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DOCTOR PAY BY THE NUMBERS
Average gross fee-for-service payment per Alberta physician who received at least $60,000 in payments in 2010-11
Physical Medicine: $296,888
Family medicine: $316,335
Orthopedic Surgery: $459,951
Plastic Surgery: $479,010
Internal medicine: $487,178
General Surgery: $513,969
Thoracic/Cardiovascular Surgery: $770,914
Source: Canadian Institute for Health Information
Notes: Figures shown are before taxes. They do not take into account other sources of income beyond fee-for-service payments, nor do they take into account a doctor’s overhead costs. Neurosurgeons in Alberta do not receive fee for service payments as they are compensated through a different model.
Average gross clinical payment per physician, by province, 2010-11
New Brunswick: $264,299
N. L.: $260,166
Nova Scotia: $250,486
P. E. I: $235,768
National average: $307,482
Source: Canadian Institute for Health Information
Notes: Figures shown are before taxes. Payments include both fee for service as well as alternative payment plans. They do not take into account a doctor’s overhead costs.
TYPICAL REVENUE STREAMS FOR PHYSICIANS
While exceedingly difficult to account for all the variables that determine how much Alberta doctors take home in pay, here are some typical revenue streams and costs for four different types of physicians.
Family doctors are generally among the lowest earners in their profession. Of the 3,600 family physicians in Alberta, the province says just 26 had billings of more than $1 million last year. Family practices operate on different models but often have two to five doctors who pool their revenues and decide how to share the wealth and the office costs.
• The fee-for-service system is the dominant income source. The most common is a simple office visit at $36, but the fee is 20 per cent higher if the patient is 75 or older. The rate for a complete physical is $89.
• Doctors can also bill patients directly for uninsured services. Some offices, for example, may charge for writing a sick note, doing a phone consultation or completing forms. But they can’t bill for writing a prescription.
• Some general practitioners take shifts in emergency departments. Others may work in an Alternative Relationship Plan, in which they share in a set block of funding to provide ongoing care to a particular population.
• Staff pay and benefits are by far the biggest costs. Family practices need administrative help to run their offices, while some employ other health professionals.
• Basic office costs include rent, utilities, office supplies and furniture, computer equipment, insurance, security and maintenance.
• Doctors must also buy their own medical supplies, from tongue depressors and cotton swabs to latex gloves and exam tables.
Emergency Room Doctor:
Like family physicians, ER doctors typically get paid through fee-for-service, though the services they provide tend to be a bit different.
• Fees may include $368 for a resuscitation, $300 for a trauma assessment of a severely injured patient, $107 to perform an intubation, and between $27 and $95 for doing rotation duty.
• Groups of ER doctors, such as those who work at a specific hospital, may pool together their bills and decide among themselves how to divide it.
• Emergency room physicians often have the lower expenses than their counterparts since much of the support staff, supplies and equipment they need are provided by the hospitals where they work.
• Such doctors still have some costs, including administrative help, and fees for the College of Physicians and Surgeons.
Many surgeons have a “blended” mode of income in which they use fee-for-service, and receive additional money for academic work.
• Fees for a cardiac surgeon include $293 for an open-chest heart massage, $5,181 for a heart transplant, and $2,070 for a triple bypass, while the implantation of a pacemaker runs between $540 and $1,100, depending on the difficulty.
• Each surgery may generate several fees depending on what needs to be done. Separate fees are charged for the services of an anesthesiologist and surgical assistant.
• Surgeons have limited operating room time, so many of their fees are generated from office work, such as consultations with patients.
• Teaching and research duties are often paid separately, though a surgeon’s university.
• A handful of surgeons, such as Alberta neurosurgeons, do not charge fees. They are instead paid through an Academic Alternative Relationship Plan in which they share a block of funding to perform both clinical and academic work.
• Surgeons maintain offices, which are sometimes located in hospitals. All the associated costs apply: staff, rent, supplies and equipment.
Eye specialists are often among the highest earners in their profession, making money in both the public and private systems. They also have among the highest costs.
• Ophthalmologists spend time in hospitals, but many also own private clinics equipped with operating suites. These private facilities can be contracted to perform publicly funded procedures such as cataract removals. AHS covers the clinic’s overhead costs for such surgeries (staff, equipment, utilities, etc.), while doctors still bill a fee for their surgical work.
• The fee for a cataract extraction is $490, a cornea transplant is $946, and suturing a damaged cornea is $405. There are also fees for consultations and various patient examinations.
• Ophthalmologists can also bill patients directly for procedures that are not provincially funded, such as laser eye surgery. The costs vary from provider to provider. Lasik surgery is typically between $1,000 and $2,000 for both eyes.
• Ophthalmologists have office expenses like other doctors, but can have particularly high costs for specialized equipment.
• There may also be higher staff costs, as private clinics that perform surgery likely need to have nurses and other professionals on the payroll.