An overview of physician payments and cost per service
Total payments
November 17, 2022 — In response to the pandemic, governments in Canada introduced public health measures that led to an initial decrease in physician–patient interactions.Reference 1 For the first time on record, total clinical payments decreased by approximately 2% in 2020–2021 to $28.9 billion. The number of services physicians provided between 2019–2020 and 2020–2021 also dropped by 7.9%. Family physicians provided 7.1% fewer services in 2020–2021 and specialists provided 8.9% fewer services.
Total clinical payments to physicians, 1999–2000 to 2020–2021
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| Fiscal year | Total gross clinical payments (in billions of dollars) | FFS clinical payments (in billions of dollars) |
|---|---|---|
| &²Ô²ú²õ±è;1999–2000 | $9.7 | $8.6 |
| &²Ô²ú²õ±è;2000–2001 | $10.2 | $8.9 |
| &²Ô²ú²õ±è;2001–2002 | $11.0 | $9.2 |
| &²Ô²ú²õ±è;2002–2003 | $11.6 | $9.6 |
| &²Ô²ú²õ±è;2003–2004 | $12.4 | $10.0 |
| &²Ô²ú²õ±è;2004–2005 | $13.0 | $10.4 |
| &²Ô²ú²õ±è;2005–2006 | $14.1 | $11.1 |
| &²Ô²ú²õ±è;2006–2007 | $14.9 | $11.6 |
| &²Ô²ú²õ±è;2007–2008 | $16.3 | $12.2 |
| &²Ô²ú²õ±è;2008–2009 | $17.9 | $12.9 |
| &²Ô²ú²õ±è;2009–2010 | $19.3 | $14.0 |
| &²Ô²ú²õ±è;2010–2011 | $20.5 | $14.7 |
| &²Ô²ú²õ±è;2011–2012 | $22.0 | $15.7 |
| &²Ô²ú²õ±è;2012–2013 | $22.8 | $16.1 |
| &²Ô²ú²õ±è;2013–2014 | $24.1 | $17.1 |
| &²Ô²ú²õ±è;2014–2015 | $24.9 | $17.8 |
| &²Ô²ú²õ±è;2015–2016 | $25.7 | $18.5 |
| &²Ô²ú²õ±è;2016–2017 | $26.4 | $19.2 |
| 2017–2018 | $27.4 | $19.9 |
| &²Ô²ú²õ±è;2018–2019 | $28.2 | $20.5 |
| &²Ô²ú²õ±è;2019–2020 | $29.5 | $21.2 |
| &²Ô²ú²õ±è;2020–2021 | $28.9 | $20.3 |
FFS: Fee-for-service.
Source
National Physician Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information.
Average payments
Average gross clinical payments ($343,500 at the pan-Canadian level in 2020–2021) decreased in most jurisdictions in 2020–2021 compared with the previous year (-3.4% at the pan-Canadian level), but payments generally were still higher than 5 years ago. Between 2016–2017 and 2020–2021, average payments increased between 3% and 12% in Atlantic Canada, and by 16% in Yukon. Quebec and Ontario also saw increases, albeit slightly smaller at 3% and 2%, respectively. The Prairies and British Columbia saw decreases over the same time frame, ranging from -1% to -5%.
Average clinical payments to physicians, 2016–2017 and 2020–2021
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| Jurisdiction | 2016–2017 | 2020–2021 |
|---|---|---|
| N.L. | $273,899 | $283,461 |
| P.E.I. | $378,280 | $405,100 |
| N.S. | $265,431 | $298,543 |
| N.B. | $302,132 | $313,140 |
| Que. | $328,360 | $338,538 |
| Ont. | $346,660 | $351,992 |
| Man. | $360,287 | $349,274 |
| Sask. | $359,775 | $351,790 |
| Atla. | $385,522 | $367,230 |
| B.C. | $289,850 | $286,413 |
| Y.T. | $275,715 | $320,164 |
| Canada | $340,989 | $343,528 |
Source
National Physician Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information.
Type of payment
The predominant method of reimbursement for physicians’ clinical activity in Canada is fee-for-service (FFS), but other models exist, such as salary, sessional payments, capitation and other contracts. Any non-FFS payments are referred to here as alternative payment plans (APPs).
In 2020–2021, there was a 70/30 split for FFS and APP payments (70% FFS; 30% APP). The split has been stable at the pan-Canadian level for the past 10 years, with some jurisdictional variations. While FFS accounts for approximately 70% of total clinical payments, almost all physicians (96%) received at least some payment through FFS. APPs accounted for about 30% of total clinical payments, and about two-thirds of physicians (64%) received at least some payment through APPs.
Share of physician payments by type of payment, 2020–2021
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| Jurisdiction | APP clinical payments | FFS clinical payments | Percentage of physicians who received any APP payments | Percentage of physicians who received any FFS payments |
|---|---|---|---|---|
| N.L. | 36.2% | 63.8% | 51% | 89% |
| P.E.I. | 40.2% | 59.8% | 83% | 88% |
| N.S. | 67.0% | 33.0% | 97% | 56% |
| N.B. | 35.6% | 64.4% | 70% | 90% |
| Que. | 22.8% | 77.2% | 89% | 99% |
| Ont. | 37.0% | 63.0% | 45% | 98% |
| Man. | 29.3% | 70.7% | 71% | 91% |
| Sask. | 44.0% | 56.0% | 49% | 62% |
| Atla. | 14.1% | 85.9% | 26% | 83% |
| B.C. | 19.2% | 80.8% | 60% | 95% |
| Y.T. | 43.1% | 56.9% | 57% | 99% |
| Canada | 29.5% | 70.5% | 64% | 96% |
Source
National Physician Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information.
Service utilization costs
Consultations and visitsReference 2 accounted for almost three-quarters of clinical services and two-thirds of clinical payments. The average cost per service was $73.45 for 2020–2021, a 2.9% increase over the previous year. The average cost per service was impacted by multiple factors, including FFS rate changes and shifts in the volume of services provided. For example, the volume of major assessments dropped by 24% while other assessments decreased by 5.9%. Major surgery services fell by 9.4% compared with drops of 20.8% in minor surgery and 19.9% in diagnostic and therapeutic services. Fluctuations in service volumes changed the distribution of more expensive and less expensive services, contributing to the overall increase in the average cost per service over the previous year.
The average cost per service varied considerably across the different specialty groups. Costs ranged from $52.36 and $56.02 for dermatology and family medicine to $213.46 and $238.50 for thoracic/cardiovascular surgery and neurosurgery, respectively.
Average cost per service by specialty, 2020–2021
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| Group | Specialty | Average cost per service |
|---|---|---|
| Family medicine | Family medicine | $56.02 |
| Medical specialties | Internal medicine | $90.02 |
| Cardiology | $87.42 | |
| Gastroenterology | $112.03 | |
| Neurology | $115.44 | |
| Psychiatry | $110.31 | |
| Pediatrics | $88.65 | |
| Dermatology | $52.36 | |
| Physical medicine | $97.26 | |
| Anesthesia | $190.58 | |
| Surgical specialties | General surgery | $134.78 |
| Thoracic/cardiovascular surgery | $213.46 | |
| Urology | $85.69 | |
| Orthopedic surgery | $126.81 | |
| Plastic surgery | $119.78 | |
| Neurosurgery | $238.50 | |
| Ophthalmology | $66.91 | |
| Otolaryngology | $69.92 | |
| Obstetrics/gynecology | $90.40 | |
| Total physicians | Not applicable | $73.45 |
Source
National Physician Database, Canadian Institute for ºìÁì½í¹Ï±¨ Information.
Related resources
References
1.
Canadian Institute for ºìÁì½í¹Ï±¨ Information. Virtual care: A major shift for Canadians receiving physician services. Accessed March 24, 2022.
2.
Canadian Institute for ºìÁì½í¹Ï±¨ Information. National Grouping System (NGS) (PDF). 2016.
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