What Doctors Charge vs. Other Common Services

84 thoughts on “What Doctors Charge vs. Other Common Services”

1. ECG (OHIP professional and technical fee) = $11

   ECG is cardiac testing modality to diagnose life saving problems such as heart attack, arrhythmia and many other conduction abnormalities and congenital cardiac conditions.

   Time to complete one ECG = 15 minutes or more. Patient checks in, undresses, electrodes and leads are applied, rhythm is recorded and stored in the system, doctor interprets and types in interpretation, final ECG is faxed over to referring doctor, patient dresses up, checks out.

   Up to 4 ECGs can be done per hour, therefore, $44 or LESS is paid per hour, which has to be split between the technologist, receptionist, equipment costs, the doctor, and office rent/lease. Doesn’t take too much calculation to figure out that performing a life saving ECG brings a DEFICIT to doctor because cost of performing ECG exceeds fee paid by OHIP.

   As a comparison to other services I will use 20 minute check up on echocardiography computer software in our clinic (GE computer software)= $1500. If you don’t believe it, I have receipt t prove it!

   1. Brilliant example!

      Our old ECG machine will not be replaced when it dies. It’s great to provide the service to our rural patients, but we can’t justify going in debt to offer medical services.

      Thanks so much for reading and commenting!

      Best regards,

      Shawn

   2. I have never seen a doctor do an ECG, the nurse does. Therefore, they are being paid $11 for the few minutes (at most) it takes to review it. Please don’t tell me doctors are are sitting with the patient and doing 4 ECG’s in one hour and only getting paid $44/hr. Don’t get me wrong, doctors deserve high pay. They spend a lot of time in school and are saving lives. However, don’t make up information to support what you should be paid.

      1. Good point, Althen. The technical component of the fee can only be billed by MDs who are paying someone to perform the test. So, $6.60 is supposed to pay for the nurse/tech, equipment, supplies, etc. The professional component, $4.45, pays for the professional interpretation of the ECG. Just like dentists charge for work that their staff does, doctors should be able to bill too. $6.60 does is not enough to pay the staff to do the test.

         I hope this helps!

         Shawn

      2. The doctor interprets the ECG. Accurate interpretation can mean the difference between life and death. Let’s not understate the importance and the value of that.

         1. Excellent! So far, the interpretation that saves a life gets valued at less than $5. I appreciate you taking time to read and comment!! Shawn

2. Great post…keep up your enlightening posts

   1. Thanks Karim! Feel free to correct, highlight or add comments as you see fit. Thanks again, Shawn

      1. When you analyses it that way doctor’s remuneration looks pathetic. However could you please compare the annual income of doctors vs others and have the same results? I am not in anyway disputing your claims but feels it is not a complete picture.

         1. Thanks for your question! You might like What’s My Doctor Billing to See Me? It has had >12,000 views so far and seems to meet the need you are looking for.

            Thanks again for reading and commenting!

            Best

            Shawn

3. How about:

   Fecal Disimpaction : $36.80
   Drain Cleaning : $93 (one coupon per customer, cannot be combined with other offers)

   1. Brilliant! Thanks Raj (and thanks for sharing on FB)!!

4. Interesting comparisons! If massage therapists, womens hair stylists, and plumbers do so well compared to doctors, how do you explain the difference in annual incomes.
   Massage Therapist ~ $50000
   Stylist ~ $60000
   Plumber ~ $80000
   ER doctor ~ $300000 plus

   Please feel free to make corrections.

   1. Thanks for commenting, Adam!

      It looks like you, as the government hoped, want to discuss total incomes. Please be sure to add your comments to the post on total incomes: “What’s My Doctor Billing to See Me?” It goes into detail about your concern. BTW, it has over 8,000 views since it was published 3 days ago. You might like it.

      I know that you and other readers can see past the publish-total-incomes move. Again, I’d love it if you read the blog on total incomes.

      If you have any corrections on the fees charged, I’d be happy to make corrections!

      Regards,

      Shawn

      1. Great discussion. As an MD, I would not make the salary that a hairdresser or plumber or other skilled trade could make unless I worked the fast pace, long hours, and nights that I do.

         If MDs worked at a relaxed pace and spent 1/2hour+ with each patient (see 16 a day), they would not match the income of the skilled trades.

         If all MDs worked at this comfortable pace the healthcare system in Ontario would grind to a halt! We work extremely hard to keep the system going and try to keep our wait lists down! I would just like a little thank you once in a while.

         1. Well said, Les! I don’t think anyone’s mentioned the impact that MD slow-down would have on the whole system. Doctors get pilloried for earning above average incomes because they work long and hard. Pretty disheartening. It sure is nice to see a familiar name from years ago! I hope you are well; thanks again! Shawn

            1. Let me preface this post with the fact that I am not a doctor. Aside from the doctors who keep me healthy, I don’t really know any doctors. I simply have an appreciation for fair market value of services and this article peaked my interest…

               I would point out that the actual hair dressers and plumbers are more like the nurses in these comparisons and if you’re putting your life on the line, we should be comparing the high end establishments of these service providers vs an “average price”.

               So the accurate comparison is with the owners of these higher end businesses and not the workers.

               When you compare a doctors total compensation to what a successful business owner can make you’d be surprised. I personally know 2 people who own 2-3 salons each and make doctor compensation look like chump change.

               When you consider the value of saving a life vs making someone’s hair look good its a shame that the doctors are being villified.

               We should be thankful that our doctors are not all capitalists and move to the US to make more money. The US would gladly take all of our well-educated doctors and pay them a substantial amount more than what they make here leaving us with a system in shambles.

               For those of you that feel that doctors are overpaid, stop trolling message boards and take that time to research medical schools. Then, work hard to meet the acceptance criteria, apply, and go get a medical degree. If you can’t afford medical school, there are guys on Bay St. that will loan you the money (who also make more than doctors) and after years of hard work and debt accumulation, you too can be a doctor. There is nothing stopping you from taking this path in life…

               1. Wow! Steve, I wish everyone had the same balanced perspective. Unfortunately, it takes a bit of thinking and looking around to arrive at the nuanced opinion you shared. I really, really appreciate you sharing this. Docs feel that no one cares right now. Having said that, this whole things with go no where unless we make it about patient care.

                  Caps and cuts to medical service funding does not sit well with patients, especially baby boomers. And it shouldn’t. This will end up poorly for patients. It just might take a few years.

                  Thanks again for taking time to share such a thoughtful note!

                  Best regards,

                  Shawn

               2. I sure don’t like as a RN to be compared to hair dressers & plumbers. That was disrespectful.

                  I support our physicians in Ontario & feel their pain because as nurses we’ve been going through this for years with limited support from physicians as we RN’ s are being replaced with RPN’s that are trained by RN’s (perhaps we need to stop teaching them)

                  Thanks for comparing us to them. I have saved many lives as well & also some physicians from makinga serious mistake like for I.E. when I was in training it was my assessment that clarifies from chart to patient to Dr that he was about to surgically removed the wrong lung … had the right vs the left mixed up ….

                  Just saying!

   2. Adam, I understand your your concern about the difference in “income” but by no means are income and billings ( 300000 plus) are the same. The article on Doctors Billings definitely highlights this point.

      Furthermore, I think one aspect that never can be quantified in terms of $ as well is the risk that is carried with each one of these professionals decisions hence why the compensation is different. Set aside length of training, education, debt, # of client/patients seen in a day (which can be 50-100 for Er doc vs 20-30 for plumbers/stylists) etc, the risk an Er doctor or any physician carries with his or her decision I think would be greater than a plumber/stylist. Agree/Disagree?

      1. Great point, Karim! I didn’t bother correcting the total salaries because they belong in the other discussion. Having said that, I know a number of plumbers and massage therapists. They do much better than what was quoted. Again, the issue is the fee, not total income.

         Thanks for sharing!

         Shawn

   3. I think if the hairdresser’s fee was applied to doctors work hours, you would understand it better. So let’s say a hairdresser charges $50 a haircut that takes about an hour. Doctors work long hours, at least 5 days a week, they are booked solid. So if the hairdresser works 10 hours a day, 5 days week and works 48 weeks in the year (to account for 4 weeks vacation) that works out to be $120,000 per year. But we know hairdressers don’t get paid that much and $50 is not a high rate. So why do they make less? Well there’s taxes and they have to pay for rent, whether its a chair in a salon versus their own place. They also don’t work 10 hour days that are booked solid with clients back to back. That’s the problem with billings. It’s the amount before taxes and any costs doctors incur.

      1. Thanks for helping with your reply SC! Well said; excellent points!

   4. I would imagine you would have a hard time finding hair stylists who routinely work overnight shifts and holidays (there is a fee premium for this for ER docs).

      1. Good point. As a starter, we might compare fees, time, time of day, risk, responsibility and much more. I hoped to just start with a bald comparison of fees and time. But you’re right, fees and time miss some of the most important features of the service provided.

         Thanks so much for sharing your comment!

         Best

         Shawn

   5. Average Work Hours Ortho Spine Surgeon: 100-110/week

      Average work hours massage therapist?

      Cannot discuss Physician total pay without bringing hours into it

      1. Precisely! And a number of other qualifiers… Thanks for commenting! Shawn

         1. Yes – like 15-17 years education since grade school, a $150-250,000 Student LOC, membership fees and dues, and the 50+ unemployed Canadian trained Orthopedic surgeons with staggering waitlist times of 18 months to 2 years just to see a specialist.

            1. Great point, Rae-Anne!

5. By all means, if MDs feel they are underpaid then they should consider a career change. Perhaps you feel a hairdresser has a better QOL? No? This is absolutely ridiculous. If you don’t feel you are paid enough consider a move down south or a career change.

   1. Thanks for your comment, Sheryl. I guess you haven’t had a chance to read through the other posts, so I understand why you might come away with your impression.

      Docs generally love what they do. Many of us would do it for free if we could find a way to feed our families. The central issue is that underfunded services cause service shortages. It happens in every industry. If you set the price of bread arbitrarily low, there will be no bread on the shelves. It’s a fundamental law of economics. We must fund care appropriately to provide accessibility for those who need it desperately.

      The post tries to compare common services with common things physicians provide. As a taxpayer, are you paying doctors too much for each of the services doctors provide? I’d be interested to hear of any doctors’ fees that people believe to be overpaid…even one.

      We need to discuss services, access and patient experience. It must be about patients, not doctors, no matter how hard the government and media try to spin it otherwise.

      Patients and services; not doctors.

      Thanks again for commenting and giving me a chance to try to clear up a common misconception.

      Regards,

      Shawn

      1. “Many of us would do it for free if we could find a way to feed our families.”

         So you must be getting a pretty sweet deal then since your families are fed and your houses and Mercedes are paid off?

         “The central issue is that underfunded services cause service shortages.”

         I’m pretty sure that’s now how it works in this case. People are still clamouring to get into med school. Every dollar more in your pocket for the same billing/procedure is another billing/procedure that can’t be taken by another doc or used to hire another nurse.

         Are you forgetting the per-patient fee that GPs get?

         All of your comparisons in this article are total bunk. If I don’t want a massage, or a coffee, or an overpriced haircut, I can shop around or not buy one at all. Not so if I have cancer. The fact that vets rip off the public is not related to your plight.

         There is a definite public good to the government holding the reins on MD billings. I’d rather that than the US system.

         You try to tell us that total income doesn’t matter, but again that’s horse dung. Sure billings per procedure might not be much, but your position gives you the opportunity to do many, many procedures and make a lot of money.

         If you think you’re so underpaid, you should quit and/or lobby for physicians to be put on the sunshine list to prove it to the public.

         The fact that you assume that the only way others could think differently from you is because they are afflicted by government propaganda just goes to show how out of touch with reality you really are.

         1. Thanks for sharing your (strong) comments. There are too many unsubstantiated quips for me to respond fully, but I appreciate you sharing them nonetheless. Hardworking, compassionate people who do well in school and want to help will always keep med schools full. That was the case long before doctors were paid for their services at all. As for Mercedes, I drive a 10 year old Dodge pick-up with 300,000 km on it. But it must not be about me!! It must be about patients. I hope you’re able to change your mind and start making this discussion about patients, access and care.

            Regards,

            Shawn

         2. ER doctors in the US make less than Canadian ER doctors. The government isn’t your savior.

         3. Phil,

            To address one of your points, not ever doc in Ontario get a per-patient fee. Only in the FIT/FHO models do these fees get paid out (and the government is phasing those out).

            1. Thanks for pointing that out! Shawn

         4. Easy Phil…doc income isn’t an issue with public. Shawn is simply explaing to those that are misinformed. Look at dentist fees. Everyone can go to medical doctor, not everyone can visit dentist and keep teeth healthy. They get dentures not crowns. When you have a heart attack or cancer, consider the training involved and the skill needed to keep us alive. The docs aren’t complaining ….the govt is placing the blame of hc on docs as if they are after more and more $. You will be a very happy guy your doctor is there when you need them. You will be very upset and screaming at the system when you can’t walk because your hip has deteriorated and you have to wait for 1 year for operation.

            Cheers

            Don

            1. Very well said, Don! The only way forward is to have more conversations like this, I think. I appreciate Phil expressing a strong opinion and also for having others help out with the response. Awesome!

               Best regards,

               Shawn

   2. Sheryl, MDs generally do not feel they are underpaid, but to suggest they are overpaid is ridiculous. Their pay is absolutely commensurate with the amout of responsibility and training their work entails. And yes, I am pretty sure a hairdresser can acheive a better work-life balance than a doctor, and thus a better quality of life.

      1. Well said! I sure appreciate others helping out with replies. Thank you!! Shawn

6. Hi Shawn, I would disagree that billings and income are different. As a physician you are self employed so the smarter you run your business, the more of those billings you get to keep. If you choose to run a small clinic where you and likely a colleague are the sole physicians then sure you have to ‘eat’ more of the costs but that becomes a personal choice (I also get the patient experience / fee for service conflict but anecdotally the patient experience focussed physician appear to be in the minority)

   If you use economies of scale (more physicians in the same clinic, rotating schedules for coverage… = more patients (or customers) to offset overheads then there is greater potential to retain those billings.

   You also neglect to mention secondary sources of income which are more lucrative (e.g. insurance forms, dr’s notes etc). For example your 10 min simple consult gets you $30, you then write ‘off work for 3 days” on a Rx pad and collect another $35. While this generates only a portion of your income in a full disclosure scenario, which you are advocating for, you should share this information too (e.g. time for dr’s note to be written vs fee for this)

   While I appreciate that your profession has a high demand in terms of hours and consequences, many other professions (engineer, accountant, lawyer etc) that earn similar take home salaries have similar demands and consequences with respect to hours worked, legal ramifications etc.

   Lastly, I do understand the issue you are raising is that in any other industry if you feel your compensation is inadequate then the labour market allows you to find an alternative employer and physicians do not have this luxury, however the ‘poor physician’ picture you paint is perhaps not an entirely accurate representation.

   1. Thanks for such a well written note, Ben. I’m known to be very gullible, so I will assume you are serious. If you were being ironic about the work notes, the joke’s on me!

      I factored in economies of scale in the original note. Doc’s need 1.5 staff minimum. In Southern Ontario, the overhead quoted remains conservative as stated.

      I write a note for work once every few days in my office. I charge $15 plus GST and round it to $20. Many patients hesitate at the cost, so I don’t bother collecting most of the time. I agree, if I could just do doctors’ notes all day, I’d be rich!

      I used A007 to simplify the overlap of higher and lower billings you mention. In reality, we bill many A001s at $15 that still require 5-10 minutes if you stay rushed. If I ever pause to chat about family issues during an exam, a visit turns into 30 minutes very quickly. Same code A007 $33.70.

      Finally, I never wanted to paint a ‘poor physician’ story. The message has always been: “Fee cuts harm patient care.” I tried to present an inside look at the business of medicine to demonstrate how cuts will harm patients’ access and experience of healthcare. To be certain, doctors will do everything possible to mitigate the negative impact, but it will negatively impact patients.

      Thanks again for sharing such an articulate note. I appreciate the chance to engage on some common urban myths.

      Kind regards,

      Shawn

   2. I’m a family and ER doctor in rural ontario and have charged for a sick note maybe twice in 8 years of practice. I’d also gladly give up any income I receive from insurance forms to not be bothered with them. More often than not fees for these forms are the “responsibility of the patient”(I think insurance companies do this on purpose knowing many patients can’t afford the multiple forms they send and will drop the claim) and once again I simply defer the fee. I think many would be surprised at the number of hours a family doctor spends on forms per week and receives no compensation for his efforts.

      1. Exactly! Well said, Mike. Outside observers assume doctors are getting ‘rich’ by filling out forms. They don’t realise that forms are one of the most common reasons physicians list for retiring from practice.

         Thanks for sharing you comment!

         Shawn

7. The other thing to consider for those of us who work in specialities requiring overnight or 24-hour call is that these life-saving decisions need to be made equally quickly and properly in very ill patients at 3pm and 3am. I am not sure if others would agree but there is a steep fee increase when a plumber needs to come at those hours but this is simply expected from the Ontario public. I also doubt that anyone can find an accountant to review taxes for one hour at 3am, but if it were possible, I am sure the fees would be prohibitive to most!

   1. Great point! ! Thanks so much for adding that, Richard.

   2. Right on Richard. I am an anesthesiologist and we take care of the sickest patients at all hours, jumping from resuscitating the flat neonate to safely anaesthetizing the 99 year old trauma patient. You simply cannot make a valid $-for-$ comparison with discretionary spending like haircuts and massages.

      1. Great comment, Murray. Comparisons pain our sense of reality, but we have to start somewhere, no?

8. I think a few commenters here are missing the point, I’ll do my best to clarify.

   These cuts will directly affect Ontarians healthcare. If the cuts were a simple 3% fee cut across the board the effects would be minimal.

   However this isn’t how the fee cuts work. The government is balancing the budget by refusing new graduates the ability to roster patients.

   What does this mean? Here’s an example.

   In a fee -for-service model (FFS) a 35 year old male with a cough and a 72 year old male with heart failure, COPD, prior strokes and high cholesterol are billed the same ($33.70) despite the fact that the 72 year old takes much longer to assess (ie. Is it a COPD exacerbation, did he have a heart attack with worsening heart failure, is it a cold, is it an aspiration event?). Because overhead is constant and I need to see 4 patients per hour to pay myself a salary I can either cut the 35 year olds visit short or jam the 72 year old into a 15 minute slot. Neither leads to good quality care.

   In a rostered model you get a yearly fee, the fee is higher the more complicated the patient is. You the. Get around $3 per person you see. I can schedule the 72 year old for 30 minutes and the 35 year old for 15 without worrying about how this will affect my billings.

   The system also has safeguards against “over rostering”. If I roster too many patients and my patients need to seek care at FFS or walk in clinics I am deducted $25 from the yearly fee. This provides a strong incentive to only take on as many patients as I can properly take care of.

   This has also created a black market for rostered positions. Previously if you took over a retiring physicians practice you would either do it for free or would pay for a partnership in the clinic. With the sudden lack of rostered positions retiring docs are selling these rostered positions for a premium. The going rate? I’ve been quoted $50-100k.

   So a new grad has two options. They can buy a rostered spot and take on an immediate $100k debt over and above the $200k they are currently in debt. Essentially they have a mortgage with no real estate.

   They could also start FFS and push patients through as quickly as possible. Obviously this leads to worsened quality care, especially for the complex patients who need high quality primary care.

   I’m taking the third option, and I know of at least three other new grads who are as well. There are other provinces with better billing codes and progressive models for primary care. Why play the Ontario governments game when you can go to a province where your profession is appreciated?

   Again, this is not the entitled generation whining for more pay. This is a generation of new doctors who are being forced to work in a factory style family practice or move provinces. Both of these will end up affecting how you receive primary care in the future.

   1. Wow, Matt! What a brilliant, clear and pointed description of how these cuts impact new grads. Absolutely brilliant. Thanks so much for sharing this. I hope it gets the attention it deserves. Fantastic!

      1. I think the reason why you’re receiving such angry comments is because your blog post is ridiculous. Comparing fees to arbitrary, unrelated items is confusing and people write off your message immediately.

         Matt’s explanation is concise, clear and really sums up things quite well.

         1. Thanks, Kyle. Can you suggest better comparisons? I’d be interested to hear!

            Can you offer 3 or 4 services – or even just 1 – comparable skilled trades or professional service that’s paid less than the fees listed?

            At the advice of some trusted friends and family members, I attempted to offer common medical fees juxtaposed with fees people are used to paying. The fees serve as comparators, not the service.

            For what it’s worth, there’s been tremendous positive feedback. I’m sorry you didn’t find it useful.

            Regards,

            Shawn

9. I have to add that doctors work at least 20+ hrs/week that is unpaid. As a specialist I review charts before I see consults (unpaid), review pertinent radiology images, test results…etc. Sometimes I can do prep-work for 45 mins-1h before I see patient for a consult. In addition, all of my evenings are devoted to paperwork! I do not have a life where I come home and have all evenings to myself.

   At the end of the day I enjoy my profession – yes. But it can be an all consuming role. I firmly believe that in Ontario – doctors are not overpaid.

   1. Thanks for sharing that, Maria! People need to hear personal experiences like yours. Thanks again for taking time to read, reflect and comment!

      Best,

      Shawn

10. I absolutely agree that doctors in Ontario are not overpaid. Having some fairly serious health issues over the last couple of years, I have met and “studied” a lot of them. You can tell that many of them are so burned out from the system they are stuck working in that they can’t even focus on what your issue is or provide the attention/care that they should/would be doing if time/pay permitted. Contrast this to a specialist I paid out of pocket to see in NYC once who charges $550 an hour and does not take any form of insurance, let’s just say, he was able to spend a lot more time with me and really listen/discuss everything involved with the visit and issue at hand. Seeing both of these scenarios, I would love to receive the latter of my examples everytime I went to any doctor or specialist but people need to remember how lucky we as ontarians and Canadians are to have universally provided health care. If you keep slashing away at it and cutting services and doctor’s pay, it will only continue to decline as what has been seen over the years. I believe the article writer was trying to make relatively the same point.

    1. What a great note, Matt. I believe patient service and experience need to be central to a ‘high quality’ system. There’s no such thing as a quality outcome that delivers a terrible patient experience. We can find ways to inject a tiny bit of the devotion to patient service, that you experienced in NY, into our public system. It would help but never completely change the experience to what you experienced.

       I truly appreciate the chance to hear some of those who oppose this approach. At the same time, I’m shocked by some of the thoughts that come out. It shows how desperately we need this discussion!

       Thanks for taking time to read and comment!

       Shawn

11. Physician’s can’t bill for phone calls to patient’s like lawyers can bill their clients. So, 4 patient phone calls at 15 mins per call that’s an hour of their time not being PAID for!!! I ask you PUBLIC, would you work an hour for free at your job??? I think not, so why should it be expected from your physician?? With all this cost cutting and my daughter in her grade 11 year of high school contemplating medical school,we will be watching very closely over the next few years and she just may need to consider another avenue as this situation is very discouraging….I was a medical secretary back in the Bob Rae day’s and look how that turned out….really think long and hard people who are quick to comment, not everyone on this earth can do the job of a PHYSICIAN……

    1. Wow. Patrice, your note carries passion and insight from an inside observer. Your daughter has so many great options open to her. Many jobs exist in unregulated or less-regulated fields that still involve patient interaction, life long learning, and daily challenge. Although things might change in time for her to apply for medical school, I suspect it will take a few more years than she’d be prepared to wait.

       Thank you so much for reading and sharing your thoughts! Best of luck to your daughter!

       Shawn

12. Pingback: Ontario’s Doctors in the News | Ontario’s Doctors

13. I received this in an email, shared with permission, from Amanda:

    …I am a family physician in a small town in Ontario and am working other positions (public health, university teaching) to be able to subsidize the cost of keeping my family practice office open. I am definitely one of those docs who is pulling the provincial average down and cannot afford to keep money in the corporation by incorporating or income split as my spouse is a teacher and it would not benefit our tax situation. I adore my job, I am love teaching future physicians and believe family medicine is the backbone of our health system. I never thought, however, that I would spend so much time worrying about money after having been in practice 15 years. I have considered closing my practice several times because my overhead runs upwards of 60-70% some months. I can’t cut my expenses anymore and am not willing to sacrifice the quality of my patient encounters to push people through faster.

    I know none of this is news to you but I just want to thank you for taking the time to open this dialogue and for being honest and transparent and open in your writing. I feel validated and among outstanding company in reading your articles and comments. I wouldn’t change my career and feel privileged and blessed to be a small town family doc but believe the government and media are not being accurate in their portrayal of our situation….

    …Our small town has lots of unemployment, low education levels and families struggling to put food on the table. I am so thankful and recognize my blessing and privilege in being able to do what I love and be paid anything for it. But – I fear I can’t continue providing this needed service if I can’t keep putting food on my own children’s table….

14. I’m sorry Shawn, but this is a silly demonstration and comparing apples and oranges. By your logic, a hairstylist should make 60% more annually than a physician if they can charge 60% more for a 30 minute procedure. Last time I checked, the average salary for a hairstylist in Ontario was not $580 000.

    This discussion board seems to be nothing more than an exercise in group-think, but I understand that you need to vent.

    But perhaps I’m wrong. Perhaps physicians really are charging minute amounts for life-saving procedures and the government is looking to cut that minuscule amount down even further. It seems then, that you would welcome scrapping the antiquated fee-for-service model in favour of a standard salary.

    1. Thanks Claire. Please read the comment posted this morning by an Orthopedic surgeon about hours worked. He made the same point you just did. If someone works 100 hrs per week at $100/hr they can do very well indeed. That’s been the point all along. Just because the figures are “silly” does not mean they are untrue.

       I’m happy to see that you seem to be willing to consider that physicians do, in fact, bill “minute amounts”. Many advocate for exactly what you suggest, a salary. However, the government gets far too good a deal with fee for service. Politicians could never afford to pay physicians on salary. Furthermore, malpractice suits against employee get handled by employers; yet another reason why the government declines to become the doctors’ employer.

       Thanks for taking time to engage.

       Best regards,

       Shawn

       1. What I meant by silly, is that its conflating the issue. Expensive haircuts and coffee are luxury items that people can opt to buy or not buy and are subject to the free market, whereas life-saving procedures are primarily funded by the government and are necessary items. It seems to me like you’re more interested in privatized medicine if you’re comparing procedures to coffee. The only real comparison that would make sense would be to compare your rates against other public sector employees in the health industry – most of whom make less annually.

          I’m a health professional too, and I believe strongly in universal healthcare. If you would like to be able to apply your trade in the free market then by all means – you should go to a country where you can compete against your colleagues to raise the rates of common procedures.

          I just think that we all need to equally share the weight of the aging baby boomer crisis across all the health disciplines if we want to support universal healthcare for all.

          1. Thanks Claire. You raise 3 common arguments for centralized rationing of service availability and cost.

             1. ‘Medical care is not a luxury like other things.’ Ergo, other things can have much higher prices because we can go without them. While this logic applies to coffee, it does not apply to a blocked drain ($93), central heating ($100 for gas company just to show up to your door), or the cost of towing your broken down car off the highway. Many so-called luxuries are not. Many other essentials in society carry a price much higher than medical essentials.

             2. ‘You should move to another country if you don’t like the system here.’ This sometimes comes packaged as, “Well, you chose to be a doctor. Sucks to be you!” Canadian doctors have just as much a right to advocate for progress, innovation and excellence as the other folks who advocate for no change, rigidity and short-sighted fee cuts. (This argument is condescending, disdainful and heartless.)

             3. ‘We’re all in this together so tighten your belt!’ Yes, we ARE all in this together. We might consider how fee cuts will harm access to medical services for those who need it most. We’ve discussed this at length in other posts. If it were just about cuts, docs would have seriously considered them. This ‘offer’ decimates healthcare, especially for the most vulnerable. I assume you are a unionized healthcare worker who can collectively bargain with arbitration and strike action as real possibilities. If this is true, it seems a bit rich to be told to “equally share the weight” when unionized workers strike as soon as they do not get their way.

             Finally, calls for “universal healthcare” must not mean more and more of the same. If we don’t improve our ‘universal system’, we won’t have any system at all. We all believe in caring for those who cannot care for themselves. All European countries have universal systems that outperform ours. Now, let’s get to work rebuilding something we can be proud of.

             Regards,

             Shawn

             1. You were incorrect to assume I am a unionized healthcare worker. I’ve read your previous blog posts on the dangers of nursing unions before. Im a nurse practitoner in a primary healthcare setting and I’m a salaried employee seeing as many clients a day as my physician colleagues.

                It seems we’re at an impass though.

                1. Thanks for sharing that! Cheers.

15. Hi,

    I wanted to thank you for your blog and your recent posts as I hope they have helped the public understand a bit about the healthcare system and the current issue about budget cuts. Unfortunately, it is disheartening to read that even when so clearly explained there are still so many people that don’t understand and are set on the gross numbers on billings.

    I think a point, and a point that also may not go over too well, is that patients have become extremely entitled over the years and costing the system unnecessarily. So yes, although some people make an argument that healthcare is not a “luxury” some patients treat it as it is. Patients demand tests that their naturopath “recommends” but may not be medically indicated (costs OHIP a physician visit $33, lab tests), tests to be done before they go for surgery in the US, and lengthening hospital stays even though they are medically stable and just don’t feel like going home yet ($1 000/night in hospital). Stuff like this is what contributes to bankrupting the system.

    As far as the career itself, I’m not even sure why I bothered at this point with 10 years of training, 200k in debt and poor prospects right out of the gate in family medicine. Apparently the way to go is being a physician assistant. 100k+ salary, 2 year degree and none of the responsibility with a great work life balance. I’d strongly advise anyone wanting to go into medicine to reconsider, or at least go to a different province.

    1. Thank you for your comments, TammyMD! (MD to distinguish you from the other Tammy commenting here).

       I sure appreciate hearing you say that we’ve explained things “so clearly”. With all the repeated questions, it feels as though it must have come out garbled (although it HAS been great to hear all the questions so as to afford an attempt to clear up misconceptions).

       You raise a new element that we haven’t touched on, patient accountability. I have mixed feelings on this. On the one hand, it seems popular for the media to berate patients for ‘inappropriate visits’. But on the other hand, no one wants to give patients true choice or decision making power in the system. We like to hear patients’ opinions but make them all sit in waiting rooms just the same.

       In your last paragraph, I recognize that walking-at-the-bottom-of-the-deep-end-of-the-pool feeling. No one can dismiss the facts you share. I might offer some encouragement. Even though it’s terrible now – and it is very bad for new physicians – it gets better 10 or 15 years into practice. By then, you should start to see the end of your debts. You get to a point where you can exhale and forget about the financial pressures you face now. There’s no guarantee. But if you make frugality a passion, you will gain independence from debt slavery at some point. Through it all, you have to endure the obloquy of being a ‘rich doctor’.

       Thank you so much for sharing your thoughts! I trust you will do whatever’s necessary to settle into work in a spot where people appreciate the tremendous value you provide.

       Kind regards,

       Shawn

16. Also forgot to mention and this may be a good separate topic for a post, all the other things that physicians have to pay for on their own or miss out on.

    We do not get benefits (vision/medications/DENTAL/physio/anything!), pension, paid vacation, personal days, or *maternity leave*! None of that 1 year off for us. Most physicians very quickly go back to work after 6 weeks to 3 months because they can’t afford it because of debt. We pay for our own disability insurance and malpractice insurance too.

    1. Great idea! We should take your list and start a new post/thread. I’ll get to work on it tonight. Thanks again, Shawn

17. This is total drivel. Do you make more than the nurses that work for you? The answer is likely yes. How much different is your job? Is it much worse? If it is much worse then why don’t you become a nurse?

    As for the years of study argument, you should keep in mind that your schooling is subsidized by tax payers (all higher education is in Canada) and if you didn’t find school enjoyable that is a shame because education is a privilege. And the reality is, this schooling and your job involves memorizing a lot of information that was not discovered by you, nor were the drugs you prescribe. Medicine relies on many people and many parts. Why should doctors be paid more than the nurse that draws blood, the ambulance attendant that brings patients to the hospital, or the scientist that discovers the cause of a disease? If these individuals slowed down you would have the same disruptions in healthcare.

    This is not a criticism of doctors. They do great things and are integral to public health. It is a criticism of the ridiculous ‘doctors are underpaid’ argument. If you make over $120,000 per year (after your overhead) than you do just fine and are making much more than most Canadians.

    1. Thanks for taking time to comment, Aaron. You sound frustrated.

       In your first paragraph, you seem to focus on total income again. We’ve been over that quite a bit; please check out earlier responses. Then you ask whether medical work differs from nursing work. Yes, there’s no comparison. That’s why they each requires completely different training programs. Doctors and nurses both work with patients. Your comment is a bit like asking about whether a computer scientist, an electrical engineer, and a website developer aren’t really the same thing; they all work with computers.

       You raise the well worn argument about medical trainees owing the country a massive debt for the training they received. After $200,000 of tuition and 100 hour work weeks (= much less than a few dollars per hour), medical trainees pay their debt to society back in spades. Indeed, large academic hospitals could not continue to provide patient care but for medical trainees’ slave labour.

       The second half of your note drifts into fascinating rhetoric about all workers being valuable. You ask why anyone should be paid differently than anyone else. Marx asked the same questions. Marxist social experiments have failed spectacularly all around the world over the last 100 years. It would take a much longer note to reply, but I’ll just say I do not support Marxist revolutionary thought.

       Your final comment about total income ends back where you started. Quoting total incomes misses the point completely. Earning $80,000 plus generous benefits, pension and early retirement for driving a bus or subway seems substantively different than earning basically the same ($120k benefits included) for delivering medical care. Again, other countries have experimented with setting physician compensation arbitrarily low which caused the decimation of their medical systems.

       Thanks again for sharing your comments.

       Regards,

       Shawn

18. Good idea to start this conversation. Thanks! There is definitely a divide between doctors and “others” in the opinions I see and its great to always TALK these things through. There is always some truth on both sides of any such divides.

    1. Thanks for taking time to read and comment, Adi!

       The comments become the best part of the post, by far. Good observation regarding “a divide”. Politicians know this and leverage it to get their policies through. As long as we can inform the public and then let people make up their own minds. They’re smarter than we realise.

       Thanks again!

       Shawn

19. Hi,
    I didn’t read all the comments, so I don’t know if this was addressed, but I do want to comment on comparing the vet bill to a human breast lump excision. The human cost you list is how much the surgeon receives. The cost that goes to your vet pays for not only the veterinary surgeon, but for his vet tech (analogous to a nurse,) the anaesthetic, the sterile surgical drapes, any and all medical supplies used during the procedure etc. etc. One of the problems with human “free” medical care is that the public (and most medical practitioners!!) really have no idea how much every pack of sutures, every bottle of injectable medicine, every sterilized piece of equipment etc actually costs. Your vet knows this, because she has to buy and supply it. Maybe find out how much the vet actually takes home.

    1. Great point, Lanada.

       It was our own lab retriever. I can dig out the bill, but I believe the surgeon’s bill was around $800. The procedure took 2 hours. The $700 for sutures, supplies, drain, etc. seems expensive, too. I do NOT begrudge the vet getting $400 per hour. I believe professionals are worth that much at least.

       You make a great point about the public (and practitioners!) having no idea about costs. So true!

       By the way, our dog, Lexi, is doing well 6 months later.

       Thanks again for taking time to read and comment!

       Kind regards,

       Shawn

20. Interesting post shared by my doctor sister. Maybe it is an entirely separate issue but what impact

    1. Thanks Christine. Did your post get cut off? Feel free to write some more! If you want to start the same way, we can delete what you’ve started here. Either way, thanks so much for reading and commenting! Cheers. s

21. Thanks for this Shawn. Doctors are not underpaid, this is obvious to those of us working I the profession. It may sound elitist but it should be pointed out that anyone who has gone into medicine has been near or at the top of their undergraduate class, and after that degree has spent another 4 years in medical school and after that another 2-7 years of residency followed by the most difficult comprehensive exams imaginable. That is worthy of compensation. We shouldn’t compare our salaries to hairdressers’, to do so degrades the profession. Medicine requires far more effort to get to the point where you can work I your field, and this should never be underestimated (although my barber does an excellent job). These are also years of deferred income. So let’s compare our doctor fees to dental fees, and specialist fees to those of orthodontists or periodontists – it seems like a more honest comparison. I invite the public to look at their next dental bill. Then ask their doctor how much they make for a simple check-up. It becomes very clear that physicians are underpaid for the incredible responsibility we have.
    On a separate note-
    I asked a colleague why he thought docs often have nice cars…. Answer? Because it is the only time we have without intense pressure to see patients, do admin work, complete hospital charts, answer pages etc… our cars are our oasis. Yesterday I blasted Glenn Gould (rebel, I know). I ignore my phone, pager and enjoy 30 minutes of peace. I am secretly jealous of the nurses when they go on “break” or “lunch”. None of my colleagues do that. I am always behind in checking labs, filling out ridiculous insurance forms, dealing with pharmacies looking for whatever Limited Use code… It is a crazy busy life, but every now and then we save one person, change a life for the better, laugh through our shared mortality and I know I cannot do anything else.

    1. Great note, Phil! Of course, I agree with you. I wrote the post on the advice of my mother, a wise woman not to offend. 🙂 The comparisons were made for the similarity in dollar figures only, no other comparison was implied beyond humour.

       Thanks for sharing about cars. I had not thought of that; I’m not really a car lover. I use vehicles as tools and appreciate them only for their utility or lack thereof and drive older ones right now.

       I will not take the bait about breaks! That would open a whole debate for sure. Let’s see if anyone else throws gasoline on that spark. 🙂

       Thanks again for taking time to read and comment!

       Best regards,

       Shawn

22. why not just collectively decide on a reasonable user fee, perhaps sliding scale, and every doctor start charging? I don’t think people would resent it. A modest fee, set by your college or such. Even $1 or $2 per minute, so those with more involved issues get the time they need with the understanding it will cost a little. Canadians don’t appreciate medicine precisely because it is free. We have no problem paying for other services like a chiropractor and such, so why not yours?

    1. Thank you for sharing this. I think many people support this idea, but most do not.

       I fear we will not see substantial change until things get much worse for those with the ability to influence system change. Right now, everyone with influence and connections gets their care coordinated through friends and contacts, or goes to the USA if they end up on a wait list.

       I read an article recently suggesting that we collect the $1-$2 TOTAL and give it to charity just to make a point to government…

       Again, thank you so much for taking time to share an idea! Hopefully, people will start to plan for the next 20 years soon.

       Best,

       Shawn

23. I’ve read a few excellent stuff here. Certainly worth bookmarking for
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    1. Thanks Adi!

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