Â鶹ӰÊÓ

Canada

    • Doctors say unfair salaries driving them away from family medicine in Canada

    Share

    Dr. Garni Tatikian is having second thoughts about her future as a family doctor because of what she calls unfair salaries.

    The Toronto-based doctor, 33, has been working as a locum physician for about four years since she graduated from medical school in 2019. As a locum physician, she covers family physicians in their clinics typically a few months at a time while they are away for holidays, illness or other reasons.

    "So I haven't actually opened my own clinic and one of the reasons for that is that I'm not sure how long I'll continue to practise as a family physician," Tatikian said in a video interview with CTVNews.ca. "In the long run, a career as a family physician doesn't seem to be a financially wise one. Historically, pay raises that family physicians get from the government haven't kept up with inflation."

    Tatikian was among the Canadian health-care workers who shared their experiences with CTVNews.ca about the problems driving some to consider leaving the profession or quit altogether.

    The College of Family Physicians of Canada (CFPC) is calling for changes in how family doctors are paid to ensure the "long-term sustainability" of the discipline. The training and advocacy organization, which has more than 42,000 members, noted the "unprecedented degree of burnout" family doctors in Canada are experiencing while caring for patients with increasingly complex needs. Overworked emergency departments and primary care clinics are struggling to attract and retain a sufficient workforce, it added.

    "Despite playing a foundational role in the health care system, family physicians remain the lowest-paid medical specialty in Canada," it wrote in a statement.

    As of 2017, about 28 per cent of family physicians' gross income in Canada went toward overhead costs, the CFPC added.

    Dr. Garni Tatikian says her future is uncertain as a family doctor. (Supplied)

    Tatikian notes it's expensive to run a clinic, which can be 25 to 35 per cent of family physicians' salaries.

    "Those costs do continue to rise proportional to inflation," Tatikian said. "So when the rate at which your expenses rise is higher than the rate at which your income rises, you effectively have a sinking ship, which is why we're seeing family physicians close their clinics all over the province. So many of them haven't actually seen a take-home raise in years."

    'Like an assembly line'

    Under Ontario's billing system, she says most people she knows pay more for a haircut than what family doctors earn in an hour.

    She says physicians in Ontario can register under one of the existing models of payment but the system doesn't take into account how long physicians spend with patients.

    The model most family physicians are paid through is known as fee-for-service. This allows physicians to get paid per patient per appointment, which uses the code A007 and costs $37.95, regardless of how many issues are discussed per appointment or how long it takes.

    This model essentially involves running your own practice as a business, according to the CFPC. Moreover, the CFPC said the business aspects of operating a clinic can reduce time for patient care, add to workloads, and significantly increase the risk for burnout and stress.

    Family doctors in Canada received an average of $252,663 net in 2021 and, based on self-reported data, had $93,451 in average overhead expenses in 2017, which the CFPC notes is likely underestimated due to inflation.

    "So patients think their physicians get paid hundreds of dollars every time they see them," Tatikian explains, "but this couldn't be further from the truth."

    As an example, she says a physician who spends five minutes with a patient will bill the same A007 as the one who spends 20 minutes with a patient, with both receiving $37.95.

    Consequently, a physician can treat a clinic "like an assembly line."

    "As such, it's possible for a physician to make a good income by powering through patients, limiting them to 1 issue per appointment," Tatikian said in an email. "However, no one is happy this way. The physician either burns out and loses compassion or leaves the field all together. The patients, understandably, aren't happy either."

    Family doctors also don't get paid for doing administrative work, she adds. "So a physician that actually spends time with their patient and sees multiple issues a visit is rewarded with a pretty low hourly rate," she says.

    While Tatikian doesn't have an idea yet of what she'll do if she decides to quit family medicine, she says many options exist for family physicians. In hospitals, they can work as hospitalists, palliative care physicians, emergency medicine physicians and providers of low-risk obstetrics.

    "At least when you're working in the hospital, you not only get paid a little bit more, but you don't have to worry about overhead the same way (as in a clinic outside of a hospital)," she said. "If I don't see a reason to believe that the financial situation that this field is in is going to improve in a reliable way, I'll have to start reconsidering my options."

    Ontario Medical Association CEO Kimberly Moran says there's a "significant variation" in the salaries of family doctors across Canada and throughout Ontario, depending on the province and practice model they work in.

    In the past 10 years, the situation has gotten worse, she said.

    "Over the last 10 years, inflation has grown by over 25 per cent while their compensation has only grown by about six per cent," Moran said in a video interview with CTVNews.ca, noting there are similar trends across Canada. "And over the same time period, the unnecessary administrative burden has probably about doubled."

    The problem has resulted in not enough new doctors choosing to become traditional family doctors who provide comprehensive longitudinal care, or those who see patients over the course of their life for a range of health issues, Moran said. "What that means is we're really seeing a big increase in the number of Canadians and Ontarians who don't have a family doctor."

    Solutions to crisis

    The CFPC recommends an alternative way of paying family physicians. One option it proposed is blended capitation, where a physician or practice receives a fee per patient, while maintaining a fee-for-service component for some services. Through this model, family doctors would be compensated for their full range of tasks and services, including administration and paperwork. It would also encourage team-based care, the CFPC argues.

    "This model is preferable as it incentivizes better care for patients, while the pure fee-for-service model rewards high-volume care and disincentivizes comprehensiveness and management of complexity," the CFPC said in a statement.

    Moran says a team-based approach to care led by family doctors is important because it allows doctors to delegate administrative burden to other staff members and ensure patients are able to see other team members such as physiotherapists and mental health therapists.

    "And what that will do is free up the family doctor's time to see other patients," she said. "So working in team-based care models is very much the way of the future."

    Anne Génier, a spokesperson for Health Canada and the Public Health Agency of Canada, says improving primary care access is a shared priority of all levels of government.

    "The Government of Canada continues to work with provinces and territories to help Canadians obtain access to a regular primary care provider or team and address backlogs," Génier said in an email to CTVNews.ca.

    The federal government announced in February 2023 it would provide $196.1 billion over 10 years, including $46.2 billion in new funding, for provinces and territories to improve health-care services for Canadians through bilateral agreements.

    In response to the concerns about family doctors' salaries, Hannah Jensen, spokesperson for Ontario Minister of Health Sylvia Jones, said the Ontario Medical Association and the ministry have been in talks for a new Physician Services Agreement since October 2023. Jensen said the province is tackling the administrative burden on physicians through new initiatives, such as replacing fax machines with digital communications options for all health-care providers. The province also announced in February what it called the biggest expansion of inter-professional primary care teams since they were established in Ontario.

    "We are investing $110 million, triple the original amount set out in our 23/24 budget to create and expand 78 primary care teams, that will ensure 98% of Ontarians are connected to a primary care provider over the next several years," Jensen said in an email to CTVNews.ca.

    The CFPC notes that physician compensation falls under provincial and territorial jurisdiction. Provinces such as British Columbia, Manitoba, Nova Scotia and Saskatchewan recently adopted new Physician Services Agreements (PSA) that are more favourable to family physicians, it said.

    "The PSAs have rightly provided payment provisions for time, patient interactions, and the number and complexity of patients in their practice – things that are lacking in traditional fee-for-service payments for family docs," said Courtny Vaz, spokesperson for the physician's group, in an email to CTVNews.ca.

    She said the federal government can provide compensation for administrative work because family doctors are expected to fill out federal health forms. "Family docs don't get paid to fill out these forms at the federal or provincial level and instead, they are expected to pass the costs onto patients," Vaz explained.

    CTVNews.ca Top Stories

    Three men were injured after trying to subdue a man armed with a knife during afternoon prayers at a Montreal-area mosque Friday afternoon.

    Police have arrested an 18-year-old woman who allegedly stole a Porsche and then ran over its owner in an incident that was captured on video.

    Since she was a young girl growing up in Vancouver, Ginny Lam says her mom Yat Hei Law made it very clear she favoured her son William, because he was her male heir.

    A 15-year-old boy who was the subject of an emergency alert in New Brunswick has been arrested.

    Advocates have identified the woman who died this week after being shot by police in Surrey, B.C., as a South American refugee who was raising a young daughter.

    The search for a missing six-year-old boy in Shamattawa is continuing Friday as RCMP hope recent tips can help lead to a happy conclusion.

    Provincial police investigating the death of a cat that was allegedly set on fire in Orillia earlier this week released surveillance video of a person of interest in the case.

    • Advocates have identified the woman who died this week after being shot by police in Surrey, B.C., as a South American refugee who was raising a young daughter.

    • The debate over sexual orientation and gender identity education in schools is heating up. Protests both for and against SOGI in the curriculum took place across the country Friday.

    • A fire that destroyed a historic bridge in Kamloops, B.C., is now being investigated as arson, local Mounties say.

    • Police have arrested an 18-year-old woman who allegedly stole a Porsche and then ran over its owner in an incident that was captured on video.

    • The parents of a teenager who died after allegedly consuming the poisonous products of a Mississauga man are now suing him, as well as several doctors involved in her care.

    • One person was rushed to the hospital with life-threatening injuries after a multi-vehicle collision in Milton, Ont. on Friday night.

    • The man charged with fatally stabbing lifelong Banff resident Ethan Enns-Goneau in 2022 has been convicted of second-degree murder.

    • Environment Canada issued a frost advisory for Calgary late Friday afternoon.

    • Calgary Mayor Jyoti Gondek is urging the Alberta government to preserve pieces of the massive Green Line transit project now being dissolved.

    • Agreement in principle has been reached to build a new NHL arena at LeBreton Flats has been reached between the Ottawa Senators and the National Capital Commission (NCC), the two sides announced Friday.

    • For years, the commute to Ottawa's west end was one of the biggest complaints for attending fans. But those who live in Kanata and in the immediate LeBreton area say the move would be a big change their respective neighbourhoods.

    • Ottawa police are investigating a shooting downtown Friday afternoon.

    • Three men were injured after trying to subdue a man armed with a knife during afternoon prayers at a Montreal-area mosque Friday afternoon.

    • When Bernard Morissette got a call from Loto-Quebec on Sept. 18 and was asked if he was sitting down, he had no idea what was coming his way.

    • A man who asserted his right to work in French has won his case before the Tribunal, invoking the new provisions of the province's French-language law (Bill 96) to that effect.

    • Two Edmonton Police Service officers have been criminally charged in connection with an assault.

    • There's a friendship in the Edmonton Oilers crease between Stuart Skinner and Calvin Pickard.

    • A woman is dead after a highway collision on Saddle Lake Cree Nation.

    • A 15-year-old boy who was the subject of an emergency alert in New Brunswick has been arrested.

    • Mattea Roach among the Maritimers honoured with the King Charles III Coronation Medal Friday.

    • The Halifax Regional Detachment of the RCMP is asking the public for assistance locating a man wanted on a provincewide arrest warrant in relation to an assault in Lower Sackville.

    • The search for a missing six-year-old boy in Shamattawa is continuing Friday as RCMP hope recent tips can help lead to a happy conclusion.

    • A plane approaches the grass runway at Harv’s Air School south of Steinbach. Nothing is getting in the way of a clear, smooth landing, but owner Harv Penner worries, that could soon change.

    • The University of Manitoba's College of Dentistry is dealing with some unexpected consequences from the federal government's new Canadian Dental Care Plan

    • Regina police are responding to a collision involving a motorcycle on Friday evening.

    • Five Regina schools were placed into lockdown or secure the building mode following a report of a weapons investigation at Miller High School on Friday.

    • A 21-year-old man from Codette, Sask. is facing numerous charges in connection to a fatal crash near Wapella, Sask. Wednesday night that claimed the life of a 22-year-old Alberta woman.

    • Protests were held in front of Kitchener City Hall on Friday, both for and against LGBTQ2S+ inclusive education and queer rights in schools.

    • Levels of hydrogen sulfide gas are being monitored at Brantford Collegiate Institute after a leak in their geothermal system.

    • A new scam is being reported in communities across the country.

    • Hospital beds in hallways, supply shortages in the neonatal intensive care unit, and operating rooms being put on hold are some of the concerns nurses are voicing, according to the Saskatchewan Union of Nurses (SUN).

    • The Saskatchewan RCMP major crimes unit is investigating after a 29-year-old man died in hospital.

    • A garage fire in Saskatoon’s Willows neighbourhood on Friday narrowly missed igniting an attached home, according to the fire department.

    • Emergency crews in northern Ontario found the bodies of four people inside a home where a fire broke out Thursday night.

    • Police have arrested an 18-year-old woman who allegedly stole a Porsche and then ran over its owner in an incident that was captured on video.

    • A Brampton driver, 27, was charged this week when northern Ontario police stopped the SUV he was driving on Highway 17 after a reported shooting and found more than $100,000 in cash.

    • A man is in hospital with life threatening injuries following a collision between a motorcycle and a vehicle on Friday afternoon.

    • NEW

      NEW

      Under intense cross-examination from Crown Attorney Jennifer Moser, the embattled former Mayor of Woodstock stuck to his story denying that he ever did anything inappropriate to his female accuser.

    • Two men from Barrie have been charged after a deadly shooting at a park in Keswick on Wednesday.

    • Provincial police investigating the death of a cat that was allegedly set on fire in Orillia earlier this week released surveillance video of a person of interest in the case.

    • A jury has found a Barrie man guilty of second-degree murder for the stabbing death of a man at a Banff bar two years ago.

    • The Special Investigations Unit (SIU) is searching for the occupants of a vehicle caught on security cameras during a fatal police-involved shooting on Goyeau Street.

    • Windsor police say a 25-year-old mother has been charged with the drowning death of her 5-year-old child in the family’s backyard pool.

    • The federal government is investing $18.4 million dollars into the region.

    • New Democrat Leader David Eby has launched his British Columbia election campaign a day early, making the key battle ground of Surrey his first stop.

    • The Old Man Lake wildfire near Sooke is the only one currently burning on Vancouver Island. It’s a region of the province that this year saw a drastic drop in blazes in the backcountry.

    • Police in Victoria, B.C. issued a warning this week about lighters that look like pistols, saying they have received 20 reports of firearms in public spaces since July 1 that turned out to be gun-shaped torches.

    • A pair of runaway pigs are in the custody of an animal sanctuary in the Okanagan after evading police and volunteers for hours earlier this week.

    • The Red Bridge, a historic landmark in Kamloops, B.C., was completely destroyed by fire early Thursday morning.

    • Animal protection officers in British Columbia have rescued three pit bulls – including one that gave birth to 10 puppies – from a rat-infested home in Kelowna.

    • After a summer of preparation, the Lethbridge Hurricanes are ready to open the 2024-25 season.

    • As a new semester is underway, Lethbridge Polytechnic and the University of Lethbridge say the number of students on campus is on the rise.

    • A Lethbridge resident is facing charges after police seized drugs and weapons at a traffic stop for bicycle equipment violations.

    • A 26-year-old driver from Surrey, B.C., has been charged with three counts of criminal negligence causing death and bodily harm in a crash that killed two youths in northern Ontario last year.

    • Ontario Provincial Police say three suspects from southern Ontario have been charged and drugs worth $300,000 have been seized following a traffic stop Sept. 16.

    • A Brampton driver, 27, was charged this week when northern Ontario police stopped the SUV he was driving on Highway 17 after a reported shooting and found more than $100,000 in cash.

    N.L.

    Local Spotlight

    Getting a photograph of a rainbow? Common. Getting a photo of a lightning strike? Rare. Getting a photo of both at the same time? Extremely rare, but it happened to a Manitoba photographer this week.

    An anonymous business owner paid off the mortgage for a New Brunswick not-for-profit.

    They say a dog is a man’s best friend. In the case of Darren Cropper, from Bonfield, Ont., his three-year-old Siberian husky and golden retriever mix named Bear literally saved his life.

    A growing group of brides and wedding photographers from across the province say they have been taken for tens of thousands of dollars by a Barrie, Ont. wedding photographer.

    Paleontologists from the Royal B.C. Museum have uncovered "a trove of extraordinary fossils" high in the mountains of northern B.C., the museum announced Thursday.

    The search for a missing ancient 28-year-old chocolate donkey ended with a tragic discovery Wednesday.

    The Royal Canadian Mounted Police is celebrating an important milestone in the organization's history: 50 years since the first women joined the force.

    It's been a whirlwind of joyful events for a northern Ontario couple who just welcomed a baby into their family and won the $70 million Lotto Max jackpot last month.

    A Good Samaritan in New Brunswick has replaced a man's stolen bottle cart so he can continue to collect cans and bottles in his Moncton neighbourhood.

    Politics

    Health

    • A Nova Scotia woman has applied for a medically assisted death, saying after years of battling to receive out-of-country surgery for an illness that causes 'indescribable' pain, she struggles to maintain the will to live.

    Sci-Tech

    Entertainment

    • Getting a photograph of a rainbow? Common. Getting a photo of a lightning strike? Rare. Getting a photo of both at the same time? Extremely rare, but it happened to a Manitoba photographer this week.

    • It was the last show for longtime children's TV star Ron (Buck Shot) Barge Friday as hundreds of family, friends and fans attended a public memorial in Calgary.

    Business

    Lifestyle

    • When Bernard Morissette got a call from Loto-Quebec on Sept. 18 and was asked if he was sitting down, he had no idea what was coming his way.

    • An anonymous business owner paid off the mortgage for a New Brunswick not-for-profit.

    Sports

    • The Winnipeg Blue Bombers have won five in a row. The Edmonton Elks have won five of their last six games. They are the two hottest teams in the West. When they meet Saturday at Commonwealth Stadium, something has to give.

    • Agreement in principle has been reached to build a new NHL arena at LeBreton Flats has been reached between the Ottawa Senators and the National Capital Commission (NCC), the two sides announced Friday.

    • F1 star Max Verstappen punished over bad word

      Formula One points leader Max Verstappen was ordered to 'accomplish some work of public interest' after uttering an inappropriate word Thursday at the news conference ahead of the Singapore Grand Prix.

    Autos

    Shopping Trends

    The Shopping Trends team is independent of the journalists at Â鶹ӰÊÓ. We may earn a commission when you use our links to shop. Read about us.

    Stay Connected
    Follow Â鶹ӰÊÓ