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The salary of the average Canadian doctor has spiked to nearly 4 1/2 times that of the average worker, even though individual doctors aren't providing patients with more services, a new report concludes.

On average, Canadian doctors gross $387,000 a year, a salary that has increased by about 30 per cent over the past decade.

"What's really been driving physician income has been the really rapid increase in fees," said Hugh Grant, an economist at the University of Winnipeg who co-authored the report published by the University of Calgary's School of Public Policy.

"Fees have gone up a lot, and services per person haven't. They've been virtually unchanged."

The research comes as Canada's provinces face mounting pressure to curtail growing health-care costs and an aging population leans more heavily on the system.

Each province has its own negotiations between its physicians, who provide medical services, and the government, which foots the bill. Prof. Grant said in the last decade doctors have succeeded in winning that public debate, driving up salaries.

"On the one hand, the physician organization is saying, 'The government is underfunding the system, and we need more money to improve your health,' " Prof. Grant said. "Whereas the government's sitting there saying, 'Costs are running out of line,' appealing to taxpayers by saying 'There's only so much we can afford.' "

Canada's "brain drain" to the United States has largely disappeared, Prof. Grant said, as Canadian incomes have risen and job opportunities south of the border have dried up.

In recent negotiations, both Alberta and Ontario, which have some of the highest physician incomes in the country, have tried to rein in doctors' wages.

Last year the Ontario Medical Association agreed to freeze doctors' overall pay for two years, locking funding for physician services at $11-billion annually.

Alberta Premier Alison Redford struck a similar deal with her province's physicians this spring, working out a seven-year contract that freezes doctors' wages for the first three years.

"I'm really encouraged, because of what we've been able to achieve in this new agreement, that we're going to be tackling some of the issues that are discussed in the report in a meaningful way," said Alberta Health Minister Fred Horne. "But they do have to be addressed, and I think it's true in every province, not just Alberta."

Doctors' average income varies widely by province. Ontario doctors lead the country with an average annual gross income of $470,000. Doctors in Quebec and B.C. have the lowest average income, making about $300,000 a year.

Dr. Michael Giuffre, president of the Alberta Medical Association, argued that by zeroing in on physician incomes, Prof. Grant's report only looks at one expense in a complex system.

"If we look at the health-care expenditure system, physicians represent about 15 to 16 per cent of total expenditures," Dr. Giuffre said, pointing to hospitalization and drug expenses as major costs.

Dr. Giuffre also noted the report uses gross incomes, as opposed to doctors' take-home pay after subtracting expenses.

Mr. Horne said Alberta continues to look for ways to make the system more efficient, such as giving pharmacists the ability to renew or modify prescriptions.

"We can all look at the dollars, and the dollars matter, but if we focus less on just cost reduction and we focus more on value for money, I think we would get further. And if we started to talk about these things on a pan-Canadian basis, then I think we can really go somewhere."

A spokesperson for the Canadian Medical Association said that physician pay is a matter for the individual provincial medical associations.