trouble ahead for health costs: doctors working less, making more
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7/27/2019 Trouble ahead for health costs: Doctors working less, making more
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umanitoba.ca http://umanitoba.ca/outreach/evidencenetwork/archives/131
Trouble ahead for health costs: Doctors working less, making
more
Physician workloads decreasing while their incomes are rising
A version of this commentary appeared in the Globe and Mail, Vancouver Sun and the New Brunswick Telegraph-
Journal
Physicians are the second largest component of provincial
government health spending in Canada, averaging about 20
percent of overall healthcare budgets — and constituting one of
the fastest growing public health sector costs of recent years.
This is despite the fact that Canada has relatively few physicians
compared to many other developed countries.
According to 2013 OECD health statistics, at 2.4 practicingdoctors per 1,000 people, Canada ranks 28th out of 34 OECD
countries. These countries range from a high of Greece — with
6.1 practicing doctors per 1,000 people to Chile’s low of 1.6.
Canada is just behind the United States at 2.5 and ahead of
Japan, Mexico and Poland — all tied at 2.2.
Recent Canadian growth in physician ranks has some pundits alarmed. However, in a new study for Health Policy, I
demonstrate that it is not growing physician numbers that we need to worry so much about. The greater strain on ou
health budgets will come not from more doctors, but from more doctors earning more while working less.
Estimated determinants of provincial government health spending show physician numbers alone are indeed apositive driver of healthcare spending after controlling for other factors. From 1975 to 2009, the increases in
physician numbers accounted for a range of about three to 13 percent of the increase in average real per capita tota
provincial government health expenditures, ranging from a low of two to eight percent for Manitoba to a high of five t
18 percent for Quebec.
These results support the conventional wisdom that expansion in the number of billing physicians is itself a driver of
health system spending. Yet, physician numbers contribute less to spending increases than do increasing fees and
service volumes. Indeed, a Canadian Institute for Health Information (CIHI) study on health cost drivers found new
technology, utilization and price inflation to be at the top of the list, along with population growth and aging.
We also need to recognize that many of our doctors are working fewer hours than generations past. One study founthat 27.7 percent of Canadian family doctors (FP/GPs) reduced their work hours between 2005 and 2007, and that
33.9 percent of them planned further reductions in their weekly work hours between 2007 and 2009. Only 8.1 perce
planned to increase their weekly working hours. Another study found that younger and middle-aged family physician
carried smaller workloads than their same age peers a decade earlier. Older physicians — many who are
approaching retirement — are carrying a heavier workload relative to younger physicians.
This, while according to CIHI, payments to physicians for their services continue to grow — rising six percent in 201
11, after increases of 9.7 percent in 2008-09 and 7.9 percent in 2009-10. While total physician numbers are growing
for many physicians, their individual workloads appear to have declined but their compensation has not.
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Doctors do work long hours and it is understandable they may desire a better work-life balance. However, in an era
tight public budgets, having more physicians doing less and costing more may be seen as a luxury. This sentiment
was undoubtedly a driver behind Ontario’s recent decision to tackle physician fees, especially given that physicians
Ontario account for about one-quarter of the government’s health spending – the highest share in the country.
The recent increases in physician numbers from ramped up medical school enrollment may not be the biggest caus
for concern when it comes to future health care spending. Rather, the drivers of public healthcare spending are a
complex interaction between physician numbers, physician decision-making, physician work-load, diagnostic and
drug technologies, population growth, aging, the cost and deployment of human resources, provincial health systeminstitutions and the role of demand side economic variables such as incomes and patient preferences.
So what can be done?
Future cost control in health spending will either need to restrain growth in service volumes and utilization — an
unpopular move with the public – or it will need to tackle fees much more directly — an unpopular move with
healthcare providers.
One thing is certain: the recent trend toward doing less for more is not a sustainable option.
Livio Di Matteo is an expert advisor with EvidenceNetwork.ca and Professor of Economics at Lakehead University.
His recent study, “Physician Numbers As a Driver of Provincial Government Health Spending in Canadian HealthPolicy” appeared in Health Policy.