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

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:

Year	Physicians	Growth
2015	10,019	–
2016	10,294	275
2017	10,680	386
2018	10,806	126
2019	11,205	399

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:

Year	Rate	Change
2015	240	–
2016	244	4
2017	250	6
2018	249	-1
2019	254	5

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

Year	Family	Change	%	Specialists	Change	%
2015	125	–	–	115	–	–
2016	126	1	0.8%	118	3	2.6%
2017	129	3	2.4%	121	3	2.5%
2018	127	-2	-1.6%	123	2	1.7%
2019	127	0	0%	127	4	3.3%
Avg		0.5	0.4%		3	2.5%

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:

Year	AB	CA	BC	ON	QC
2015	240	229	227	221	245
2016	244	231	236	222	246
2017	250	236	238	226	251
2018	249	241	249	235	248
2019	254	241	250	232	252
5-year difference	14	12	23	11	7
% change	5.8%	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.

	RF	Change	%	RS	Change	%	UF	Change	%	US	Change	%
2015	663	–	–	63	–	–	4545	–	–	4740	–	–
2016	683	20	3.0%	58	-5	-7.9%	4626	81	1.8%	4910	170	3.6%
2017	696	13	1.9%	63	5	8.6%	4815	189	4.1%	5086	176	3.6%
2018	669	-27	-3.9%	63	0	0%	4802	-13	-0.3%	5243	157	3.1%
2019	711	42	6.3%	65	2	3.2%	4860	58	1.2%	5531	288	5.6%
Avg		12	1.8%		0.5	1.0%		78.8	1.7%		197.8	4.0%

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.

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.