Originally published in The Ottawa Citizen July 9, 2002
Original Title: Who Wants to be a Millionaire

How much are doctors paid? It varies depending on the medical specialty. Certainly some specialties provide a greater income for its 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 3000 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% more than the actual fees.

After three years for a bachelor’s degree and four years for a medical degree, the new physician enters residency. Depending on the specialty, residency can last from two to seven years. It takes nine years of university to become a family doctor, ten to 15 for other specialties. As usual the public, always ahead of our elected officials, have 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 Counseling/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 which can take 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/counseling is $50.45 per half hour. Doctors are not paid for specialist referrals, telephone consultations and telephone prescription renewals. The average office overhead expenses consume between 40 to 50% of these gross billings.

What about that Pap test or IUD that was replaced? A Pap test is $4.35; an IUD insertion is $20.80. A well baby check up including vaccination is $31.05. Deliver a baby, $338.95. If delivered after midnight, $567.74.

OHIP pays for 90 minutes of counseling per topic per year. There are no such restrictions for psychotherapy. Many illnesses 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 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-complaint the patient. Costs increase due to unused medications, deteriorating medical conditions and increased hospital admissions.

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

• Gross income: $162,123.21. (The figure oft quoted by governments)
• Office overhead: $63,799.77.
• Medical dues and licensure: $4446.00.
• RRSP contributions: $13,500.
• Taxable income: $77,539

He works an average 50 hours per week including weekends. This translates into an hourly wage of $39.30 based on net income. He does not have a pension plan, vacation pay, disability benefits, EI, dental plan and sick days. These all have to be paid out of his after tax income.

I paid $65 per hour to have my car repaired. There are television actors that portray doctors who are paid more per season than what a physician will earn in their lifetime. Despite the public perception that doctors “make lots of money”, most doctors earn a comfortable middle class income.

Office overhead is the crux of the problem. Costs increase by three to four percent 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 latest agreement with the government provided a two percent increase in fees the last two years with the latest increase being one percent this past April.

Our society idolizes celebrities and sports personalities and willingly contributes to their lucrative salaries. How much are nine to 15 years of university training plus the years of practice experience worth? The markets usually decide these things. But our system is centrally controlled. We all live with it because of the choices we make. I do not think you will encounter many physicians who will complain about their salaries. I write this column to counter the common media mantras that we are fat cats earning gazillions of dollars.

We are indeed privileged to have the opportunity to practice medicine. All of us want to just get on with what we do best. If we are to have others determine our fees, all we ask is to be treated fairly like anyone else.

By the way, the surgeon’s fee for a hip replacement: $675.60, a heart transplant: $1400.75. My last car tune up: $800. And no one had to worry about the life of the car.

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© Dr. Barry Dworkin 2002