N A T I O N A L AVERAGE PAYMENT

N A T I O N A L AVERAGE PAYMENT
NATIONAL
P H Y S I C I A N
D A T A B A S E
AVERAGE PAYMENT
PER PHYSICIAN REPORT, CANADA
1999/2000 AND 2000/2001
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
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Fax: (613) 241-8120
www.cihi.ca
ISBN 1-55392-157-7 PDF
 2003 Canadian Institute for Health Information
Cette publication est disponible en français sous le titre
« Rapport sur les paiements moyens par médecin Canada,
1999-2000 et 2000-2001 » ISBN 1-55392-159-3 PDF
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Table of Contents
Foreword................................................................................................................. i
Preface ..................................................................................................................iii
Introduction ............................................................................................................ 1
Methodological Notes............................................................................................... 2
Background.......................................................................................................... 2
Data Sources and Collection .................................................................................. 2
Data Quality......................................................................................................... 6
Data Definitions.................................................................................................... 7
Computations....................................................................................................... 8
Data Limitations ................................................................................................. 10
Privacy and Confidentiality................................................................................... 12
Products and Services ......................................................................................... 13
Data Tables
Average Payment per Fee-for-service Physician Who Received at Least $60,000 in
Payments by Type of Practice, Canada and the Provinces
Table 1-1: 1999/2000 ........................................................................................... 17
Table 1-2: 2000/2001 ........................................................................................... 18
Average Payment per Full-time Equivalent Fee-for-service Physician by Type of Practice,
Canada and the Provinces
Table 2-1: 1999/2000 ........................................................................................... 19
Table 2-2: 2000/2001 ........................................................................................... 20
Table 3-1: Average Payment per Fee-for-service Physician Who Received at
Least $60,000 in Payments by Type of Practice, Canada and the Provinces,
1999/2000 and 2000/2001.................................................................................... 21
Table 3-2: Percent Change in Average Payment per Fee-for-service Physician
Who Received Payments at Least $60,000 in Payments by Type of Practice,
Canada and the Provinces, 1999/2000 and 2000/2001 ............................................. 21
Table 3-3: Average Payment per Full-time Equivalent Fee-for-service Physician
by Type of Practice, Canada and the Provinces, 1999/2000 and 2000/2001 ................ 22
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Data Tables (cont’d)
Table 3-4: Percent Change in Average Payment per Full-time Equivalent
Fee-for-service Physician by Type of Practice, Canada and the Provinces,
1999/2000 and 2000/2001.................................................................................... 22
Average Payment per Physician by Category of Payment, Canada and the Provinces,
1999/2000 and 2000/2001
Table 4-1: Family Medicine ..................................................................................... 23
Table 4-2: Medical Specialties ................................................................................. 23
Table 4-3: Internal Medicine.................................................................................... 24
Table 4-4: Neurology ............................................................................................. 24
Table 4-5: Psychiatry ............................................................................................. 25
Table 4-6: Pediatrics .............................................................................................. 25
Table 4-7: Dermatology .......................................................................................... 26
Table 4-8: Physical Medicine ................................................................................... 26
Table 4-9: Anesthesia ............................................................................................ 27
Table 4-10: Surgical Specialties............................................................................... 27
Table 4-11: General Surgery ................................................................................... 28
Table 4-12: Thoracic/Cardiovascular Surgery............................................................. 28
Table 4-13: Urology ............................................................................................... 29
Table 4-14: Orthopedic Surgery............................................................................... 29
Table 4-15: Plastic Surgery ..................................................................................... 30
Table 4-16: Neurosurgery ....................................................................................... 30
Table 4-17: Ophthalmology..................................................................................... 31
Table 4-18: Otolaryngology..................................................................................... 31
Table 4-19: Obstetrics/Gynecology .......................................................................... 32
Table 4-20: Total Specialties................................................................................... 32
Table 4-21: Total Physicians ................................................................................... 33
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Appendices
Appendix A—Net Population Estimates................................................................... A–1
Appendix B—NPDB Authorization Officers .............................................................. B–1
Appendix C—NPDB Specialty Categories ................................................................ C–1
Appendix D—Fee-for-service Radiology and Laboratory Coverage in NPDB .................. D–1
Appendix E—Physician Counts .............................................................................. E–1
Appendix F—Population Per Physician .................................................................... F–1
Appendix G—Physicians Per 100,000 Population..................................................... G–1
Appendix H—Full-time Equivalent Methodology: History and Calculations.................... H–1
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Foreword
The Canadian Institute for Health Information (CIHI) is a national organization mandated
to coordinate the development and maintenance of a comprehensive and integrated health
information system for Canada. One way it fulfills this role is by forging alliances with
leaders in the health and health information fields.
CIHI’s mission is based upon collaborative planning with all provincial, territorial and
federal governments, as well as all other major partners in national health care services.
The Institute is responsible for providing accurate and timely information necessary to
establish sound health policies, manage the Canadian health system effectively, and create
public awareness of factors affecting good health.
The Average Payment Per Physician Report, Canada, 1999/2000 and 2000/2001 is
produced by Health Human Resources at CIHI to support health human resource planning
and utilization analysis. CIHI wishes to acknowledge the support of the Provincial/Territorial
Health Ministries and the CIHI Expert Group on Physician Databases in the development
and publication of this report.
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Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Preface
The Average Payment Per Physician Report, Canada, 1999/2000 and 2000/2001 is the
fifth Average Payment Per Physician Report produced by CIHI since the National Physician
Database (NPDB) was transferred from Health Canada to CIHI. Other previously produced
reports in the Average Payment Per Physician series include:
•
Average Payment Per Physician Report, Canada, 1998/1999 and 1999/2000 (2002)
•
Average Payment Per Physician Report, Canada, 1996/97 to 1998/99 (2001)
•
Average Payment Per Physician Report, Canada, 1993/94 to 1995/96 (1999)
•
Average Payment Per Physician Report, Canada, 1989/90 to 1993/94 (1997)
•
Average Fee Payments for Full-time Physicians by Specialty, Canada by Province,
1985/86–1988/89 (1991)
•
Average Fee Payment Per Physician and Physician/Population Ratios, Canada by
Province and Territory, 1981/82 to 1985/86 and 1986/87 Where Available (1988)
Prior to 1995, Average Payment Per Physician reports were produced by the Health
Information Division at Health Canada. These publications were produced using the
Medical Care Database (MCDB), the predecessor of the National Physician Database
(NPDB). In August 1995, both databases were transferred to CIHI.
The MCDB was developed following the implementation of the Medical Care Act in
1967 and was used to monitor the services provided and payments made by the
provincial/territorial medical insurance plans. The NPDB expanded on the MCDB by
including information on physician demographic and practice characteristics, and the
age and gender of patients.
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Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Introduction
The National Physician Database (NPDB) has been used by the federal and provincial/
territorial governments, medical stakeholder groups and various private organizations and
researchers as a data source for the average payment patterns of Canadian fee-for-service
physicians. This information is used by federal and provincial/territorial governments for
program administration, evaluation and policy development.
This publication provides information on average payments for fee-for-service physicians.
Average payment results are presented in two series:
•
per fee-for-service physician who received at least $60,000 in payments; and
•
per full-time equivalent fee-for-service physician.
Figures on the number of physicians, population per physician and physician per population
ratios for each of the three categories are also included.
Average payment results represent gross payments made to fee-for-service physicians
only. Payment figures do not represent net physician income (e.g. personal income, after
making overhead payments). Also, non fee-for-service payments made to physicians are
excluded from the figures.
It should be noted that in 2000/2001, Saskatchewan changed its policy allowing those
physicians granted a locum license by the College of Physicians and Surgeons of
Saskatchewan for more than eleven months to obtain their own billing number. The policy
amendment also applied to locums for shorter periods of time where the College indicated
the physicians’ intent to establish a practice for a period of more than eleven months.
In previous years, these locum physicians would have billed through a sponsoring
physician who had a billing number. This policy change has the effect of increasing the
number of physicians or full-time equivalent physicians and alternately reducing the
average payments.
It should be noted that 1999/2000 results were previously presented in the publication
entitled Average Payment Per Physician Report, Canada, 1998/1999 and 1999/2000.
CIHI has received updated information from provinces since the previous publication,
producing minor differences between this publication and the earlier one.
Any questions regarding the publications or the NPDB should be directed to:
Consultant, NPDB
Health Human Resources, CIHI
Suite 200-377 Dalhousie Street
Ottawa, ON
K1N 9N8
e-mail: [email protected]
Tel: (613) 241-7860
Fax: (613) 241-8120
CIHI 2003
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Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Methodological Notes
Background
The National Physician Database (NPDB) provides information on the demographic
characteristics of physicians and their level of activity within the Canadian medical
care system and is used by governments, professional associations, consulting firms,
pharmaceutical companies, researchers and the media for medical human resource
planning and utilization analysis. The establishment of the database was approved in
1987 by the Conference of Deputy Ministers of Health upon the recommendation of
the Advisory Committee on Health Human Resources (ACHHR).
On August 1, 1995, the NPDB was transferred to the Canadian Institute for Health
Information (CIHI). CIHI assumed the responsibilities of Health Canada in maintaining
the database. Previously, the NPDB was under the direction of the Working Group on
Medical Care Statistics (WGMCS) which was disbanded when the database was
transferred to CIHI. An Expert Group on Physician Databases was convened in April, 1996
and advises CIHI on data quality, methodology and product development matters relating
to the NPDB and the Southam Medical Database (SMDB).
The NPDB is a multi-year, multi-phase initiative. Phase 1, which is operational, contains
data on the demographic characteristics and activity levels of fee-for-service physicians.
Information on activity levels includes total payments, total services, average payment
per physician and full-time equivalent physician counts. Phase 2 is adding data on clinical
activities remunerated under alternative reimbursement plans (such as salaries, contracts
and sessional fees), and Phase 3 will contain data on non-clinical care activities of
physicians (such as teaching, research and administration).
Data Sources and Collection
NPDB Data
Data are derived from physician fee-for-service claims submitted by the provincial medical
insurance programs to CIHI. The claims data and associated physician and patient
demographic data are submitted in seven files, three of which are submitted annually and
four quarterly. Quarterly files are submitted usually within six months of the end of a
quarter and annual files within six months of the end of the fiscal year.
Files submitted include:
Title
Description
05
25
30
35
40
45
55
Utilization by Age/Sex of Patient File
Dental Services and Other Non-physician Services File
Reciprocal Billing File (Quebec does not submit this file)
Physician Characteristics File
Utilization by Fee Code and UPI File
Utilization by UPI, Sex and Age Group of Patient File
Changes to UPI File
2
File
File
File
File
File
File
File
(file not submitted by all provinces)
CIHI 2003
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Any files that do not meet appropriate layouts, as defined in the NPDB
Functional Specifications Manual, are returned to the provinces for correction
and subsequent re-submission.
For a complete description of the record layouts of these files please see the NPDB
Functional Specifications Manual, available from the Senior Analyst, NPDB, CIHI.
Average Payment Figures
Two utilization files are used to create average payment indicators, Utilization by Fee Code
and UPI File (40 File) and the Reciprocal Billing File (30 File). The Utilization by Fee Code
and UPI File contains all direct payments for fee-for-service claims by physicians,
laboratories and diagnostic facilities as well as services received by medical care plan
beneficiaries out-of-province/territory but not processed through the reciprocal billing
system (i.e. essentially services received out-of-Canada and in Quebec as well as services
excluded from the reciprocal billing agreement). The Reciprocal Billing File contains data on
out-of-province/territory services processed by the Reciprocal Billing System. This means
each province/territory sends data on services their physicians provided to out-ofprovince/territory patients. Quebec does not participate in reciprocal billing arrangements.
Type of Data: Date of Service vs. Date of Payment
Generally, utilization data files are submitted on a date of payment basis for
Newfoundland, Prince Edward Island, New Brunswick, Manitoba and Saskatchewan and
on a date of service basis for Nova Scotia, Quebec, Ontario, Alberta and British Columbia.
Provinces submitting on a date of service basis wait six months or until 98 percent of
services are captured before submitting data files for processing. Please see Table 1 for a
yearly breakdown by province of the type of data file submission.
Table 1. NPDB File Submission: Date of Service (DOS) vs. Date of Payment (DOP)
Prov
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
CIHI 2003
1999/2000
DOS
DOP
!
!
!
!
!
!
!
!
!
!
2000/2001
DOS
DOP
!
!
!
!
!
!
!
!
!
!
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Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Type of Data: Billing vs. Payment Data
All provinces, except Quebec, submit payment data. Billing data reflect the full amount
the physician billed the provincial Medical Services Plan for a particular fee code item.
Payment data reflect what was actually paid to the physician. The amount paid would be
the billed amount less any adjustments applied due to threshold values being met, income
capping or clawbacks.
In Saskatchewan payment data exclude lump sum payments made in lieu of retroactive
amendments to the Payment Schedule. These payments totaled $0.9 million in 1999/2000
and approximately $11.5 million in 2000/2001.
Payment Mode: Level of Fee-for-service Coverage
Average payment per physician data are based on physician payments/billings for
fee-for-service physicians only. The extent to which different forms of non fee-for-service
payments are used by provinces to remunerate physicians has changed over the past
several years (see Table 2). Many alternative forms of payment, such as salaried and
sessional, have become more commonplace. The use of alternative payment plans differs
by province and by specialty.
Alternative forms of reimbursement are currently not submitted to the NPDB and are not
included in the statistics presented in this report.
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CIHI 2003
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Table 2. Payment Mode: Total Physicians and Percent by Payment Mode1
Prov
Year
Total
Physicians
Nfld.
1999/2000
2000/2001
1999/2000
2000/2001
1999/2000
2000/2001
1999/2000
2000/2001
1999/2000
2000/2001
1999/2000
2000/2001
1999/2000
2000/2001
1999/2000
2000/2001
1999/2000
2000/2001
1999/2000
2000/2001
948
941
197
223
1,838
1,988
1,350
1,355
14,530
14,752
20,868
21023
2,149
2,193
1,533
1,565
4,636
4,856
7,957
8,074
P.E.I.
N.S.3
N.B.
Que.4
Ont.5
Man.
Sask.
Alta.6
B.C.
Percent by Payment Mode
FFS Only
70
70
62
55
52.8
37.9
51.2
50.3
83
82
93
83
30.2
30.0
81.6
81.7
98
98
73.1
73.2
Salary Only
Sessional Only
30
N/A
30
"
4
4
5
9
1.4
0.1
1.2
0.1
4.5
1.0
5.9
0.8
3
7
3
7
N/A
N/A
"
"
17.5 Salary/Sessional
17.2 Salary/Sessional
"
"
"
"
N/A
1
"
1
0.6
1.4
0.4
1.5
Other2
N/A
"
30
31
45.7
60.8
43.3
43.0
7
8
7
17
52.3
52.8
18.4
18.3
1
1
24.9
24.9
N/A = Not applicable.
Notes
1.
2.
3.
4.
5.
6.
Some physicians are primarily on one form of alternative reimbursement, but in special cases can bill fee-forservice. For example, In Ontario, physicians under alternative reimbursement plans can bill fee-for-service when
treating out-of-province patients and can bill fee-for-service when providing services to in-province patients when
the services they are providing are outside the scope of their alternative payment agreement and the services are
insured services. In Prince Edward Island, pediatricians on salary can bill fee-for-service when they are on call or
if there is a special request from the family for the physician to see their child.
“Other” includes physicians who are paid through other single alternative modes (e.g. contract, capitation)
as well as those who are paid through any combination of fee-for-service and/or alternative modes.
For 1999/2000, Nova Scotia counts include 38 physicians receiving radiology/internal medicine/pathology
payments only and 62 physicians receiving psychiatric payments only. Nova Scotia counts for 2000/2001
include 29 physicians receiving radiology/internal medicine/pathology payments only and 49 physicians receiving
psychiatric payments only.
Payment mode distributions for Quebec are based on the distribution of payments.
Figures for Ontario reflect the number of physicians who are eligible to bill on a fee-for-service basis. These
counts will differ from those in Appendix E, which reflects physicians who have received payments in each fiscal
year. Please contact the Consultant, NPDB for further information.
Figures provided are estimates.
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Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Population Data
Canadian population figures used in this publication are compiled by the Demography
Division of Statistics Canada. Statistics Canada prepares by special request, estimates of
the “covered population” for use with the NPDB data. The covered population reflects
people who received medical services paid for by provincial/territorial medical insurance
programs. The covered population is the total population less the members of the Canadian
Armed Forces, the Royal Canadian Mounted Police and inmates in federal penitentiaries.
These groups of people have their medical services covered by a federal medical insurance
program. Estimates are for October 1 of the given year and are revised annually. See
Appendix A for the net population data.
Note to Readers:
Readers wishing further information on data provided through the
cooperation of Statistics Canada may obtain copies of related
publications by mail from: Publication Sales, Statistics Canada,
Ottawa, Ontario, K1A 0K9, by calling 1-613-951-7277 or toll
free 1-800-267-6677. Readers may also facsimile their order by
dialing 1-613-951-1584.
Data Quality
Error/Validation Routines
The NPDB files are derived from provincial/territorial administrative systems and edit
checks are conducted on the data by the jurisdiction prior to processing the NPDB files.
As CIHI has no control over these edit checks, all data files received by CIHI are processed
through the NPDB error/validation routines. The error/validation routines are limited in
scope because the data cannot be confirmed against the source. Error/validation routines
include review of the total record counts, service counts and dollar amounts for each file,
checking each value in the fields against acceptable values, checking for invalid fee codes,
checking for Unique Physician Identifier (UPI) numbers with illogical formats and logical
review of the processed data. Any files that do not pass through the error/validation
routines are returned to the jurisdictions for correction and subsequent re-submission.
Additional Data Quality Checks
Service counts, dollar amounts and other economic indicators are validated against
previous years data and provincial/territorial annual reports.
Data providers are given the opportunity to review their own data for validity and
consistency. This publication was reviewed by the provincial/territorial medical
insurance plan authorization officers prior to publication. For a complete list of the
provincial/territorial authorization officers, please see Appendix B.
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Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Data Definitions
Full-time Equivalent Physicians
Full-time equivalent (FTE) physician counts are weighted physician counts. Physicians are
weighted based on the total payments they receive. A detailed description of CIHI’s fulltime equivalent methodology is given in Appendix H.
In summary, a physician’s FTE value is calculated using his or her total payments in
relation to set amounts that define upper and lower payment benchmarks for a medical
specialty group within a province. FTE values are calculated as follows:
FTEi
= Total_Payi / Lower_Benchmarkj
If physician i earns less than the
lower benchmark value
=1
If physician i earns an amount equal
to or within the benchmark values
= log (Total_Payi / Upper_Benchmarkj)
If physician i earns more than the
upper benchmark value
where:
•
FTEi is the FTE value assigned to the ith physician
•
Total_Payi is the sum of all payments made to the ith physician
•
Lower_Benchmarkj is the lower benchmark value set for the physician specialty group
within the home province of the ith physician
•
Upper_Benchmarkj is the upper benchmark value set for the physician specialty group
within the home province of the ith physician
Province and specialty specific benchmarks are adjusted to account for variations in
provincial fee schedules (see Appendix H). Benchmarks are reduced for provinces with
lower than average fees and increased for provinces with higher than average fees.
Thus, FTE values are payment based workload measures that can be used to compare
activity levels across medical specialty groups and provinces.
Province/Territory of Practice
Province/territory of practice is the jurisdiction where the physician is registered and
receives payments from the provincial/territorial medical care plan. Physicians may practice
in more than one jurisdiction in a given fiscal year. For example, the physician may move
from one province to another during the fiscal year, or may provide services in two
provinces on a regular basis, e.g. a physician providing services in provincial border areas
such as Ottawa-Hull. This can result in the double counting of physicians except at the
national level where physician counts are not based on province/territory of practice.
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Average Payment Per Physician Report
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Specialty
Physician specialty designations are assigned by the provincial/territorial medical care
plans and grouped within the NPDB to a national equivalent. Of the two specialties, latest
acquired certified specialty and plan payment specialty, the latter is used for the purposes
of this report.
In three provinces, Nova Scotia, Quebec, and British Columbia, data for Public Health
Specialists are reported in the General Practice figures. For all provinces/territories,
uncertified specialists, Community Medicine and Family Medicine are also grouped with
General Practice, except in Ontario where Community Medicine, Public Health,
Occupational Medicine and Pediatric Cardiology are received as Internal Medicine
Specialists. Internal Medicine includes the sub-specialties such as Cardiology,
Gastroenterology, Haematology, Rheumatology and Medical Oncology. Psychiatry includes
Neuropsychiatry. Neurology includes EEG specialists, and Physical Medicine includes
specialists in Electromyography. Specialists in the double specialty of
Ophthalmology/Otolaryngology are included with the Ophthalmologists.
Additionally, the very few Plastic Surgeons and Urologists in Prince Edward Island are grouped
into the General Surgery category for privacy and confidentiality reasons.
Physicians in Quebec may have two different status’ which include two different
specialties, one for in-province billings and one for billings outside Quebec. These two
different status’ appear on the 35 file (Physician Characteristics File) as two different
records with the same Unique Physician Identifier which results in duplicate records on the
file as far as individual physician’s are concerned. Only the second record is retained on
the NPDB system. This results in incorrect specialty assignment for some payments.
Approximately 100 physicians per year are affected by this incorrect assignment.
For a complete listing of the specialty designations and their groupings please
see Appendix C.
Unique Physician Identifier (UPI)
A unique identifier is created by the province/territory using components of the physician’s
first and last names (scrambled using an algorithm), the physician’s date of birth, gender
and place of graduation.
Computations
Counts
Two types of physician counts are presented in this report. They are counts based
on FTE values and simple head counts. Physician count results are given in Appendix E.
These counts are used to calculate results for the two average payment series presented in
this report, average payment per physician who received at least $60,000 in payments and
average payment per full-time equivalent physician.
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CIHI 2003
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
The first series, average payment per physician who received at least $60,000 in
payments, uses simple head counts. In this case, all physicians who receive payments of
at least $60,000 are counted as one physician, regardless of their clinical activity level.
The second series, average payment per full-time equivalent physician, uses physicians’
FTE values. FTE counts are the summation of physicians’ FTE values. FTE totals can be
less than, equal to or greater than simple head count values. FTE counts provide an
estimate of physician numbers, adjusting for variations in clinical workload. Physicians
earning less than the lower benchmark payment values are counted as less than one
physician, while physicians earning more than the upper benchmark payment values are
counted as more than one physician. Physicians with earnings within or equal to the
payment benchmarks are counted as exactly one physician (see Appendix H for details).
All counts are based on physicians receiving payments from provincial plans on a fee-forservice basis. Canada totals represent distinct UPIs, regardless of province, as physicians
may be registered and receiving payments in more than one province. Concurrently
registered physicians will appear as separate physicians in each province, for both average
payment series. In the average payment per physician who received at least $60,000 in
payments series, physicians are only counted once in the Canada totals. Therefore, Canada
totals will not necessarily equal the sum of the ten provinces for this series.
Physicians that receive payments under more than one specialty designation, possibly in
multiple provinces, are assigned exclusively to the specialty in which most of their
payments have been made.
Average Payment
All average payment figures are created based on a fiscal year, April 1–March 31.
Figures released in annual provincial reports may differ if they use the calendar year
rather than the fiscal year.
Average payment amounts are calculated as follows for the two data series:
Average payment per physician who received at least $60,000 in payments
Average payment amounts are reported for each medical specialty group for each province.
Average payment amounts are calculated as the sum of all payments made to physicians
who receive at least $60,000 in payments divided by the number of physicians who
receive at least $60,000 in payments.
Average payment per full-time equivalent fee-for-service physician
Average payment amounts are reported for each medical specialty group for each province.
Average payment amounts are calculated as the sum of all payments made to physicians
divided by the sum of all physician FTE values.
Both of these average payment series are being introduced, for the first time, in this
Average Payment Per Physician Report. In 2001, CIHIs Expert Group on Physician
Databases reviewed the relevance of average payment results presented in the Average
CIHI 2003
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Average Payment Per Physician Report
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Payment Per Physician Report. Based on this review, the Expert Group recommended that
the two new series be used in place of past average payment indicators.
The average payment per fee-for-service physician who received least $60,000 in
payments series replaces a previous series that used $50,000 as its inclusion threshold.
The threshold increase recognizes cumulative increases to provincial fee schedules and the
effects of inflation.
The average payment per full-time equivalent fee-for-service physician series replaces a
previous series that only included average payments made to physicians with FTE values of
1 or greater. The previous series excluded approximately 40% of physicians for whom
payment information is available. The previous series also counted physicians with FTE
values >1 as just one physician, thus potentially inflating average payment amounts. The
advantages of the new series, average payment per full-time equivalent physician, are that
it includes payments made to all physicians and the sum of all FTE values is used as a
denominator, rather than a head count sum.
As with past average payment series, physicians with multiple specialty designations are
assigned exclusively to the specialty group under which most payments have
been made.
Data Limitations
Gross and Net Payments
As noted earlier, NPDB does not contain payments made to physicians through alternative
payment programs. Also, average payment figures shown in this report are not adjusted to
account for overhead expenses incurred by physicians. Thus, average payments may not
represent gross income (i.e. income from all sources) or net income (i.e. personal income).
Provinces/territories vary with respect to overhead expenses incurred by physicians
as well as payments made to physicians through alternative reimbursement programs.
Provincial/territorial medical associations gather information on physicians’ overhead
expenses and may be able to provide estimates that would allow adjustments to be
made to gross payment amounts. With respect to alternative payments, as shown in
Table 2, the Atlantic provinces and Manitoba have proportionately more physicians
receiving payments through non fee-for-service arrangements.
Specialty Designations
Provinces/territories are requested to provide two types of specialty information on the
NPDB files—latest acquired certified specialty and payment plan specialty. The latest
acquired certified specialty is the most recently acquired specialty designation from the
Royal College of Physicians and Surgeons of Canada, the Corporation professionelle des
médecins du Québec or the College of Family Physicians of Canada. The payment plan
specialty may or may not be different from the latest certified specialty and should
reflect the specialty area in which the physician provides the majority of their services.
The payment plan specialty is not provided by all provinces/territories.
10
CIHI 2003
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
For the purpose of this report, the payment plan specialty is used. Provinces may
provide latest certified specialty instead of plan payment specialty if they do not have
that information available. The latest certified specialty may or may not coincide with
specialty orientation of the work actually carried out by a physician.
Additionally, any physician who practised under more than one specialty during the
fiscal year was assigned the specialty under which he/she received the majority of
his/her payments.
In 1997/1998, Newfoundland changed how it paid uncertified specialists. Prior to
October 1997, such physicians were coded as uncertified specialists and grouped
with Family Medicine for the purposes of the NPDB. Starting in October 1997,
Newfoundland’s uncertified specialists were allowed to bill as specialists and are now
reported as specialists within Average Payment Per Physician reports.
CIHI average payment per physician statistics may vary from provincial “Annual Statistics”
because of differences in the way specialties are grouped. For example, CIHI groups
Neuropsychiatry in with Psychiatry whereas Quebec groups it with Neurology. CIHI
includes Electromyography with Physical Medicine whereas Quebec does not. The subspecialties which constitute CIHI’s Internal Medicine Specialty are reported on individually
in the Régie de l’assurance maladie du Québec annual statistics report. Please refer to
Appendix C for the CIHI Specialty groupings.
Finally, base year FTE benchmark calculations for Quebec include payments made through
the provincial workers’ compensation board. Similar payments are not reported by other
provinces/territories, except British Columbia where such payments are reported after the
base year (1995/1996). As such, this report includes workers’ compensation payments
for Quebec and excludes them for British Columbia. In order to improve interprovincial
comparability, future NPDB reports will exclude workers’ compensation payments from
base year benchmark calculations as well as other NPDB indicators.
Radiology and Pathology (Laboratory) Physicians
Radiologists, pathologists and laboratory directors are excluded from this report.
Payments for radiology and laboratory services performed by a physician, who is
neither a radiologist, pathologist nor laboratory director, are included. Medical care
plan fee payments to radiologists or pathologists are nil or very small in the four
Atlantic provinces, relatively small in Quebec, but substantial in the other jurisdictions.
Omitting such payments in all jurisdictions improves comparability. See Appendix D for
information on the extent of fee-for-service payments for radiology and laboratory
services that are included in the NPDB data files, but excluded from this report.
CIHI 2003
11
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Privacy and Confidentiality
There are three safeguards utilized by CIHI to protect the privacy and confidentiality of
the physician data.
Unique Physician Identifier (UPI)
Physician names are not used on the provincial/territorial files. Instead, a Unique Physician
Identifier (UPI) is generated by the province/territory using components of the physician’s
name, their date of birth, gender and place of M.D. graduation. The name portion of the
UPI is scrambled using an algorithm known only to the provinces/territories. The UPI helps
protect the privacy and confidentiality of the physician and allows for the tracking of the
physician throughout their career in Canada.
NPDB Data Access/Release Policy
The release of data from the NPDB is governed by the NPDB Data Access/Release
Policy which was established by the provincial/territorial ministries of health and is
administered by CIHI. Depending on the type of client, the level of data aggregation, the
province/territory and indicator of interest, CIHI may not be able to release data to the
client without prior approval from the province(s)/territory(ies). Additionally, any cell
counts of less than five are suppressed and are aggregated to the next level.
CIHI Privacy and Confidentiality Policy
The release of any data from NPDB, whether as a regular product or as a custom
request, is governed by CIHI’s Principles and Policies for the Protection of Personal
Health Information and Policies for Institution-identifiable Information. Refer to CIHI’s
Web site (www.cihi.ca) for further information including a copy of the policies and
procedures document.
12
CIHI 2003
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Products and Services
There are three types of products that are generated from the NPDB—ad hoc requests,
publications and special projects. Ad hoc requests are generally short queries that do not
require major programming resources. Services counts and dollars amounts by specific fee
codes or procedures are the most common forms of ad hoc request. Most ad hoc requests
can be handled through standard reports that are generated annually. Publications currently
available include:
•
Average Payment Per Physician Report, Canada
•
Full-time Equivalent Physicians Report, Canada
•
National Grouping System Categories Report, Canada
•
Reciprocal Billing Report, Canada
For details on publication years and reporting periods covered by these reports, please
refer to the CIHI Web site (www.cihi.ca).
Special projects require project planning and the commitment of extra resources.
Please contact Health Human Resources at CIHI for costs associated with these
products and services.
CIHI 2003
13
Data Tables
Table 1-1. Average Payment per Fee-for-service Physician Who Received at Least $60,000 in Payments
by Type of Practice, Canada and the Provinces, 1999/2000
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Family Medicine
176,295
182,917
169,464
167,958
149,788
202,126
165,090
Medical Specialties
214,310
216,038
199,012
236,871
173,899
255,423
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
234,770
**
219,426
137,866
**
n/a
205,894
250,199
n/a
**
**
**
n/a
172,428
226,262
206,191
146,660
179,532
311,322
155,220
199,294
281,746
245,406
200,501
215,131
257,142
**
197,442
188,827
175,881
122,271
157,113
214,669
201,070
191,433
Surgical Specialties
288,889
300,680
310,113
282,700
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
243,965
**
345,425
210,118
**
**
333,214
459,517
274,417
315,943
n/a
**
**
**
n/a
**
**
265,457
295,164
389,417
309,396
353,690
277,419
n/a
377,977
230,264
251,991
Total Specialties
243,932
259,987
Total Physicians
203,708
212,603
Sask.
Alta.
B.C.
205,791
189,382
182,773
185,626
182,376
230,643
216,453
220,063
223,602
327,183
252,815
180,450
231,551
291,733
196,039
231,076
196,195
186,775
136,925
162,677
190,072
100,788
224,153
286,770
234,498
201,873
155,413
**
**
200,190
243,906
163,325
182,498
178,691
369,364
125,008
231,506
278,698
255,164
159,596
188,319
291,135
156,047
213,280
268,202
216,725
165,513
195,868
276,259
181,954
218,907
221,729
320,959
264,749
327,421
333,104
296,313
293,277
272,023
336,492
275,791
257,996
242,089
**
355,032
306,158
257,262
207,914
255,513
221,755
218,837
174,877
177,070
244,972
241,715
225,515
302,404
431,893
323,004
300,043
264,775
312,746
383,233
363,719
306,224
254,823
290,276
225,167
251,001
343,873
162,952
364,918
195,501
251,564
269,048
482,136
290,014
320,352
242,626
**
505,510
436,459
280,436
289,654
619,431
302,139
270,626
292,956
326,566
448,063
430,294
300,979
281,356
331,389
337,725
247,320
213,509
328,838
396,224
276,136
261,150
273,242
351,391
295,974
268,413
239,522
276,147
364,433
317,532
278,617
253,088
259,722
190,576
277,421
212,934
272,741
255,894
248,766
248,368
204,888
208,357
170,255
237,449
189,424
231,766
216,724
209,105
214,327
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
17
Canada*
Table 1-2. Average Payment per Fee-for-service Physician Who Received at Least $60,000 in Payments
by Type of Practice, Canada and the Provinces, 2000/2001
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
170,984
187,816
171,736
166,157
154,326
204,698
183,408
197,183
191,851
184,264
188,601
Medical Specialties
217,866
205,671
202,051
230,545
177,694
262,539
196,101
231,265
220,052
224,643
230,366
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
244,479
111,668
200,580
158,823
206,038
n/a
229,970
255,365
n/a
**
**
**
n/a
172,835
222,791
256,250
146,240
165,048
343,528
157,187
206,201
281,900
236,312
181,727
215,397
227,763
**
187,822
193,359
176,085
120,678
158,294
215,944
203,751
183,756
341,928
258,295
180,885
231,559
294,237
194,621
236,107
209,585
197,135
143,357
176,604
198,496
141,933
244,151
281,830
242,302
205,794
160,621
**
**
199,147
246,142
172,975
188,044
184,745
371,490
123,381
232,210
288,614
246,583
162,373
196,235
293,003
154,797
213,173
276,955
219,167
169,766
200,954
275,952
180,827
222,851
Surgical Specialties
294,108
302,279
331,365
287,187
225,596
331,213
290,392
332,721
344,744
304,142
303,377
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
242,210
**
337,594
221,942
**
**
349,070
407,155
262,714
321,493
n/a
**
**
**
n/a
**
**
261,686
318,908
386,325
319,597
346,489
331,947
**
386,653
290,168
277,355
261,085
342,135
291,423
267,003
241,424
**
373,651
288,505
265,741
207,964
265,592
225,715
227,319
183,579
147,661
257,506
244,267
225,380
312,130
471,014
330,281
309,027
260,700
325,418
399,908
364,037
321,095
261,425
318,613
260,810
280,382
367,500
**
399,723
202,505
296,686
279,810
457,086
327,679
320,554
261,635
**
506,348
365,250
282,212
300,263
587,023
323,666
283,751
310,855
281,788
481,734
451,193
306,615
281,126
351,820
334,161
248,927
228,965
347,983
417,991
279,030
263,348
280,128
365,930
305,271
278,729
252,380
272,586
381,708
321,928
289,188
Total Specialties
248,493
253,975
263,366
258,311
195,011
285,488
229,227
274,075
262,189
253,905
256,352
Total Physicians
205,663
213,893
210,422
206,278
174,119
242,795
206,786
226,427
220,655
212,021
219,368
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
18
Table 2-1: Average Payment per Full-time Equivalent Fee-for-service Physician by Type of Practice,
Canada and the Provinces, 1999/2000
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Family Medicine
133,949
153,910
173,045
159,792
138,667
175,679
139,273
Medical Specialties
174,756
198,921
210,212
195,460
152,564
216,000
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
192,478
138,231
143,013
114,297
**
**
194,878
234,556
**
**
**
**
**
167,968
235,891
198,898
149,708
194,673
464,030
**
208,673
215,129
165,920
166,208
178,223
**
**
186,063
174,227
141,826
100,628
132,808
215,510
132,226
178,001
Surgical Specialties
259,913
286,758
321,537
285,466
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
207,790
**
305,686
241,725
**
**
348,771
335,358
234,365
266,618
n/a
**
**
**
n/a
**
**
**
285,185
348,809
328,748
324,124
293,098
**
361,192
368,294
299,515
Total Specialties
206,287
241,657
Total Physicians
161,093
185,289
Sask.
Alta.
B.C.
Canada*
167,127
181,019
193,863
167,816
179,221
205,140
209,919
221,150
196,157
267,994
213,030
157,141
181,775
286,973
155,930
212,942
192,779
161,037
133,925
135,962
237,467
99,018
259,801
244,202
165,912
152,846
161,270
**
**
201,848
226,589
179,259
162,560
176,412
337,446
180,043
259,638
269,019
247,976
174,672
206,834
336,245
206,155
192,383
232,479
184,640
144,685
166,418
271,806
151,290
205,366
214,815
289,484
280,073
281,807
331,934
336,360
278,650
258,199
400,253
294,956
267,169
257,354
**
328,197
300,346
263,516
198,885
223,764
224,322
203,297
170,308
175,328
235,090
244,075
227,099
268,098
478,422
297,378
287,186
242,565
274,279
333,640
332,349
273,547
254,241
353,463
289,251
261,148
270,779
**
396,104
270,377
253,477
256,667
368,395
284,344
262,417
237,848
**
338,898
308,925
267,017
290,725
511,280
328,616
302,173
298,563
301,794
403,170
379,151
310,291
304,562
428,452
351,448
295,884
257,173
335,381
405,937
330,794
337,947
254,472
351,185
289,141
263,378
234,379
253,203
328,457
306,221
269,931
264,044
235,466
172,432
239,470
213,606
238,742
249,791
260,987
223,656
210,650
193,758
155,677
205,560
173,740
193,271
208,856
220,674
193,287
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
19
Table 2-2: Average Payment per Full-time Equivalent Fee-for-service Physician by Type of Practice,
Canada and the Provinces, 2000/2001
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
134,616
156,657
177,134
159,639
144,065
176,689
150,155
164,049
185,028
196,403
170,548
Medical Specialties
178,994
196,407
216,329
195,182
161,640
219,224
189,670
207,014
213,073
227,038
202,469
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
195,779
**
138,731
125,004
**
n/a
204,991
236,865
**
**
**
**
**
171,382
238,233
218,218
153,245
190,320
478,726
**
216,412
216,797
162,447
160,984
178,364
**
**
183,979
184,342
157,315
99,260
136,286
231,866
137,921
188,663
273,301
213,074
157,433
182,487
289,028
155,217
214,264
204,496
175,586
139,467
149,754
244,099
123,134
266,633
247,036
164,463
157,337
164,817
**
**
199,656
230,237
185,888
165,016
178,771
340,118
184,123
263,877
278,807
248,305
178,600
215,807
343,520
220,114
193,085
240,482
192,015
147,256
170,076
281,155
155,391
210,170
Surgical Specialties
269,200
292,321
330,527
286,447
229,537
292,785
295,063
281,180
348,857
343,306
287,580
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
211,601
**
314,249
245,526
**
**
363,310
331,324
234,875
268,806
n/a
**
**
**
n/a
**
**
**
294,156
360,050
341,541
330,199
306,072
**
373,084
383,267
308,208
257,468
405,620
299,992
268,168
256,624
**
335,886
293,894
264,204
212,059
231,113
244,890
222,099
193,385
163,047
243,277
260,308
243,324
271,371
486,656
300,314
290,407
242,165
279,222
338,560
333,318
277,342
262,419
367,581
306,344
278,913
283,522
**
408,730
292,726
269,570
261,158
349,922
300,839
263,416
235,802
**
338,640
292,296
266,005
310,578
527,793
337,396
327,354
323,201
291,603
425,945
391,548
318,293
303,768
427,484
353,750
298,865
259,243
347,026
416,038
333,939
344,091
261,738
363,396
298,436
274,382
244,617
255,402
336,747
313,890
277,998
Total Specialties
212,534
242,000
271,831
235,907
183,720
242,719
224,286
239,102
256,784
266,622
230,860
Total Physicians
167,448
187,774
216,636
193,454
163,248
207,876
184,655
191,330
214,046
224,429
197,885
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
20
Table 3-1: Average Payment per Fee-for-service Physician Who Received at Least $60,000 in Payments
by Type of Practice, Canada and the Provinces, 1999/2000 and 2000/2001
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
1999/2000
Family Medicine
Medical Specialties
Surgical Specialties
Total Specialties
Total Physicians
176,295
214,310
288,889
243,932
203,708
182,917
216,038
300,680
259,987
212,603
169,464
199,012
310,113
253,088
204,888
167,958
236,871
282,700
259,722
208,357
149,788
173,899
221,729
190,576
170,255
202,126
255,423
320,959
277,421
237,449
165,090
182,376
264,749
212,934
189,424
2000/2001
Family Medicine
Medical Specialties
Surgical Specialties
Total Specialties
Total Physicians
170,984
217,866
294,108
248,493
205,663
187,816
205,671
302,279
253,975
213,893
171,736
202,051
331,365
263,366
210,422
166,157
230,545
287,187
258,311
206,278
154,326
177,694
225,596
195,011
174,119
204,698
262,539
331,213
285,488
242,795
183,408
196,101
290,392
229,227
206,786
Sask.
Alta.
B.C.
Canada*
205,791
230,643
327,421
272,741
231,766
189,382
216,453
333,104
255,894
216,724
182,773
220,063
296,313
248,766
209,105
185,626
223,602
293,277
248,368
214,327
197,183
231,265
332,721
274,075
226,427
191,851
220,052
344,744
262,189
220,655
184,264
224,643
304,142
253,905
212,021
188,601
230,366
303,377
256,352
219,368
Source: NPDB, CIHI
Table 3-2: Percent Change in Average Payment per Fee-for-service Physician Who Received Payments
at Least $60,000 in Payments by Type of Practice, Canada and the Provinces, 1999/2000 and 2000/2001
Nfld.
1999/2000 and 2000/2001
Family Medicine
Medical Specialties
Surgical Specialties
Total Specialties
Total Physicians
-3.01
1.66
1.81
1.87
0.96
P.E.I.
2.68
-4.80
0.53
-2.31
0.61
N.S.
1.34
1.53
6.85
4.06
2.70
N.B.
Que.
-1.07
-2.67
1.59
-0.54
-1.00
3.03
2.18
1.74
2.33
2.27
Ont.
1.27
2.79
3.19
2.91
2.25
Man.
11.10
7.53
9.69
7.65
9.17
Sask.
-4.18
0.27
1.62
0.49
-2.30
Alta.
1.30
1.66
3.49
2.46
1.81
B.C.
Canada*
0.82
2.08
2.64
2.07
1.39
1.60
3.02
3.44
3.21
2.35
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
21
Table 3-3: Average Payment per Full-time Equivalent Fee-for-service Physician by Type of Practice,
Canada and the Provinces, 1999/2000 and 2000/2001
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
1999/2000
Family Medicine
Medical Specialties
Surgical Specialties
Total Specialties
Total Physicians
133,949
174,756
259,913
206,287
161,093
153,910
198,921
286,758
241,657
185,289
173,045
210,212
321,537
264,044
210,650
159,792
195,460
285,466
235,466
193,758
138,667
152,564
214,815
172,432
155,677
175,679
216,000
289,484
239,470
205,560
139,273
179,221
280,073
213,606
173,740
2000/2001
Family Medicine
Medical Specialties
Surgical Specialties
Total Specialties
Total Physicians
134,616
178,994
269,200
212,534
167,448
156,657
196,407
292,321
242,000
187,774
177,134
216,329
330,527
271,831
216,636
159,639
195,182
286,447
235,907
193,454
144,065
161,640
229,537
183,720
163,248
176,689
219,224
292,785
242,719
207,876
150,155
189,670
295,063
224,286
184,655
Sask.
Alta.
B.C.
Canada*
167,127
205,140
281,807
238,742
193,271
181,019
209,919
331,934
249,791
208,856
193,863
221,150
336,360
260,987
220,674
167,816
196,157
278,650
223,656
193,287
164,049
207,014
281,180
239,102
191,330
185,028
213,073
348,857
256,784
214,046
196,403
227,038
343,306
266,622
224,429
170,548
202,469
287,580
230,860
197,885
Source: NPDB, CIHI
Table 3-4: Percent Change in Average Payment per Full-time Equivalent Fee-for-service Physician by Type of Practice,
Canada and the Provinces, 1999/2000 and 2000/2001
Nfld.
1999/2000 and 2000/2001
Family Medicine
Medical Specialties
Surgical Specialties
Total Specialties
Total Physicians
0.50
2.43
3.57
3.03
3.95
P.E.I.
1.79
-1.26
1.94
0.14
1.34
N.S.
2.36
2.91
2.80
2.95
2.84
N.B.
Que.
-0.10
-0.14
0.34
0.19
-0.16
3.89
5.95
6.85
6.55
4.86
Ont.
0.57
1.49
1.14
1.36
1.13
Man.
7.81
5.83
5.35
5.00
6.28
Sask.
-1.84
0.91
-0.22
0.15
-1.00
Alta.
2.21
1.50
5.10
2.80
2.48
B.C.
Canada*
1.31
2.66
2.06
2.16
1.70
1.63
3.22
3.20
3.22
2.38
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
22
Table 4-1: Average Payment per Physician by Category of Payment, Canada and the Provinces, 1999/2000 and 2000/2001
Family Medicine
Nfld.
Canada*
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
176,295
2000/2001
170,984
182,917
187,816
169,464
171,736
167,958
166,157
149,788
154,326
202,126
204,698
165,090
183,408
205,791
197,183
189,382
191,851
182,773
184,264
185,626
188,601
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
153,910
156,657
173,045
177,134
159,792
159,639
138,667
144,065
175,679
176,689
139,273
150,155
167,127
164,049
181,019
185,028
193,863
196,403
167,816
170,548
133,949
134,616
Source: NPDB, CIHI
Table 4-2: Average Payment per Physician by Category of Payment, Canada and the Provinces, 1999/2000 and 2000/2001
Medical Specialties
Nfld.
Canada*
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
214,310
2000/2001
217,866
216,038
205,671
199,012
202,051
236,871
230,545
173,899
177,694
255,423
262,539
182,376
196,101
230,643
231,265
216,453
220,052
220,063
224,643
223,602
230,366
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
198,921
196,407
210,212
216,329
195,460
195,182
152,564
161,640
216,000
219,224
179,221
189,670
205,140
207,014
209,919
213,073
221,150
227,038
196,157
202,469
174,756
178,994
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
23
Table 4-3: Average Payment per Physician by Category of Payment, Canada and the Provinces, 1999/2000 and 2000/2001
Internal Medicine
Nfld.
Canada*
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
234,770
2000/2001
244,479
250,199
255,365
226,262
222,791
281,746
281,900
188,827
193,359
327,183
341,928
196,195
209,585
286,770
281,830
243,906
246,142
278,698
288,614
268,202
276,955
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
234,556
236,865
235,891
238,233
215,129
216,797
174,227
184,342
267,994
273,301
192,779
204,496
244,202
247,036
226,589
230,237
269,019
278,807
232,479
240,482
192,478
195,779
Source: NPDB, CIHI
Table 4-4: Average Payment per Physician by Category of Payment, Canada and the Provinces, 1999/2000 and 2000/2001
Neurology
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
**
2000/2001
111,668
n/a
n/a
206,191
256,250
245,406
236,312
175,881
176,085
252,815
258,295
186,775
197,135
234,498
242,302
163,325
172,975
255,164
246,583
216,725
219,167
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
198,898
218,218
165,920
162,447
141,826
157,315
213,030
213,074
161,037
175,586
165,912
164,463
179,259
185,888
247,976
248,305
184,640
192,015
138,231
**
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
24
Table 4-5: Average Payment per Physician by Category of Payment, Canada and the Provinces, 1999/2000 and 2000/2001
Psychiatry
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
219,426
2000/2001
200,580
**
**
146,660
146,240
200,501
181,727
122,271
120,678
180,450
180,885
136,925
143,357
201,873
205,794
182,498
188,044
159,596
162,373
165,513
169,766
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
149,708
153,245
166,208
160,984
100,628
99,260
157,141
157,433
133,925
139,467
152,846
157,337
162,560
165,016
174,672
178,600
144,685
147,256
143,013
138,731
Source: NPDB, CIHI
Table 4-6: Average Payment per Physician by Category of Payment, Canada and the Provinces, 1999/2000 and 2000/2001
Pediatrics
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
137,866
2000/2001
158,823
**
**
179,532
165,048
215,131
215,397
157,113
158,294
231,551
231,559
162,677
176,604
155,413
160,621
178,691
184,745
188,319
196,235
195,868
200,954
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
194,673
190,320
178,223
178,364
132,808
136,286
181,775
182,487
135,962
149,754
161,270
164,817
176,412
178,771
206,834
215,807
166,418
170,076
114,297
125,004
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
25
Table 4-7: Average Payment per Physician by Category of Payment, Canada and the Provinces, 1999/2000 and 2000/2001
Dermatology
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
**
2000/2001
206,038
**
**
311,322
343,528
257,142
227,763
214,669
215,944
291,733
294,237
190,072
198,496
**
**
369,364
371,490
291,135
293,003
276,259
275,952
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
464,030
478,726
**
**
215,510
231,866
286,973
289,028
237,467
244,099
**
**
337,446
340,118
336,245
343,520
271,806
281,155
**
**
Source: NPDB, CIHI
Table 4-8: Average Payment per Physician by Category of Payment, Canada and the Provinces, 1999/2000 and 2000/2001
Physical Medicine
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
2000/2001
n/a
n/a
n/a
n/a
155,220
157,187
**
**
201,070
203,751
196,039
194,621
100,788
141,933
**
**
125,008
123,381
156,047
154,797
181,954
180,827
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
n/a
**
**
**
**
**
**
132,226
137,921
155,930
155,217
99,018
123,134
**
**
180,043
184,123
206,155
220,114
151,290
155,391
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
26
Table 4-9: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Anesthesia
Nfld.
Canada*
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
205,894
2000/2001
229,970
172,428
172,835
199,294
206,201
197,442
187,822
191,433
183,756
231,076
236,107
224,153
244,151
200,190
199,147
231,506
232,210
213,280
213,173
218,907
222,851
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
167,968
171,382
208,673
216,412
186,063
183,979
178,001
188,663
212,942
214,264
259,801
266,633
201,848
199,656
259,638
263,877
192,383
193,085
205,366
210,170
194,878
204,991
Source: NPDB, CIHI
Table 4-10: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Surgical Specialties
Nfld.
Canada*
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
288,889
2000/2001
294,108
300,680
302,279
310,113
331,365
282,700
287,187
221,729
225,596
320,959
331,213
264,749
290,392
327,421
332,721
333,104
344,744
296,313
304,142
293,277
303,377
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
286,758
292,321
321,537
330,527
285,466
286,447
214,815
229,537
289,484
292,785
280,073
295,063
281,807
281,180
331,934
348,857
336,360
343,306
278,650
287,580
259,913
269,200
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
27
Table 4-11: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
General Surgery
Nfld.
P.E.I.^
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
243,965
2000/2001
242,210
315,943
321,493
295,164
318,908
272,023
261,085
207,914
207,964
302,404
312,130
254,823
261,425
269,048
279,810
289,654
300,263
281,356
281,126
273,242
280,128
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
266,618
268,806
285,185
294,156
258,199
257,468
198,885
212,059
268,098
271,371
254,241
262,419
256,667
261,158
290,725
310,578
304,562
303,768
254,472
261,738
207,790
211,601
Source: NPDB, CIHI
Table 4-12: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Thoracic/Cardiovascular Surgery
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
2000/2001
**
**
n/a
n/a
389,417
386,325
336,492
342,135
255,513
265,592
431,893
471,014
290,276
318,613
482,136
457,086
619,431
587,023
331,389
351,820
351,391
365,930
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
n/a
n/a
348,809
360,050
400,253
405,620
223,764
231,113
478,422
486,656
353,463
367,581
368,395
349,922
511,280
527,793
428,452
427,484
351,185
363,396
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
^ PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
28
Table 4-13: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Urology
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
345,425
2000/2001
337,594
**
**
309,396
319,597
275,791
291,423
221,755
225,715
323,004
330,281
225,167
260,810
290,014
327,679
302,139
323,666
337,725
334,161
295,974
305,271
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
328,748
341,541
294,956
299,992
224,322
244,890
297,378
300,314
289,251
306,344
284,344
300,839
328,616
337,396
351,448
353,750
289,141
298,436
305,686
314,249
Source: NPDB, CIHI
Table 4-14: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Orthopedic Surgery
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
210,118
2000/2001
221,942
**
**
353,690
346,489
257,996
267,003
218,837
227,319
300,043
309,027
251,001
280,382
320,352
320,554
270,626
283,751
247,320
248,927
268,413
278,729
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
324,124
330,199
267,169
268,168
203,297
222,099
287,186
290,407
261,148
278,913
262,417
263,416
302,173
327,354
295,884
298,865
263,378
274,382
241,725
245,526
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
29
Table 4-15: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Plastic Surgery
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
2000/2001
**
**
^
^
277,419
331,947
242,089
241,424
174,877
183,579
264,775
260,700
343,873
367,500
242,626
261,635
292,956
310,855
213,509
228,965
239,522
252,380
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
^
^
293,098
306,072
257,354
256,624
170,308
193,385
242,565
242,165
270,779
283,522
237,848
235,802
298,563
323,201
257,173
259,243
234,379
244,617
Source: NPDB, CIHI
Table 4-16: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Neurosurgery
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
2000/2001
**
**
n/a
n/a
n/a
**
**
**
177,070
147,661
312,746
325,418
162,952
**
**
**
326,566
281,788
328,838
347,983
276,147
272,586
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
n/a
n/a
**
**
**
**
175,328
163,047
274,279
279,222
**
**
**
**
301,794
291,603
335,381
347,026
253,203
255,402
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
^ PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
30
Table 4-17: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Ophthalmology
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
333,214
2000/2001
349,070
**
**
377,977
386,653
355,032
373,651
244,972
257,506
383,233
399,908
364,918
399,723
505,510
506,348
448,063
481,734
396,224
417,991
364,433
381,708
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
361,192
373,084
328,197
335,886
235,090
243,277
333,640
338,560
396,104
408,730
338,898
338,640
403,170
425,945
405,937
416,038
328,457
336,747
348,771
363,310
Source: NPDB, CIHI
Table 4-18: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Otolaryngology
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
459,517
2000/2001
407,155
**
**
230,264
290,168
306,158
288,505
241,715
244,267
363,719
364,037
195,501
202,505
436,459
365,250
430,294
451,193
276,136
279,030
317,532
321,928
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
**
**
368,294
383,267
300,346
293,894
244,075
260,308
332,349
333,318
270,377
292,726
308,925
292,296
379,151
391,548
330,794
333,939
306,221
313,890
335,358
331,324
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
31
Table 4-19: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Obstetrics/Gynecology
Nfld.
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
274,417
2000/2001
262,714
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
Canada*
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
265,457
261,686
251,991
277,355
257,262
265,741
225,515
225,380
306,224
321,095
251,564
296,686
280,436
282,212
300,979
306,615
261,150
263,348
278,617
289,188
**
**
299,515
308,208
263,516
264,204
227,099
243,324
273,547
277,342
253,477
269,570
267,017
266,005
310,291
318,293
337,947
344,091
269,931
277,998
234,365
234,875
Source: NPDB, CIHI
Table 4-20: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Total Specialties
Nfld.
Canada*
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
243,932
2000/2001
248,493
259,987
253,975
253,088
263,366
259,722
258,311
190,576
195,011
277,421
285,488
212,934
229,227
272,741
274,075
255,894
262,189
248,766
253,905
248,368
256,352
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
241,657
242,000
264,044
271,831
235,466
235,907
172,432
183,720
239,470
242,719
213,606
224,286
238,742
239,102
249,791
256,784
260,987
266,622
223,656
230,860
206,287
212,534
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
32
Table 4-21: Average Payment per Physician by Category of Payment, Canada and the Provinces,1999/2000 and 2000/2001
Total Physicians
Nfld.
Canada*
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Fee-for-service Physicians who received
at least $60,000 in payments
1999/2000
203,708
2000/2001
205,663
212,603
213,893
204,888
210,422
208,357
206,278
170,255
174,119
237,449
242,795
189,424
206,786
231,766
226,427
216,724
220,655
209,105
212,021
214,327
219,368
Full-time Equivalent
Fee-for-service Physicians
1999/2000
2000/2001
185,289
187,774
210,650
216,636
193,758
193,454
155,677
163,248
205,560
207,876
173,740
184,655
193,271
191,330
208,856
214,046
220,674
224,429
193,287
197,885
161,093
167,448
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
n/a = Not Applicable - There were no physicians for this specialty for this province.
Notes
Please refer to tables 1-1 through 2-2 for detailed notes by year, province and series.
Based on gross payments.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
33
Appendix A
Net Population Estimates
Table A1. Statistics Canada Net Population Estimates for Canada, by Provinces, 1999 to 2000
Year
1999
2000
Nfld.
(PP)
(PR)
540.0
536.2
P.E.I.
138.5
138.2
N.S.
N.B.
932.5
934.1
750.7
750.5
Que.
Ont.
7,337.9
7,377.4
11,534.7
11,732.3
Man.
1,140.6
1,142.9
Sask.
1,024.6
1,018.4
Alta.
2,962.7
3,011.5
B.C.
4,025.2
4,058.7
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
Notes
Net population estimates are produced by excluding from total estimates the members of the Royal Canadian Mounted Police,
the Canadian Armed Forces personnel and the number of inmates in Federal and Provincial institutions.
PR=Updated postcensal estimates.
PP=Preliminary postcensal estimates.
The estimates are based on 1996 census counts, adjusted for net census undercoverage
These figures have been rounded independently to the nearest hundred.
A–1
Canada*
30,387.4
30,700.2
Appendix B
NPDB Authorization Officers
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
NPDB Authorization Officers
NEWFOUNDLAND
Dr. Ed Hunt
Medical Consultant
Medical Services Division
Department of Health & Community
Services
300 Prince Phillip Drive
3rd Floor, West Block Federation
Building
P. O. Box 8700
St. John's, Newfoundland
A1B 4J6
Phone: (709) 729-3157
Fax: (709) 729-5238
NOVA SCOTIA
Mr. Derek C. Dinham
Executive Director, Insured Programs
Branch
Department of Health
P.O. Box 488
Joseph Howe Building
1690 Hollis Street, 12th Floor
Halifax, Nova Scotia
B3J 2R8
Phone: (902) 424-6880
Fax: (902) 424-0605
QUEBEC
M. Jacques Barry
Chef
Service des statistiques
Régie du l’assurance-maladie
du Québec
1125 Chemin St.-Louis
Sillery, Quebec
G1S 1E7
Phone: (418) 682-5163
Fax: (418) 643-7381
CIHI 2003
PRINCE EDWARD ISLAND
Mrs. Johanne Irwin
Physician Services Manager
PEI Health & Social Services
16 Garfield St.
P.O. Box 2000
Charlottetown, Prince Edward Island
C1A 7N8
Phone: (902) 368-6736
Fax: (902) 368-6136
NEW BRUNSWICK
Ms. Fay Mackie
Director of Medicare
Medicare/Prescription Drug Program
Dept. of Health & Community Services
P.O. Box 5100
Carleton Place
Fredericton, New Brunswick
E3B 5G8
Phone: (506) 453-2415
Fax: (506) 453-2726
ONTARIO
Ms. Susan Fitzpatrick
Manager
Information and Project Management
Provider Services Branch
Ministry of Health
2nd Floor, MacDonald Cartier Building
49 Place d’Armes, P.O. Box 48
Kingston, Ontario
K7L 5J3
Phone: (613) 548-6524
Fax: (613) 548-6309
B–1
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
MANITOBA
SASKATCHEWAN
Ms. Deborah Malazdrewicz
Manager
Decision Support Services
Manitoba Health
4029-300 Carlton Street
Winnipeg, Manitoba
R3B 3M9
Phone: (204) 786-7169
Fax: (204) 772-7213
Ms. Carmelle Mondor
Research Officer
Medical Services and Health Registration
Branch
Department of Health
3475 Albert Street
Regina, Saskatchewan
S4S 6X6
Phone: (306) 787-3450
Fax: (306) 787-3761
ALBERTA
Ms. Linda Mattern
Director Health Workforce Planning
Alberta Health and Wellness
P.O. Box 1360 Station Main
22nd Floor, 10025 Jasper Avenue
Edmonton, Alberta
T5J 2N3
Phone: (780) 422-2720
Fax: (780) 422-2880
BRITISH COLUMBIA
Ms. Deb McGinnis
A/Senior Manager
Health Information Access Centre (HIAC)
Ministry of Health Planning & Ministry of
Health Services
7-1, 1515 Blanshard Street
Victoria, British Columbia
V8W 3C8
Phone: (250) 952-0969
Fax: (250) 952-0979
YUKON
Mr. Joe MacGillivray
Director
Insured Health Services
Yukon Government
P.O. Box 2703
2071 2nd Avenue
Whitehorse, Yukon
Y1A 2C6
Phone: (867) 667-5202
Fax: (867) 393-6486
e-mail: [email protected]
B–2
NORTHWEST TERRITORIES
Mr. Warren St. Germaine
Director
Financial & Management Services
Department of Health and Social Services
Government of the Northwest Territories
P.O. Box 1320
7th Floor, Center Square Tower
Yellowknife, Northwest Territories,
X1A 2L9
Phone: (867) 920-8931
Fax: (867) 920-4969
CIHI 2003
Appendix C
NPDB Specialty Categories
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
NPDB Physician Specialty Categories
01
Family
010
011
012
013
014
Medicine
Residency
General Practice
Family Practice
Community Medicine/Public Health
Emergency Medicine
Medical Specialists
02
Internal Medicine
020 General Internal Medicine
021 Cardiology
022 Gastroenterology
023 Respiratory Medicine
024 Endocrinology
025 Nephrology
026 Hematology
027 Rheumatology
028 Clinical Immunology and Allergy
030 Oncology
031 Geriatrics
032 Tropical Medicine
035 Genetics 1
04
Neurology
040 Neurology & EEG
041 Neurology
042 EEG
05
Psychiatry
050 Psychiatry & Neuropsychiatry
051 Psychiatry
052 Neuropsychiatry
06
Pediatrics
060 Pediatrics
07
Dermatology
065 Dermatology
08
Physical Medicine/Rehabilitation
070 Physical Medicine & Rehabilitation
071 Electromiography
09
Anesthesia
075 Anesthesia
CIHI 2003
C–1
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Surgical Specialists
10
General Surgery
080 General Surgery
11
Thoracic/Cardiovascular Surgery
086 Thoracic Surgery
087 Cardiovascular Surgery
088 Cardiovascular/Thoracic Surgery
12
Urology
090 Urology
13
Orthopedic Surgery
095 Orthopedic Surgery
14
Plastic Surgery
100 Plastic Surgery
15
Neurosurgery
110 Neurosurgery
16
Ophthalmology
115 Ophthalmology
116 Ophthalmology/Otolaryngology
17
Otolaryngology
120 Otolaryngology
18
Obstetrics/Gynecology
126 Obstetrics
127 Gynecology
128 Obstetrics/Gynecology
Note: Although Genetics is no longer a sub-specialty of Internal Medicine it is included
in the Internal Medicine category because the number of physician records
assigned this specialty is relatively small. The previous version of this publication
reported the figures as a separate specialty within the Medical Specialists broad
specialty category.
C–2
CIHI 2003
Appendix D
Fee-for-service Radiology and
Laboratory Coverage in NPDB
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Fee-for-service Radiology and Laboratory Coverage in NPDB
Radiology and laboratory services supplied to CIHI for use in NPDB are not uniform or
complete. For this reason the data are not routinely used in the NPDB publications. The
following notes were provided by the provincial medical insurance plans regarding the
radiology and laboratory services included on the NPDB file submissions.
Newfoundland
!"
!"
No laboratory services data are supplied to NDPB as these services are paid through the
hospital funding.
Physicians can be paid on a fee-for-service basis for interpretation services on certain
diagnostic services such as EEG, ECGs, etc. These services would be included in the
NPDB file submissions.
Prince Edward Island
!"
!"
No laboratory services data are supplied to NDPB as these services are paid through the
hospital funding.
Radiologists interpretation fees are included in the NPDB file submissions.
Nova Scotia
!"
!"
No laboratory services data are supplied to NDPB as these services are paid through the
hospital funding.
The majority of radiology billings are not included in NPDB file submissions. For Nova
Scotia, the majority of radiology billings are not included in fee-for-service earnings.
New Brunswick
!"
!"
No laboratory services data are supplied to NDPB as these services are paid through the
hospital funding.
All radiology services are excluded in the NPDB file submissions.
Quebec
!"
!"
No laboratory services are included.
Radiology services provided by physicians in private practice are included in the NPDB
file submissions.
Ontario
!"
!"
Approximately 50 percent of all laboratory services are funded through OHIP and
therefore are included in the NPDB file submissions. The remaining 50 percent are
funded via Public Health (1 percent) and Hospital global budgets (49 percent).
Information on Radiology services was not available.
CIHI 2003
D–1
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Manitoba
!"
!"
Laboratory services provided in the NPDB file submissions are those provided by
privately owned fee-for-service laboratories. Laboratory services provided in urban/rural
facilities are not included in the NPDB file submissions.
Radiology services submitted include all private radiology services and all urban facility
radiology services. Rural facility radiology services, approximately 11 percent of the
total dollar value for radiology services, are not included in NPDB file submissions.
Saskatchewan
"
Since 1993/1994, the only laboratory services included in the NPDB file submissions
are common in-office laboratory services provided by physicians other than
pathologists. Responsibility for private laboratory services provided by specialists in
pathology was transferred to District Health Boards in October 1993 and no longer
funded on a fee-for-service basis.
"
Facility-based radiology services which are funded through District Health Boards are
excluded from the NPDB file submissions, as well as radiology services provided
through the Screening Program for Breast Cancer.
Alberta
!"
Up to July 1, 1995 only non-hospital based laboratory services were included.
!"
Only non-facility based radiology services are included in NPDB file submissions.
British Columbia
!"
Laboratory and radiology services when performed on a fee-for-service outpatient basis
are included in NPDB File Submissions, but inpatient services are not included.
D–2
CIHI 2003
Appendix E
Physician Counts
Table E1: Fee-for-service Physician Counts of Physicians Who Received at Least $60,000 in Payments
by Type of Practice, Canada and the Provinces, 1999/2000
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
314
83
615
459
4,858
8,445
599
631
2,199
3,541
21,797
Medical Specialties
129
25
232
181
3,187
4,958
390
226
1,016
1,466
11,845
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
61
**
17
16
**
n/a
26
12
n/a
**
**
**
n/a
6
68
6
47
22
11
6
72
70
10
21
20
7
**
50
1,365
153
596
385
170
56
462
1,869
160
1,356
575
157
101
740
129
12
86
56
9
8
90
89
11
28
33
**
**
59
342
43
233
150
33
17
198
453
64
396
158
54
24
317
4,481
465
2,789
1,425
446
219
2,020
Surgical Specialties
85
27
220
180
1,706
2,505
230
174
519
885
6,532
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
23
**
7
13
**
**
11
7
16
10
n/a
**
**
**
n/a
**
**
6
50
13
20
21
11
n/a
45
18
42
33
12
18
28
13
**
26
14
32
400
60
125
249
86
46
253
159
328
630
27
189
331
129
56
371
195
577
50
17
18
32
11
6
28
17
51
50
8
15
21
14
**
22
9
33
118
16
35
83
33
17
78
29
110
190
32
69
133
56
28
158
68
151
1,557
190
498
917
354
161
992
517
1,346
Total Specialties
214
52
452
361
4,893
7,463
620
400
1,535
2,351
18,377
Total Physicians
528
135
1,067
820
9,751
15,908
1,219
1,031
3,734
5,892
40,174
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
E–1
Table E2: Fee-for-service Physician Counts of Physicians Who Received at Least $60,000 in Payments
by Type of Practice, Canada and the Provinces, 2000/2001
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
289
83
609
463
4,981
8,434
623
668
2,300
3,546
22,084
Medical Specialties
140
27
234
182
3,013
5,011
421
237
1,056
1,485
11,833
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
61
6
20
16
6
n/a
31
12
n/a
**
**
**
n/a
8
72
6
47
21
11
6
71
71
10
20
20
7
**
51
1,364
152
438
360
172
53
474
1,907
157
1,352
583
152
105
755
147
14
89
62
9
9
91
96
12
30
33
**
**
59
356
43
237
157
34
19
210
465
65
398
158
54
28
317
4,574
465
2,636
1,421
449
229
2,059
Surgical Specialties
94
27
211
175
1,706
2,515
228
173
539
865
6,539
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
22
**
7
16
**
**
12
9
18
10
n/a
**
**
**
n/a
**
**
6
47
13
20
23
10
**
46
11
40
34
11
17
27
13
**
25
14
31
400
61
128
246
82
43
253
159
334
630
26
194
341
129
55
361
201
578
52
17
17
32
10
**
28
19
48
47
8
13
24
13
**
22
10
33
124
18
34
88
34
18
79
29
115
164
49
67
134
50
26
153
69
153
1,535
209
499
935
343
157
979
521
1,361
Total Specialties
234
54
445
357
4,719
7,526
649
410
1,595
2,350
18,372
Total Physicians
523
137
1,054
820
9,700
15,960
1,272
1,078
3,895
5,896
40,456
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
E–2
Table E3: Full-time Equivalent Fee-for-service Physician Counts by Type of Practice,
Canada and the Provinces, 1999/2000
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
431.29
104.71
627.62
501.39
5,499.93
9,977.99
749.56
810.26
2,363.04
3,432.97
24,498.76
Medical Specialties
163.12
29.93
228.29
226.83
3,801.63
5,983.94
427.11
261.68
1,081.83
1,493.78
13,698.14
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
75.29
6.42
26.82
22.57
**
**
28.01
13.18
**
**
**
**
**
6.66
67.50
6.22
50.98
21.04
7.38
**
70.51
93.78
15.01
28.48
25.62
**
**
53.85
1,520.30
196.06
828.54
489.68
170.44
87.97
508.64
2,315.51
192.99
1,616.29
756.13
161.73
129.95
811.34
144.76
14.69
96.96
76.16
7.42
9.09
78.03
107.23
15.75
39.42
32.91
**
**
59.17
380.46
41.70
268.39
163.61
36.29
12.74
178.64
477.24
67.77
375.07
150.67
47.37
20.37
355.29
5,195.25
556.98
3,336.11
1,742.11
444.97
272.58
2,150.14
Surgical Specialties
95.91
28.36
213.75
181.49
1,782.07
2,808.19
220.95
204.18
525.12
789.50
6,849.52
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
27.61
**
7.91
11.49
**
**
10.64
9.66
18.97
11.85
n/a
**
**
**
n/a
**
**
**
52.26
14.59
18.83
23.13
10.42
**
47.29
11.38
35.72
35.68
10.09
17.03
27.34
12.34
**
28.29
14.38
32.70
426.91
68.64
124.16
270.76
90.77
48.05
265.02
158.85
328.91
722.61
24.40
206.80
351.07
142.48
64.85
427.68
214.97
653.33
51.61
14.03
14.35
31.06
14.10
**
25.93
12.96
51.16
53.28
10.47
15.30
25.77
14.48
**
32.99
12.73
35.23
119.42
19.43
32.18
75.37
32.40
18.40
87.01
33.02
107.89
176.83
24.81
66.73
113.71
47.42
27.55
155.90
57.51
119.04
1,678.06
190.17
505.01
933.43
365.99
176.64
1,084.36
527.18
1,388.68
Total Specialties
259.03
58.29
442.04
408.32
5,583.70
8,792.13
648.06
465.86
1,606.95
2,283.28
20,547.66
Total Physicians
690.32
163.00
1,069.66
909.71
11,083.63
18,770.12
1,397.62
1,276.12
3,969.99
5,716.25
45,046.42
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
E–3
Table E4: Full-time Equivalent Fee-for-service Physician Counts by Type of Practice,
Canada and the Provinces, 2000/2001
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
382.89
102.87
618.10
502.36
5,582.18
10,056.66
793.89
836.54
2,452.49
3,434.38
24,762.36
Medical Specialties
175.15
30.97
227.37
221.60
3,529.70
6,126.54
464.10
271.04
1,129.15
1,504.54
13,680.16
77.53
**
30.09
22.62
**
n/a
35.02
13.10
**
**
**
**
**
8.34
68.77
7.24
49.36
19.24
8.00
**
70.35
94.49
14.76
25.59
25.40
**
**
52.38
1,481.74
177.00
697.40
456.47
161.52
81.84
473.73
2,421.85
194.02
1,614.63
762.70
156.12
136.09
841.13
162.96
15.93
102.96
78.96
7.62
11.49
84.18
111.80
18.16
40.88
33.48
**
**
59.15
392.53
43.51
279.04
175.85
37.21
13.20
187.81
489.48
66.00
378.23
150.13
46.38
21.09
353.23
5,314.25
542.74
3,223.45
1,727.85
430.98
275.57
2,165.32
103.67
28.06
215.00
178.56
1,701.00
2,875.06
226.99
206.69
536.06
776.65
6,847.74
25.75
**
7.52
14.71
**
**
11.57
11.12
20.24
11.96
n/a
**
**
**
n/a
**
**
**
52.12
13.95
18.82
24.73
11.01
**
47.91
8.74
36.87
35.56
9.39
16.66
27.16
12.23
**
27.83
13.95
32.21
399.60
71.06
118.93
256.84
81.03
41.23
270.00
149.81
312.50
734.77
25.25
214.82
367.03
140.96
64.96
428.48
221.13
677.66
52.74
14.75
14.61
32.30
13.00
**
27.57
13.50
53.64
51.04
10.45
14.16
29.34
14.80
**
33.05
12.50
35.47
121.68
20.02
32.74
76.63
32.90
17.42
89.70
33.53
111.44
154.48
40.67
63.38
113.66
45.70
26.34
154.93
58.20
119.29
1,639.70
210.70
503.93
946.28
354.49
169.87
1,094.27
523.48
1,405.02
Total Specialties
278.82
59.03
442.37
400.16
5,230.70
9,001.60
691.09
477.73
1,665.21
2,281.19
20,527.90
Total Physicians
661.71
161.90
1,060.47
902.52
10,812.88
19,058.26
1,484.98
1,314.27
4,117.70
5,715.57
45,290.26
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
Surgical Specialties
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
E–4
Appendix F
Population Per Physician
Table F1: Population per Fee-for-service Physician Who Received at Least $60,000 in Payments
by Type of Practice, Canada and the Provinces, 1999/2000
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
1,720
1,669
1,516
1,636
1,510
1,366
1,904
1,624
1,347
1,137
1,394
Medical Specialties
4,186
5,540
4,019
4,148
2,302
2,326
2,925
4,534
2,916
2,746
2,565
8,852
**
31,765
33,750
**
n/a
20,769
11,542
n/a
**
**
**
n/a
23,083
13,713
155,417
19,840
42,386
84,773
155,417
12,951
10,724
75,070
35,748
37,535
107,243
**
15,014
5,376
47,960
12,312
19,059
43,164
131,034
15,883
6,172
72,092
8,506
20,060
73,469
114,205
15,587
8,842
95,050
13,263
20,368
126,733
142,575
12,673
11,512
93,145
36,593
31,048
**
**
17,366
8,663
68,900
12,715
19,751
89,779
174,276
14,963
8,886
62,894
10,165
25,476
74,541
167,717
12,698
6,781
65,349
10,895
21,324
68,133
138,755
15,043
6,353
5,130
4,239
4,171
4,301
4,605
4,959
5,889
5,708
4,548
4,652
23,478
**
77,143
41,538
**
**
49,091
77,143
33,750
13,850
n/a
**
**
**
n/a
**
**
23,083
18,650
71,731
46,625
44,405
84,773
n/a
20,722
51,806
22,202
22,748
62,558
41,706
26,811
57,746
**
28,873
53,621
23,459
18,345
122,298
58,703
29,469
85,324
159,520
29,004
46,150
22,372
18,309
427,211
61,030
34,848
89,416
205,977
31,091
59,152
19,991
22,812
67,094
63,367
35,644
103,691
190,100
40,736
67,094
22,365
20,492
128,075
68,307
48,790
73,186
**
46,573
113,844
31,048
25,108
185,169
84,649
35,695
89,779
174,276
37,983
102,162
26,934
21,185
125,788
58,336
30,265
71,879
143,757
25,476
59,194
26,657
19,517
159,934
61,019
33,138
85,840
188,742
30,632
58,776
22,576
Total Specialties
2,523
2,663
2,063
2,080
1,500
1,546
1,840
2,562
1,930
1,712
1,654
Total Physicians
1,023
1,026
874
915
753
725
936
994
793
683
756
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
Surgical Specialties
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Net population figures are used to calculate these figures.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
F–1
Table F2: Population per Fee-for-service Physician Who Received at Least $60,000 in Payments
by Type of Practice, Canada and the Provinces, 2000/2001
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
1,855
1,665
1,534
1,621
1,481
1,391
1,835
1,525
1,309
1,145
1,390
Medical Specialties
3,830
5,119
3,992
4,124
2,449
2,341
2,715
4,297
2,852
2,733
2,594
8,790
89,367
26,810
33,513
89,367
n/a
17,297
11,517
n/a
**
**
**
n/a
17,275
12,974
155,683
19,874
44,481
84,918
155,683
13,156
10,570
75,050
37,525
37,525
107,214
**
14,716
5,409
48,536
16,843
20,493
42,892
139,196
15,564
6,152
74,728
8,678
20,124
77,186
111,736
15,539
7,775
81,636
12,842
18,434
126,989
126,989
12,559
10,608
84,867
33,947
30,861
**
**
17,261
8,459
70,035
12,707
19,182
88,574
158,500
14,340
8,728
62,442
10,198
25,688
75,161
144,954
12,803
6,712
66,022
11,647
21,605
68,375
134,062
14,910
5,704
5,119
4,427
4,289
4,324
4,665
5,013
5,887
5,587
4,692
4,695
24,373
**
76,600
33,513
**
**
44,683
59,578
29,789
13,820
n/a
**
**
**
n/a
**
**
23,033
19,874
71,854
46,705
40,613
93,410
**
20,307
84,918
23,353
22,074
68,227
44,147
27,796
57,731
**
30,020
53,607
24,210
18,444
120,941
57,636
29,989
89,968
171,567
29,160
46,399
22,088
18,623
451,242
60,476
34,406
90,948
213,315
32,499
58,370
20,298
21,979
67,229
67,229
35,716
114,290
**
40,818
60,153
23,810
21,668
127,300
78,338
42,433
78,338
**
46,291
101,840
30,861
24,286
167,306
88,574
34,222
88,574
167,306
38,120
103,845
26,187
24,748
82,831
60,578
30,289
81,174
156,104
26,527
58,822
26,527
20,000
146,891
61,523
32,834
89,505
195,543
31,359
58,926
22,557
Specialists
2,291
2,559
2,099
2,102
1,563
1,559
1,761
2,484
1,888
1,727
1,671
Total Physicians
1,025
1,009
886
915
761
735
899
945
773
688
759
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
Surgical Specialties
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
Source: NPDB, CIHI
* Canada totals are ten province totals including the Yukon and excluding the Northwest Territories.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Net population figures are used to calculate these figures.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
F–2
Table F3: Population per Full-time Equivalent Fee-for-service Physician by Type of Practice,
by Type of Practice, Canada and the Provinces, 1999/2000
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
1,252
1,323
1,486
1,497
1,334
1,156
1,522
1,265
1,254
1,173
1,240
Medical Specialties
3,310
4,627
4,085
3,310
1,930
1,928
2,671
3,915
2,739
2,695
2,218
7,172
84,112
20,134
23,926
**
**
19,279
10,508
**
**
**
**
**
20,796
13,815
149,920
18,291
44,320
126,355
**
13,225
8,005
50,013
26,359
29,301
**
**
13,941
4,827
37,427
8,856
14,985
43,053
83,414
14,427
4,981
59,768
7,137
15,255
71,321
88,763
14,217
7,879
77,645
11,764
14,976
153,720
125,479
14,617
9,555
65,054
25,992
31,133
**
**
17,316
7,787
71,048
11,039
18,108
81,640
232,551
16,585
8,434
59,395
10,732
26,715
84,974
197,604
11,329
5,849
54,557
9,109
17,443
68,291
111,481
14,133
5,630
4,884
4,363
4,136
4,118
4,108
5,162
5,018
5,642
5,098
4,436
19,558
**
68,268
46,997
**
**
50,752
55,901
28,466
11,688
n/a
**
**
**
n/a
**
**
**
17,843
63,914
49,522
40,316
89,491
**
19,719
81,942
26,106
21,040
74,400
44,081
27,458
60,835
**
26,536
52,204
22,957
17,188
106,904
59,100
27,101
80,841
152,714
27,688
46,194
22,310
15,963
472,734
55,777
32,856
80,957
177,867
26,970
53,657
17,655
22,100
81,297
79,484
36,722
80,894
**
43,988
88,009
22,295
19,230
97,861
66,967
39,759
70,760
**
31,058
80,487
29,083
24,809
152,481
92,067
39,309
91,441
161,016
34,050
89,724
27,460
22,763
162,241
60,321
35,399
84,884
146,105
25,819
69,991
33,814
18,109
159,791
60,172
32,555
83,028
172,030
28,023
57,641
21,882
Total Specialties
2,085
2,376
2,110
1,839
1,314
1,312
1,760
2,199
1,844
1,763
1,479
Total Physicians
782
850
872
825
662
615
816
803
746
704
675
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
Surgical Specialties
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Net population figures are used to calculate these figures.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
F–3
Table F4: Population per Full-time Equivalent Fee-for-service Physician by Type of Practice,
Canada and the Provinces, 2000/2001
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
1,400
1,343
1,511
1,494
1,322
1,167
1,440
1,217
1,228
1,182
1,240
Medical Specialties
3,061
4,462
4,108
3,387
2,090
1,915
2,463
3,757
2,667
2,698
2,244
6,916
**
17,820
23,705
**
n/a
15,311
10,550
**
**
**
**
**
16,571
13,583
129,019
18,924
48,550
116,763
**
13,278
7,943
50,847
29,328
29,547
**
**
14,328
4,979
41,680
10,578
16,162
45,675
90,144
15,573
4,844
60,470
7,266
15,383
75,149
86,210
13,948
7,013
71,745
11,100
14,474
149,987
99,469
13,577
9,109
56,079
24,912
30,418
**
**
17,217
7,672
69,214
10,792
17,125
80,933
228,144
16,035
8,292
61,495
10,731
27,035
87,510
192,447
11,490
5,777
56,565
9,524
17,768
71,233
111,406
14,178
5,172
4,925
4,345
4,203
4,337
4,081
5,035
4,927
5,618
5,226
4,483
20,823
**
71,303
36,451
**
**
46,344
48,219
26,492
11,555
n/a
**
**
**
n/a
**
**
**
17,922
66,961
49,633
37,772
84,841
**
19,497
106,876
25,335
21,105
79,925
45,048
27,633
61,365
**
26,967
53,799
23,300
18,462
103,819
62,031
28,724
91,045
178,933
27,324
49,245
23,608
15,967
464,646
54,615
31,966
83,231
180,608
27,381
53,056
17,313
21,670
77,485
78,227
35,384
87,915
**
41,454
84,659
21,307
19,953
97,455
71,921
34,710
68,811
**
30,814
81,472
28,712
24,749
150,425
91,982
39,299
91,535
172,876
33,573
89,815
27,024
26,273
99,796
64,038
35,709
88,812
154,089
26,197
69,737
34,024
18,723
145,706
60,922
32,443
86,604
180,728
28,055
58,646
21,850
Total Specialties
1,923
2,341
2,112
1,875
1,410
1,303
1,654
2,132
1,808
1,779
1,496
Total Physicians
810
854
881
832
682
616
770
775
731
710
678
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
Surgical Specialties
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Net population figures are used to calculate these figures.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
F–4
Appendix G
Physicians Per 100,000 Population
Table G1: Fee-for-service Physicians Who Received at Least $60,000 in Payments per 100,000 Population
by Type of Practice, Canada and the Provinces, 1999/2000
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
58
60
66
61
66
73
53
62
74
88
72
Medical Specialties
24
18
25
24
43
43
34
22
34
36
39
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
11
**
3
3
**
n/a
5
9
n/a
**
**
**
n/a
4
7
1
5
2
1
1
8
9
1
3
3
1
**
7
19
2
8
5
2
1
6
16
1
12
5
1
1
6
11
1
8
5
1
1
8
9
1
3
3
**
**
6
12
1
8
5
1
1
7
11
2
10
4
1
1
8
15
2
9
5
1
1
7
Surgical Specialties
16
19
24
24
23
22
20
17
18
22
21
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
4
**
1
2
**
**
2
1
3
7
n/a
**
**
**
n/a
**
**
4
5
1
2
2
1
n/a
5
2
5
4
2
2
4
2
**
3
2
4
5
1
2
3
1
1
3
2
4
5
0
2
3
1
0
3
2
5
4
1
2
3
1
1
2
1
4
5
1
1
2
1
**
2
1
3
4
1
1
3
1
1
3
1
4
5
1
2
3
1
1
4
2
4
5
1
2
3
1
1
3
2
4
Total Specialties
40
38
48
48
67
65
54
39
52
58
60
Total Physicians
98
97
114
109
133
138
107
101
126
146
132
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Net population figures are used to calculate these figures.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
G–1
Table G2: Fee-for-service Physicians Who Received at Least $60,000 in Payments per 100,000 Population
by Type of Practice, Canada and the Provinces, 2000/2001
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
54
60
65
62
68
72
55
66
76
87
72
Medical Specialties
26
20
25
24
41
43
37
23
35
37
39
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
11
1
4
3
1
n/a
6
9
n/a
**
**
**
n/a
6
8
1
5
2
1
1
8
9
1
3
3
1
**
7
18
2
6
5
2
1
6
16
1
12
5
1
1
6
13
1
8
5
1
1
8
9
1
3
3
**
**
6
12
1
8
5
1
1
7
11
2
10
4
1
1
8
15
2
9
5
1
1
7
Surgical Specialties
18
20
23
23
23
21
20
17
18
21
21
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
4
**
1
3
**
**
2
2
3
7
n/a
**
**
**
n/a
**
**
4
5
1
2
2
1
**
5
1
4
5
1
2
4
2
**
3
2
4
5
1
2
3
1
1
3
2
5
5
0
2
3
1
0
3
2
5
5
1
1
3
1
**
2
2
4
5
1
1
2
1
**
2
1
3
4
1
1
3
1
1
3
1
4
4
1
2
3
1
1
4
2
4
5
1
2
3
1
1
3
2
4
Specialists
44
39
48
48
64
64
57
40
53
58
60
Total Physicians
98
99
113
109
131
136
111
106
129
145
132
Source: NPDB, CIHI
* Canada totals are ten province totals including the Yukon and excluding the Northwest Territories.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Net population figures are used to calculate these figures.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
G–2
Table G3: Full-time Equivalent Fee-for-service Physicians per 100,000 Population by Type of Practice,
Canada and the Provinces, 1999/2000
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
80
76
67
67
75
87
66
79
80
85
81
Medical Specialties
30
22
24
30
52
52
37
26
37
37
45
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
14
1
5
4
**
**
5
10
**
**
**
**
**
5
7
1
5
2
1
**
8
12
2
4
3
**
**
7
21
3
11
7
2
1
7
20
2
14
7
1
1
7
13
1
9
7
1
1
7
10
2
4
3
**
**
6
13
1
9
6
1
0
6
12
2
9
4
1
1
9
17
2
11
6
1
1
7
Surgical Specialties
18
20
23
24
24
24
19
20
18
20
23
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
5
**
1
2
**
**
2
2
4
9
n/a
**
**
**
n/a
**
**
**
6
2
2
2
1
**
5
1
4
5
1
2
4
2
**
4
2
4
6
1
2
4
1
1
4
2
4
6
0
2
3
1
1
4
2
6
5
1
1
3
1
**
2
1
4
5
1
1
3
1
**
3
1
3
4
1
1
3
1
1
3
1
4
4
1
2
3
1
1
4
1
3
6
1
2
3
1
1
4
2
5
Total Specialties
48
42
47
54
76
76
57
45
54
57
68
Total Physicians
128
118
115
121
151
163
123
125
134
142
148
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Net population figures are used to calculate these figures.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
G–3
Table G4: Full-time Equivalent Fee-for-service Physicians per 100,000 Population by Type of Practice,
Canada and the Provinces, 2000/2001
Nfld.
P.E.I.
N.S.
N.B.
Que.
Ont.
Man.
Sask.
Alta.
B.C.
Canada*
Family Medicine
71
74
66
67
76
86
69
82
81
85
81
Medical Specialties
33
22
24
30
48
52
41
27
37
37
45
Internal Medicine
Neurology
Psychiatry
Pediatrics
Dermatology
Physical Medicine
Anesthesia
14
**
6
4
**
n/a
7
9
**
**
**
**
**
6
7
1
5
2
1
**
8
13
2
3
3
**
**
7
20
2
9
6
2
1
6
21
2
14
7
1
1
7
14
1
9
7
1
1
7
11
2
4
3
**
**
6
13
1
9
6
1
0
6
12
2
9
4
1
1
9
17
2
10
6
1
1
7
Surgical Specialties
19
20
23
24
23
25
20
20
18
19
22
General Surgery
Thoracic/Cardiovascular Surgery
Urology
Orthopedic Surgery
Plastic Surgery
Neurosurgery
Ophthalmology
Otolaryngology
Obstetrics/Gynecology
5
**
1
3
**
**
2
2
4
9
n/a
**
**
**
n/a
**
**
**
6
1
2
3
1
**
5
1
4
5
1
2
4
2
**
4
2
4
5
1
2
3
1
1
4
2
4
6
0
2
3
1
1
4
2
6
5
1
1
3
1
**
2
1
5
5
1
1
3
1
**
3
1
3
4
1
1
3
1
1
3
1
4
4
1
2
3
1
1
4
1
3
5
1
2
3
1
1
4
2
5
Total Specialties
52
43
47
53
71
77
60
47
55
56
67
Total Physicians
123
117
114
120
147
162
130
129
137
141
148
Source: NPDB, CIHI
* Canada totals are ten province totals, the Yukon and Northwest Territories are not available.
** Data for this specialty have been rolled up to the medical specialties or surgical specialties broad specialty to protect confidentiality.
PEI plastic surgeons are included with general surgeons.
n/a = Not Applicable—There were no physicians for this specialty for this province.
Notes
Net population figures are used to calculate these figures.
Physicians paid under alternative forms of reimbursement such as salary and sessional are not included.
G–4
Appendix H
Full-time Equivalent Methodology:
History and Calculations
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Historical Measurement of a
Full-time Equivalent (FTE) Physician
In Canada, physician supply has historically been measured in terms of the number of
physicians available. These data are often extended to physician/population ratios for
interprovincial comparisons or analyses of changes over time. Traditionally these statistics
have been used in planning exercises and for the assessment of policy decisions. In particular
they have been used for the following purposes:
•
to assess the factors contributing to the increases in medical care costs,
•
to provide input to physician manpower requirement studies, and
•
to assess trends in physicians' remuneration.
The number of fee-for-service physicians has always been viewed as an important health
economic indicator because of the "gatekeeper" role that physicians play in the health care
delivery system.
The use of simple counts of physicians for analysis implies that all physicians are equal
in terms of their capacity to provide patient care. This is clearly not plausible; some
physicians are semi-retired, some work part-time and many are not in active clinical
practice. Even considering only fee-for-service physicians, the availability of medical
services will vary considerably as a result of trade-offs individual physicians have made
between income and leisure time. To try to produce a more meaningful measurement
of physician supply, the practice of counting full-time and full-time equivalent physicians
was adopted.
The first and simplest methods of defining full-time physicians involved the use of income
thresholds. A dollar amount was specified and any practitioner whose income met or
exceeded this amount was counted as one full-time physician. Physicians whose total billing
was less than this amount were excluded from the count. The resultant estimates of
physician supply depended strongly on what threshold was chosen; furthermore the supply of
medical services by part-time physicians was ignored in the count. Depending on the choice
of threshold, statistics could be generated with this algorithm that indicated anything from a
serious lack of physician resources to a complete oversupply of all specialties of practitioner.
An improvement of this early method involved the counting of part-time physicians as a
fraction of a full-time physician.
Apart from the problems caused by the arbitrary choice of income threshold, there are other
limitations to this methodology. The statistics are not suitable for any time series analysis as
the sub-set of physicians earning in excess of any fixed dollar benchmark
will be affected over time by increases in the provincial schedule of benefits. As well,
interprovincial comparability will be weak because of differing benefit levels among
the provinces.
To try to improve interprovincial, inter-specialty and time series comparisons, thresholds were
redefined in terms of percentile levels of physician earnings. For example, instead of counting
all physicians receiving payments in excess of $30,000 as full-time, all practitioners billing
CIHI 2003
H–1
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
within the top 70 percent of physicians could be considered full-time. Percentile thresholds
have clear advantages over the dollar values. The impact of benefit schedule increases are
automatically adjusted. Interprovincial comparability is improved but still there is no indication
that the full-time benchmark in one province would reflect the same intensity of production as
the full-time benchmark in any other province. Additionally, percentile thresholds implicitly
adjust for changes over time, the service price and the changes in service utilization/volume
per physician. Full-time equivalent methods based on the average or median earnings are
variations on this methodology.
Development of an Improved Measure of Full-time Equivalence (FTE)
The development of a new measure for FTE was undertaken in 1984 by a working
group comprised of representatives from National Health & Welfare, provincial medicare
agencies, and academic consultants. The working group identified the following objectives
of a FTE measure:
•
provide a consistent basis for interprovincial and intraprovincial comparisons of
physician supply;
•
provide a consistent basis for measuring changes through time in physician supply; and
•
recognize workload differences among individual specialties.
Conceptual Model
All measures of full-time equivalence are to some degree arbitrary, in the sense that there is
no "best" measure to be derived through statistical techniques. The choice of a measure was
therefore determined by the objectives, and by data availability. The measure developed by
the Working Group was based on the following conceptual model.
Utilization
Supply Factors
Number of Physicians
+
S
e
r
v
i
c
e
s
X
Work Characteristics
F
e
e
s
=
E
x
p
e
n
d
i
t
u
r
e
s
Figure 1. Relationship between income and FTE values
H–2
CIHI 2003
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
In an economic context, physicians and hours of work are seen as measures of supply.
Services produced by physicians are the most basic measure of utilization, while
expenditure is the product of services and fees. The relationship between these three
variables is illustrated in Figure 1. The realistic choices for estimation of full-time
equivalence were (1) hours of work, (2) services provided, and (3) payments.
An internal study indicated a high degree of variability in income per hour worked by
fee-for-service physicians, after standardizing for specialty. Consequently, a FTE measure
based on hours of work would not provide accurate estimates of the potential output
(in terms of clinical services) of the physician population. As FTE measures are used most
often in a context where output or expenditure is an important consideration, it was
decided that a measure of output would be preferable to hours of work, which is essentially
an input measure.
Although services are measures of output, they are not weighted for intensity or
value. Expenditure measures services weighted by fees. Payments to physicians were
therefore chosen as the most appropriate measure of output with which to determine
full-time equivalence.
Rationale
In the model adopted, gross income per physician is used to measure output or workload.
As there is a wide range of output among physicians within the same specialty, a single
cut-off to measure full-time equivalence status did not seem appropriate. It was therefore
decided to use a range of output that would be realistic for a typical full-time physician.
It was essential that this range could be defined statistically, and after some experimentation
the 40th to 60th percentiles of fee adjusted, nationally defined payment distributions were
chosen as the benchmarks within which to measure full-time equivalence.
Simulations of alternative percentiles indicated that the FTE counts were relatively
insensitive to different benchmark ranges, as long as those ranges were symmetric
(e.g. the 30th to 70th percentiles yielded approximately the same total counts as the
40th to 60th percentiles).
CIHI 2003
H–3
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Comprehensiveness
The measure was designed to count all physicians providing fee-for-service care under the
Canadian medicare system. Physicians with payments less than the lower benchmark are
counted as fractions of a FTE; physicians within or equal to the benchmarks are counted as
one; and physicians above the benchmark are counted as more than one FTE. The decision
to count physicians above the benchmark as more than one FTE was based on a recognition
that many physicians have large workloads and the FTE measure should recognize this.
At the same time, an algorithm incorporating logarithms was used to prevent high income
physicians from having a very large FTE (for example, a physician whose income is three
times the upper benchmark will have a FTE of 2.1, while a physician whose income is four
times the upper benchmark will have a FTE of 2.4). The relationship between income and
FTE count is illustrated in Figure 2.
FTE Values
2.0
1.5
1.0
0.5
<- Benchmarks ->
0.0
Fee-for-service Income
Figure 2. Relationship between income and FTE values.
H–4
CIHI 2003
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
Consistency
In order to provide consistency across provinces and through time it was necessary to
remove the effects of different fee levels on physician income. The methodology adopted
allowed payments to each physician to be standardized for interprovincial fee differences in
order to compute national benchmarks for a base year. The national benchmarks were then
converted to provincial values. Each year, the provincial benchmarks are indexed by specialty
specific fee increases or decreases.
Benchmark values and FTE physician counts vary depending on the base year used for
analysis. As of 2001, CIHI’s full-time equivalent physician reports, as well as the current
report use 1995/1996 utilization data to establish a base year for implementing the FTE
methodology. Earlier reports used 1985/1986 utilization data. A complete description of
how base year changes can affect benchmarks and FTE counts is given in Appendix G
of the Full-time Equivalent Physicians Report, Canada, 1996/97 to 1998/99, published
in 2001.
Computations
Counts
All counts are based on the number of physicians receiving payments from each provincial
plan on a fee-for-service basis. Canada totals represent the sum of the provincial numbers.
Concurrently registered physicians will appear as separate physicians in each province, and
will be double counted at the national level.
FTE Measure
1. Select a base year for estimation. The current base year is 1995/1996.
2. Create a national base year FTE database.
•
Select from the NPDB all the records for physicians who received at least one fee
payment during each quarter of the base year for services provided within the
physician’s province of residence to in-province patients.
•
Create for each province and each specialty of physician, a data set that includes
each physician’s total payments in this fiscal year.
•
To eliminate the interprovincial differences in payments that are due to differences
in fee levels, adjust the gross income of each physician by the relevant Physician
Services Benefit Rates (PSBR) index.
Note: FTE statistics are not calculated for physicians in the specialties of radiology or
laboratory medicine. Physicians who received payments under more than one
specialty during the year are assigned to the specialty under which they received
the majority of their payments.
CIHI 2003
H–5
Average Payment Per Physician Report
Canada, 1999/2000 and 2000/2001
3. Calculate base year lower and upper benchmarks.
•
Within each specialty, rank order the payment amounts and establish the
distribution of physicians by payment levels.
•
Label the payment value corresponding to the 40th percentile rank as the national
lower benchmark and that of the 60th as the national upper benchmark.
•
To calculate the provincial lower and upper benchmarks, adjust the national
benchmarks by the PSBR index.
4. Calculate the benchmarks for years other than the base year.
•
Inflate (or deflate for years prior to the base year) the provincial benchmarks for
each specialty by the specialty specific annual fee increase percentages.
5. Create FTE database for estimation.
•
Select from the NPDB, all the records for physicians who received at least one fee
payment during a fiscal year for services provided within the physician’s province of
residence to in-province patients.
•
Create for each province and each specialty of physicians, a data set that includes
each physician’s total billing in the fiscal year.
6. Calculate the FTE statistics.
•
Count physicians with payments within or equal to the benchmarks as 1 FTE.
•
Count physicians with payments below the lower benchmark as a fraction of a FTE
equal to the ratio of his/her payments to the lower benchmark.
•
Count physicians with payments above the upper benchmark using a log-linear
relationship, i.e. as 1 FTE plus the logarithm of the ratio of his/her payments to the
upper benchmark.
H–6
CIHI 2003
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