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What the UCP government left out from their statement on physician pay

The UCP government recently published a statement regarding some new CIHI data regarding physicians in the country. The statement makes some claims that I wanted to clarify.

Last week, the Alberta government published a statement regarding some new data released by the Canadian Institute of Health Information regarding physicians in the country.

The statement makes some claims that I wanted to clarify.

Physicians in Alberta increased by 12% between 2015 and 2019, while population grew by 6%.

Yes, it’s true that the number of physicians increased by 12%. Well, technically, 11.8%. In 2015, there were 10,019 physicians in Alberta. In 2019, there were 11,205. That’s a difference of 11.8%.

Here’s a breakdown by year on the increase:

YearPhysiciansGrowth
201510,019
201610,294275
201710,680386
201810,806126
201911,205399

Oddly, the largest increase of physicians was last year, during the UCP’s first year in power.

Alberta has more physicians per person than the national average, and more than British Columbia, Ontario or Quebec.

Also true. Our physicians per 100,000 rate was 254 for 2019. Canada’s was 241, BC’s 250, Ontario’s 232, and Québec’s 252.

Here’s what our rate was per year:

YearRateChange
2015240
20162444
20172506
2018249-1
20192545

Most of that increase was in specialists, however. Compare these two stats, both of which are number of physicians per 100,000 people:

YearFamilyChange%SpecialistsChange%
2015125115
201612610.8%11832.6%
201712932.4%12132.5%
2018127-2-1.6%12321.7%
201912700%12743.3%
Avg0.50.4%32.5%

Our specialists have increased by 12 physicians per 100,000 over the last 5 years (10.4%), compared to family physicians, which increased by only 2 per 100,000 (1.6%). That’s not even 1 new family physician a year for every 100,000 people. In fact, the rate for family physicians has dropped by 2 since its peak in 2017, and there was no increase over 2018.

Which means the number of family physicians didn’t even track to population growth between 2018 and 2019, let alone over the entire 5-year period.

Let’s compare Alberta’s physician per 100,000 rates with those of Canada, BC, Ontario, and Québec:

YearABCABCONQC
2015240229227221245
2016244231236222246
2017250236238226251
2018249241249235248
2019254241250232252
5-year difference141223117
% change5.8%5.2%10.1%5.0%2.9%

So while it’s true that Alberta’s physicians per 100,000 rate is higher than the national rate and those of the 3 provinces the government cited, it’s barely higher than some of them.

Alberta has 2 more physicians per 100,000 than Québec has and 4 more than Ontario. For a city like Lethbridge, which has a population of 100,000, that means we have 4 more doctors than Nanaimo and 2 more than Trois-Rivières, both of which are similarly sized cities. And considering how difficult it is to find a family doctor here that’s accepting new patients, that’s a good thing.

As well, while the rate is higher than all of those provinces (some just barely) and the country, the growth of that rate tells another story. BC’s physicians per 100,000 rate, for example, grew 64% more than Alberta’s. Ontarios’s grew only 21% less, and Canada’s grew 14% less.

Plus, Alberta, Canada, and Ontario’s rates all grew by between 5% and 6% over the 5-year period, while BC’s was nearly double that.

The number of new physicians in rural Alberta grew by 6.9% from 2015 to 2019.

This also is true. In 2015, there were 726 rural doctors in Alberta, and there were 776 in 2019, an increase of 6.9%.

Most of that increase was in family medicine—there was a net increase of only 2 specialists in rural medicine during that period—so these new doctors are virtually all family doctors. Unlike, urban medicine, which saw most of their increase in the number of specialists.

Actually let’s compare the two.

RFChange%RSChange%UFChange%USChange%
20156636345454740
2016683203.0%58-5-7.9%4626811.8%49101703.6%
2017696131.9%6358.6%48151894.1%50861763.6%
2018669-27-3.9%6300%4802-13-0.3%52431573.1%
2019711426.3%6523.2%4860581.2%55312885.6%
Avg121.8%0.51.0%78.81.7%197.84.0%
RF: Rural family physicians
RS: Rural specialists
UF: Urban family physicians
US: Urban specialists

Here we do see that the majority of the growth with rural doctors has been in family medicine, compared to specialists for urban doctors. And while it is true that rural doctors have increased by 6.9% between 2015 and 2019, that amounts to only 12 doctors per year, on average, which is an increase of only 1.8% per year.

Alberta spends $5.4 billion a year on physicians

This figure is misleading. Physician salaries don’t come to a collective $5.4 billion.

First of all, $5.4 billion is how much the government spent last year. Well, technically, it was $5.378 billion.

“Expense”, Fiscal Plan 2020–23, p. 126

That’s not how much they’re spending this year. They cut that by $83 million. They budgeted $5.295 billion for this year, not $5.4 billion.

Second, as I said earlier, this isn’t just doctor salaries. Note that the item line in the above screenshot says “Physician Compensation and Development”. Consider this quote:

Budget 2020 maintains last year’s physician budget spending commitment of $5.4 billion per year (including grants to post-secondary institutions for academic medicine – reported in Advanced Education).

“Expense”, Fiscal Plan 2020–23, p. 125

Not only does the so-called $5.4 billion include physician compensation, it includes grants to post-secondary institutions for academic medicine. While it’s difficult to see exactly how this breaks down, I was able to find the following information for the 2016–2017 budget, which planned for $4.6 billion in physician compensation and development:

  • Remuneration (mainly fee-for-service)
  • On-call programme
  • Business costs programme
  • Retention benefit
  • Liability insurance premiums reimbursement
  • Rural remote norther programme
  • Continuing education reimbursement
  • Academic and clinical alternative relationship plans (ARPs)
  • Medical resident service allowances
  • Physician training and assessment support

Third, even if we look at just remuneration (mainly fee-for-service), that made up 82.6% of physician compensation and development in the 2016–2017 budget, clearly the majority of the spending is in that area. Even so, this still isn’t direct wages. This is gross revenue.

Physicians often operate businesses, with office space, nurses, administrative support staff, general business expenses (utilities, rent/leasing/mortgage, cleaning, etc), supplies, and so on. All of those expenses come out of the money given to physicians. That’s why it’s referred to as gross billings.

The $5.4 billion isn’t just given to physicians to put in their wallets. They receive the money, then use it to pay all their staff and cover all their expenses. Then they pay themselves with what’s left over. Like any other business.

If you divide the $5.4 billion by the 11,205 physicians we had last year, we’re left with $481,928. That’s how much each physician received, on average, last year. That covered their own salary, of course, but it also covered the salaries of all their staff and all their clinic expenses.

The highest level ever in the province and highest per capita of all provinces.

Of course it’s the highest level ever in the province. Our population is also the highest level ever in the province. Same goes for the cost of living. It makes sense that physician spending would follow suit.

It’s also not surprising that we pay more per capita than other provinces do. Albertans in general make more money.

In 2018, the average total income in Alberta was $105,400, the highest in the country. The next highest was Ontario, at $95,800. The national average was $89,900.

And if nurses and administrative support staff make more in Alberta than they do in other provinces, then it’s going to cost more to run a clinic in Alberta than in other provinces.

Cutting the physician compensation budget line item won’t have the effect that the provincial government hopes for. It will see clinics cutting corners to save on expenses and laying off workers, thereby driving up unemployment even more.

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By Kim Siever

I live in Lethbridge with my spouse and 5 of our 6 children. I’m a writer, focusing on political news, social issues, and the occasional poem. My politics are radically left. I recently finished writing a book debunking several capitalism myths. My newest book writing project is on the labour history of Lethbridge.

I’m also dichotomally Mormon. And I’m a functional vegetarian: I have a blog post about that somewhere around here. My pronouns are he/him, and I’m queer.

5 replies on “What the UCP government left out from their statement on physician pay”

The govt keeps quoting the CIHI (?? this may be the wrong acronym) in all its figures. It may be more fruitful to figure out how this body comes up with their calculations..

Do you provide HRT on a my-body-my-choice basis? Do you demand your doctor do so? Do you call your NDP MLA and demand they stop funding that discrimination?

If not, shut up. Also, your pronoun declarations hurt closeted trans people, but as always, cisfeminism is as cisfeminism does.

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