The importance of foreign-trained physicians

Impact of physician income source on productivity


Mark Otto Baerlocher MD1

Jason Noble MD2

Allan S Detsky MD, PhD, FRCPC3

University of Toronto Radiology1 and Ophthalmology2 Residency Programs, Departments of Health Policy Management and Evaluation and Medicine3, University of Toronto, and Departments of Medicine3, Mount Sinai Hospital and University Health Network Toronto, Ontario

 

Manuscript submitted 18th December, 2006

Manuscript accepted 2nd January, 2007

 

Clin Invest Med 2007; 30 (1): 42-43.


Based on data from the 2004 National Physician Survey1, physicians whose primary payment method was fee-for-service saw more patients per week than physicians remunerated by other methods, including salary or blended payments. This result did not change when examined according to specialty or specialty grouping (Table 1), physician age (Table 2) Family physicians versus specialists, type of practice (office-based versus hospital-based; data not shown), or practice setting (urban versus rural; data not shown). Overall, fee-for-service (FFS) physicians saw approximately twice the number of patients per week as salaried physicians. These data provide convincing evidence that FFS physicians see substantially more patients.

There are several possible explanations for this result. However, given the increasing proportion of younger physicians who are being remunerated by sources other than FFS, a decreasing interest among younger physicians in FFS method of payment, and the results presented here demonstrating such a striking difference in the number of patients seen by each group, this issue should be examined in detail, as it will likely have considerable implications with respect to future physician supply. As large segments of the physician workforce change from FFS to non-FFS positions, it is possible the ‘extra’ patients may simply be seen by those remaining FFS, ultimately driving the costs of health care higher.

 

TABLE 1.  Influence of specialty: Patient visits per week (mean ± SD) and income source.

 

≥90% FFS

≥90% Contract

≥90% Sessional

≥90% Salary

Not ≥90% of 1 method

Ob/Gyn

(n)

108.9 ± 51.2

(306)

 

 

48.5 ± 31.9

(32)

70.7 ± 36.5

(122)

Pediatrics

(n)

109.3 ± 62.6

(304)

 

 

41.7 ± 41.8

(118)

65.5 ± 50.9

(288)

Psychiatry

(n)

45.4 ± 26.8

(513)

 

28.9 ± 20.1

(56)

29.2 ± 16.5

(58)

39.4 ± 23.4

(686)

General Internal Medicine

(n)

74.7 ± 50.0

(383)

 

 

44.7 ± 40.5

(49)

60.2 ± 46.7

(207)

Medical sub-specialty*

(n)

76.6 ± 41.6

(708)

37.5 ± 19.8

(36)

 

40.8 ± 35.5

(154)

55.2 ± 38.8

(471)

Surgery**

(n)

100.6 ± 56.2

(1688)

45.9 ± 29.3

(43)

 

55.4 ± 35.9

(99)

73.3 ± 48.6

(497)

Family Medicine

(n)

133.9 ± 61.9

(5782)

78.1 ± 42.4

(189)

70.2 ± 50.0

(494)

66.9 ± 47.6

(789)

104.0 ± 58.4

(3099)

Total

(n)

111.7 ± 65.3

(10330)

62.8 ± 41.2

(387)

62.6 ± 47.8

(685)

55.7 ± 44.7

(1411)

81.8 ± 57.5

(5797)

*excluding general internal medicine; includes cardiology, gastroenterology, hematology, respirology/resp medicine, rheumatology, immunology/allergy, neurology, micro/ID, nephrology, ID, medical oncology, endo/metabolism.

**includes general surgery, CV/T surgery, neurosurgery, orthopedic surgery, plastic

surgery, urology, ophthalmology, otolaryngology, and ob/gyn

 

 

TABLE 2.  Influence of physician age. Patient visits per week (mean ± SD) and income source

Age

≥90% FFS

≥90% Contract

≥90% Sessional

≥90% Salary

Not ≥90% of any source

< 35 yr

(n)

66.3 ± 41.9

(219)

 

 

42.6 ± 35.6

(38)

52.8 ± 41.3

(174)

35-44 yr

(n)

84.1 ± 56.2

(1011)

45.5 ± 28.7

(47)

46.6 ± 36.4

(45)

43.4 ± 37.1

(179)

54.1 ± 38.2

(666)

45-54 yr

(n)

87.2 ± 59.7

(1343)

50.4 ± 35.7

(66)

42.1 ± 37.6

(48)

44.5 ± 39.7

(182)

59.9 ± 48.4

(936)

55-64 yr

(n)

87.7 ± 59.3

(1164)

46.8 ± 28.1

(47)

35.5 ± 24.1

(36)

35.4 ± 30.9

(162)

57.1 ± 44.0

(618)

> 65 yr

(n)

71.4 ± 56.8

(727)

 

31.6 ± 21.4

(49)

41.1 ± 30.3

(39)

44.2 ± 37.6

(255)

Data reproduced with permission, from CMA/RCPSC/CFPC. CMA/RCPSC/CFPC own the copyright to the data.

 

 

References

1.   National Physician Survey 2004 http://www.cfpc.ca/English/cfpc/research/janus%20project/nps/results/default.asp?s=1

 

Correspondence to:

 

Mark Otto Baerlocher, MD

Radiology Residency Training Program

University of Toronto, Toronto, Ontario

mark.baerlocher@utoronto.ca

 

 



© 2007-2012 Canadian Society for Clinical Investigation.
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