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doctors' billing

The average amount that Canadian doctors bill annually is up by about 1 per cent, an overall increase that happened despite a drop in billings by family physicians and doctors practising in Ontario.

Physicians across the country billed, on average, nearly $339,000 in 2015-16, with doctors in Nova Scotia billing the least ($262,000) and those in Alberta billing the most ($380,000), according to a new report from the Canadian Institute for Health Information (CIHI).

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CIHI's latest peek into doctors' wallets comes at a moment when much of the medical profession is up in arms over the federal government's plan to change the tax rules for private corporations, including many doctors' practices.

About 66 per cent of Canadian doctors have incorporated their practices, according to the Canadian Medical Association (CMA), one of a slew of medical groups that have warned the proposed tweaks could reduce physicians' incomes and make it harder for them to save for retirement and maternity leave.

The Trudeau government has defended the tax plan as a means of reducing income inequality, saying it would affect only the wealthiest business owners.

Figuring out exactly how wealthy Canadian doctors are is a challenge, even for CIHI, the country's official health-care statistics agency. The agency has access only to gross billings, which do not reflect the overhead that most doctors pay for office space, staff, medical supplies and other costs.

CIHI also does not know how many hours today's doctors are working, and how that might affect average billings at a time when Canada has more physicians than ever before.

But the big-picture trend is clear: Average gross billings per doctor are growing more slowly than in the past, said Geoff Ballinger, manager of physician information at CIHI.

Gone are the runaway increases of 6 or 7 per cent in the first decade of this century. Instead, average annual billings for physicians across the country grew at 0 per cent, 2.3 per cent, 0.3 per cent and 0.8 per cent in the four years leading up to and including 2015-2016, the most recent year for which figures were available.

"Provinces have been perhaps more interested in reducing health-care costs in general and have been perhaps more successful in negotiating fees with the medical associations," Mr. Ballinger said. "I think that has been a big part of the moderating effect. I think the view was that those 6-per-cent annual growth rates in the past were not sustainable over the long term."

The national figures mask some significant disparities among provinces and different types of doctors.

In Quebec, average annual gross billings per doctor rose more than 21 per cent between 2011-12 and 2015-16, from $268,504 to $325,096, a larger increase than in any other province.

Prince Edward Island, Manitoba and Alberta were next, with total increases of 11.6 per cent, 10 per cent and 8.8 per cent, respectively, over the same four-year period.

In Ontario, where more than one-third of Canada's doctors practise, average billings per doctor fell more than 6 per cent over the same period, from $372,041 in 2011-12 to $348,056 in 2015-16.

That province's doctors have been without a contract for more than three years.

"A combination of cuts, plus unilateral action by the government, has put funding for medical services in Ontario in a difficult spot," said Shawn Whatley, the president of the Ontario Medical Association.

"How will this impact patient care? People understand very easily that if you spend less money on road maintenance your roads are going to be in worse shape … for some reason people think you can cut funding for medical services and still expect the same medical services. I believe history proves that wrong."

The CIHI report also lays bare huge gaps between high-billing specialists and their counterparts in family medicine and psychiatry.

Opthalmologists billed the most, on average, at $714,000 in 2015-16, followed by cardiologists ($578,000); thoracic/cardiovascular surgeons ($569,000); neurosurgeons ($520,000) and gastroenterologists ($515,000).

Family doctors, by contrast, billed an average of $275,000 a year in 2015-2016, down 1 per cent from the previous year.

The CIHI report also highlighted how Canada's physician work force is becoming both younger and more female. Among doctors younger than 40, 54 per cent are now women.

That shift could help to explain why billings are down among family doctors, although CIHI does not have the data to say for certain if more doctors are working fewer hours – a phenomenon that would drag down average gross billings.

"I think there's a common view that, in general, younger physicians just aren't that interested in working those 60- or 70-hour weeks that their older counterparts may have in the past," Mr. Ballinger said. "Lifestyle balance is very much a bigger issue for them today than it was in the past."