DMITRY KALINOVSKY
Our Salaries Series has generated a lot of comments about the professions we've profiled, and the article on doctors was no exception.
Here are just a few comments we received online about the good, the bad and the ugly side of being a doctor.
Well paid, not overpaid
Arr wrote that doctors are well paid, but are not overcompensated when compared with others in the private sector:
My accountant bills at $250 an hour, which is more than I am paid on contract to a provincial health authority. My mechanic charges $104 an hour to fix my car. The plumber charges $80 an hour for his time. So the $197 an hour I get to make a determination on whether or not somebody has cancer versus a benign nothing seems fair in that context. Yes, it's a lot of money compared to what most Canadians earn, but remember the "brain drain" of 15 years ago? Well it's not a problem now.
Of greater concern to me is how we are going to fund our system for the next 20 years. We need an open and transparent public discussion about where we are willing to "cut" and what the impact will be. If this does not happen, non-medical administrators will make these decisions and the results will not be pretty.
When I started my career in family medicine in 35 years ago, I was able to admit patients I felt needed hospital care and obtain needed treatment. Today, the beds are scarce, and even if you manage to find one there's no guarantee that nursing care, physiotherapy, radiology or other services will be available in a reasonable time frame.
Physician salaries are only part of the cost of health care, and are not changing very much in relation to the overall cost of care. If anything needs closer examination, it is the persistent annual increase in the number of administrators and bean counters who are supposed to make the system more efficient but often just bog down the caregivers in a tangle of bureaucratic nightmares."
'Happy with my income'
Doc111 said he could make a lot more money if he billed outside the public health-care system, but over all, he is satisfied with his lot.
"I earn about $500,000 a year as an orthopedic surgeon. It's not just the long hours and high responsibility but the difficulty of the work and the complications I have to deal with that warrant the pay. There is no question in the private sector I would make double to triple that, but I happily accept the government fees per service as there are many non-financial benefits of the job.
"As well, the work and personal sacrifice/expense to get where I am is almost unmatched in any other job or profession. If anyone can name a job or profession that should make more, I challenge them, as there are very few. Many realtors and private entrepreneurs make much more, as do lawyers and other professionals, but you don't hear much complaining about their salary. The risks I take in the operating room are high and the problems I deal with are horrendous. I don't hear a lot of patients complaining about doctor's salaries, mostly it's the government because they see the bill every month and they know they are in deep trouble funding health care in the present and future.
Over all, I am totally happy with my income, even though I know I am worth more. It is both a huge burden and a great honour to do what I do. If the government continues to disrespect physicians and tries to severely cut their pay, the profession may just opt out of the provincial pay system and go private en masse. Then the rates will be based on market forces, not government-imposed capped fees or their choosing. Fees will double overnight and those who can't pay will be out of luck. No one wants that so the government had better change their tone on this issue.
Billings aren't the same as pay
Cantor12 said you can't really ask a physician how much he or she makes because it varies.
"We bill the government, we bill privately, and we bill [provincial workers' compensation boards], etc. Some of us teach and we get a stipend for that. It varies from how much you work to how efficient you are. It also varies as to your expenses – how much your rent is, how much you pay your staff.
"Most of us are in private practice, so we don't get a set salary from the government. Moreover, the older I get, depending on whether you spend your income or invest it, you could make a lot more just from investments.
"Thus, please don't ever ask what a 'salary' for an MD is. First, most of us don't get a 'salary.' We don't get pensions. We don't get benefits. We don't get paid vacations. We basically run a business. We are incorporated. And depending on how business savvy you are, you can make a lot of money, or not a lot."
Dr. Lancelot Gobbo wrote that he has no benefits or pension, and has to pay office and staff costs before he draws his own pay.
"Last week, I read that the average gross income in my province for doctors is $387,000. The highest gross I have ever billed is $295,000 but since I decided to try to remain sane, the gross has declined each year and was about $250,000 last year. Out of that, I spend about 40 per cent on expenses (office, two receptionists and running costs and professional expenses) and then make the maximum RRSP contribution that I am allowed. Taxes take about 50 per cent of the remainder, so my take home is about 30 per cent of the gross. Naturally, I will be unable to retire until I can get my government pension at 67, should I manage to live that long."
Demand for specialists can be slim
NanaimoJ said job prospects vary, depending on your specialty.
"[Job prospects] may be good for family doctors, but they are terrible for all types of surgery specialties: cardiology, gastroenterology, nephrology, radiation oncology and many other specialties.
"Medical students and residents who come out of training discover they can't find a job in their specialty. The public is partly funding their training, and – guess what – if physicians don't find a job in Canada, they either do more training that is further funded by the public or they go to another country. The lack of jobs for new trainees is a huge issue that does not ever seem to get reported."
onlinereader1 agreed, taking issue with our statement that "we always need more doctors."
"Yes there will always be a need for primary care physicians in remote parts of Canada, but there is absolutely no need for, say, cardiologists in Toronto or orthopedic surgeons in Ottawa.
"Right now, the lack of specialty positions is a huge problem that the public is completely unaware of, and this has its own implications to the health care system. Newly graduated trainees are doing one fellowship after another and picking up senior physicians' call shifts just to make some money to pay off loans and keep up their skills. The market is completely saturated."
Location, location, location
Ian said by e-mail that he wanted to add three points to our advice:
1. Medical training involves a good deal of delayed gratification. One invests a great deal of time and money (in terms of tuition and deferred wages) before beginning to see returns.
2. Medicine is an uncompromising profession. To be good at the job, and stay good, it takes a lot of time. Many people start in medicine with lots of interests and find they have little time to pursue any of them to a significant degree. Balancing practice and family life is also challenging.
3. You may not get to choose where you live. Particularly with clinical specialties, there may be regional shortages or surpluses. This means that physicians may need to relocate to get work. This seems obvious; however, after 11 years of training in addition to undergraduate studies, I thought I would have had more flexibility to choose where I live.
It's a hard life
Annabelle, who said she is the mother of one doctor and the mother-in-law of another, said her relatives work incredibly long hours and take their work along, even on vacation.
"They need understanding parents to fund the education because even with student loans they often are hard pressed for the rent. Anyone who thinks this is easy money has the wrong idea."
Responses have been edited and condensed.