Canadian doctors still make dramatically less than U.S. counterparts: study
NationalPost.com – news
Sep 14, 2011. Tom Blackwell
Despite recent fee hikes, Canadian doctors still lag dramatically far behind their American counterparts in income, according to a new study that also underscores the wide pay gap in both countries between front-line “primary-care” physicians and much-wealthier surgical specialists.
Orthopedic surgeons in Canada make less than half the $440,000 average net income of colleagues in the States while doing more procedures, two U.S. health-policy professors concluded in one of the most detailed looks yet at the differences in doctor compensation between nations.
The U.K. also pays its surgeons more than Canada, while both it and Germany better compensate primary-care doctors, like family physicians and pediatricians, the comparison of six industrialized countries suggests.
Canada should not ignore the wage gap, as a sudden shortage of certain specialists in the States could trigger a drain from here, said Dr. John Haggie, president of the Canadian Medical Association. Canada saw a net loss of doctors to the U.S. in the 1990s, as provinces instituted doctor pay caps and tried to rein-in fee increases as a way to corral health costs.
But Dr. Haggie voiced no particular envy Tuesday at the statistics just published in the journal Health Affairs, saying that factors other than money influence where doctors settle, including for some the appeal of Canada’s universal, government-funded health system.
“A good salary package is an attractor, it’s a magnet but it doesn’t always have the same effect at the other end when you’re trying to retain people,” said Dr. Haggie. “The system in which (physicians) work is part of the attraction of working here.”
That migration to the U.S. has reversed in the last few years, with a small net influx of MDs from south of the border as incomes rose here, according to statistics and the accounts of medical recruitment agencies.
The new study’s authors, both health policy professors at New York’s Columbia University, did the research to help detail why the cost of health care is so steep in the U.S. compared to other countries.
It may partly reflect an American society where the mostly highly educated and skilled people in all fields tend to earn a bigger chunk of the overall wealth than similar groups in other countries, Miriam Laugesen, the lead researcher, said in an interview.
Regardless, the 2008 figures that Prof. Laugesen and her colleague gathered offer a fascinating glimpse at the profession in six countries, with stark differences in payment between nations, and between private and public payors in those places that have two-tier systems.
The average income after expenses, in U.S. dollars, for an orthopedic surgeon in the U.S. was $442,450, compared to $208,000 in Canada, $324,000 in the U.K. and $154,000 in France.
Provincial medicare agencies pay an average fee of $652 to surgeons in Canada for a hip replacement. Government programs like Medicaid in the States reimburse almost triple that, while U.S. private insurers offer an average of just under $4,000 per hip operation.
What is more, the U.S. has twice as many orthopedic surgeons per capita, providing about 35% more hip replacements overall.
Primary-care physicians include family doctors, pediatricians, internal-medicine specialists and obstetrician-gynecologists. Those in the U.S. earned an average after expenses in 2008 of $186,582, versus $125,000 in Canada, $159,000 in Britain and just $92,000 in Australia.
The study’s authors, though, say all the countries surveyed ought to examine the wide differences in pay for primary-care versus surgical specialities, and how that affects doctor career choices.
“Primary care is not seen in every country as the most important area for (doctors) to train in,” said Prof. Laugesen. “By paying physicians more in one speciality, there can be changes in that perception.”
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