Doctors in New Brunswick are primarily paid through one of two payment systems: fee-for-service or salary. A small number of doctors are paid outside of these two options.
Fee-for-service physicians are small business owners who bill Medicare fees for the services they provide to their patients. For example, a visit to your family doctor is billed differently than the fee for delivering a baby; each have a designated value which has been carefully negotiated.
Fee-for-service doctors pay their own staff, office rent, medical equipment and supplies, and other costs, such as business taxes, from these fees. This represents a significant portion of their fees, and varies greatly depending on the needs of their clinic – for example, how many staff they employ, what kind of medical equipment they need to operate to practice effectively, and the use of equipment like electronic medical records. They receive no pension or other common benefits and are not paid while on vacation or when sick.
70% of doctors in New Brunswick are fee-for-service.
Here are some examples of physician fees for common services:
Office Visit- $ 45.60
Delivering a Baby- $ 652.80
Newborn Infant Care- $ 106.40
Nursing Home Visit- $ 60.80
Flu Shot- $ 12.16
Appendectomy $ 390.00
Tonsillectomy - Under 16 years - $146.28
Some fees can be paid at different rates depending on how they are billed and the time of day. For example, some physicians are paid for on-call services, which means they are responsible for providing care to patients in emergency or after-hours situations and receive additional compensation. It can also work the other way; a surgeon who starts a procedure and finds a life-threatening condition while the patient is in the operating room typically bills a reduced rate for the additional procedure, because they were also completing another operation at the same time.
Salaried physicians are regular employees of the government of New Brunswick. Much like other public sector workers, they receive a salary, a pension, and health benefits. Not all doctors working in government settings (i.e. hospitals) are salaried.
In every province, the professional association that represents doctors with government organises the input of physicians into negotiations. In New Brunswick, the Medical Society formally negotiates for all physician compensation, which typically results in multi-year contract.
The Canadian Institute for Health Information shows that we are 8th of 9 provinces (Quebec data unavailable) on per capita spending for physician compensation. This means NB is in the bottom 1/4 of all Provinces in terms of how much we spend per person on physician compensation. No matter how you look at it, we need to remain competitive with other jurisdictions. In practical terms, we are behind Nova Scotia and far behind Ontario and Alberta.
While the cost of the healthcare system has grown substantially, physician payments remain steady as a proportion of that spending. In 1993, physician services payments were 16.3% of the health budget; that number increased to 17.9% in 2003, and back down to 16.9% in 2014.
Doctors consider more than income when deciding where to practice. They consider the ability to provide good care, use of their specialised skills, where to raise a family, where spouses can obtain employment, and how doctors are treated in specific provinces.
Physicians are highly mobile professionals who are constantly recruited to go to other jurisdictions. Those coming to or staying in New Brunswick have made a choice to stay in the province for practice, family, or community reasons. We need to ensure they have an incentive to stay, but also maintain a strong relationship between doctors and government.