotherapy) you get docked cash, so it is in your best interest not to let that happen. Hopes that helps.

p.s. those bonuses seem to work, you should see how much flu vaccine we went through!
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