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July 9, 2002.

Doctors not paid as much as you think

Dr. Barry Dworkin
The Ottawa Citizen

What are doctors paid? It varies depending on the medical specialty. Certainly some specialties provide a greater income for practitioners, but on average most physicians are not pulling in the big bucks as perceived by the public.

In March 2000, the Coalition of Family Physicians, representing 3,000 Ontario family doctors, commissioned a survey by Northstar Partners asking Ontarians how much they thought their family doctors were paid for different services. People provided estimates that were as much as 300 per cent more than the actual fees.

After four years for a bachelor's degree and four years for a medical degree, the new physician enters residency. Depending on the specialty, residency lasts from two to seven years. It takes nine years of university to become a family doctor, 10 to 15 for other specialties.

As usual, the public, always ahead of our elected officials, has clearly stated through the Northstar survey that family doctors are not remunerated at the rate they expect.

The four most common fees or billing codes used by family physicians (FPs) are the Minor, Intermediate, General Assessment (GA) and Counselling/Psychotherapy.

The minor involves the evaluation of one body system. A sore toe, simple blood pressure check or suspicious mole would qualify for this code.

An intermediate assessment evaluates two body systems. These include visits for colds, abdominal or chest pain, headaches, rectal bleeding or HIV, amongst others.

The GA or annual exam includes a complete history and physical examination that takes 30 to 45 minutes to complete.

Ontarians estimated that family doctors are paid an average of $106.60 for an intermediate exam and $153 for an annual examination. Two thirds of respondents said that FPs are paid for specialist referrals and receive about $68.70 for this service. The actual fees are $17.30 (minor), $27.30 (intermediate), $54.10 (GA) and psychotherapy/counselling is $50.45 per half hour.

Doctors are not paid by OHIP for specialist referrals, telephone consultations and telephone prescription renewals.

The average office overhead expenses consume between 40 and 50 per cent of these gross billings.

What about that Pap test or an IUD that was replaced? A Pap test is $4.40; an IUD insertion is $21. A well baby checkup including vaccination, is $30.75. Deliver a baby, $338.95. If delivered after midnight, $571.98.

OHIP covers 90 minutes of counselling per topic per year. No such restrictions exist for psychotherapy. Many illnesses like diabetes require more than 90 minutes a year to answer patients' questions, address their concerns and provide adequate information. This is especially true for adolescent patients. Well-informed patients who understand their condition are more likely to accept their physician's recommendations and follow their treatment plan.

The ministry believes that rationing this aspect of care will save money. In fact the less informed, the more non-compliant the patient. Costs increase due to unused medications, deteriorating medical conditions and more hospital admissions.

One of my colleagues provided a breakdown of his yearly salary for 2000.

Gross income: $162,123.21. (The figure most quoted by government)

Office overhead: $63,799.77.

Medical dues and licensure: $4,446.00.

RRSP contributions: $13,500.

Taxable income: $77,539

He works an average of 50 hours per week including weekends. This translates into a pre-tax hourly wage of $39.72. There is no pension plan, vacation pay, disability benefits, EI, dental plan and sick days. Payment for these comes out of after-tax income.

Office overhead is the crux of the problem. Costs increase by three to four per cent per year. Our office staff works diligently to provide the best service to our patients. It becomes difficult to reward this good work when we cannot keep pace with the cost of inflation.

The last agreement with the government provided a two-per-cent increase in fees for 2000 and 2001 and one per cent this past April.

Our society idolizes celebrities and sports personalities and willingly contributes to their lucrative salaries. Television actors who portray doctors are paid more per season than physicians earn in their lifetimes.

It is a privilege to have the opportunity to practise medicine. Despite the public perception that doctors "make lots of money," most earn a comfortable middle class income. Most physicians want to just get on with what we do best.

I write this column to counter the common media mantras that we are fat cats earning gazillions of dollars. If we are to have others determine our fees, all we ask is to be treated fairly like anyone else. To wit, the surgeon's fee for a hip replacement: $682.35, a heart transplant: $1,414.75. My last car tuneup: $800. And no one had to worry about the life of the car.

Dr. Barry Dworkin is an Ottawa family doctor who practises obstetrics and adolescent medicine. He can be reached at drbdworkin@hotmail.com .

© Copyright 2002 The Ottawa Citizen

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