WINNIPEG — Sixteen Manitoba doctors billed the province more than $1 million for their services last year as public demand to treat everything from skin problems to vision issues continued to rise.
The numbers also show what’s needed to pay these specialists and others so they don’t fold up their shingle and leave the province.
TOP BILLING DOCTORSManitoba doctors who billed more than $1 million to the province for their services last year.• Dr. Allan Micflikier (gastroenterologist) $1,904,053• Dr. Sonny Dhalla (general surgeon) $1,528,118• Dr. Shane Silver (dermatologist) $1,516,642• Dr. Victoria Taraska (dermatologist) $1,354,386• Dr. G.A.M. Gdih (ophthalmologist) $1,278,017• Dr. Richard Leicht (ophthalmologist) $1,272,129• Dr. Frank Stockl (ophthalmologist) $1,216,715• Dr. R. Dookeran (ophthalmologist) $1,201,979• Dr. Adrian Long (ophthalmologist) $1,195,061• Dr. Daniel Chin (ophthalmologist) $1,163,258• Dr. Guillermo Rocha (ophthalmologist) $1,158,148• Dr. Edward Buchel (plastic surgeon) $1,130,843• Dr. Robert Beldavs (ophthalmologist) $1,134,679• Dr. Richard Hayday (dermatologist) $1,076,460• Dr. John Rabson (cardiologist) $1,074,162• Dr. Loris Cristante (neurosurgeon)$1,045,972Fee-for-service is a method of payment where physicians bill for each service rendered, according to a pre-arranged schedule of fees and services. Physicians who are paid on a fee-for-service basis file a claim for each service performed and are responsible for their operating costs. Not all doctors bill fee-for-service. They, such as emergency room physicians, are paid on an annual or sessional salary.The amounts only record gross payments made by Manitoba Health to the practitioner. It does not reflect earnings. A physician's net income may vary from the gross payments shown as costs of operating a practice must be paid from these gross payments.» Source: Manitoba Health annual report 2011-12
The top three billers were Winnipeg gastroenterologist Dr. Allan Micflikier, Brandon general surgeon Dr. Sonny Dhalla and dermatologist Dr. Shane Silver. The billing amounts were included in the recently released Manitoba Health’s 2011-12 annual report.
“It’s the same for any specialty or any doctor,” Silver said Friday. “We have an aging population. There’s more demand on the health-care system. As we get older, unfortunately more people have more ailments and will require more physicians visits.”
Silver said his practice is so busy he’s scheduling new patients for a first visit in May.
A decade ago, Micflikier was the only Manitoba physician to exceed $1 million in fees a year. Since then, the number of physicians making more than $500,000 has nearly quadrupled, with 124 doctors billing the province for a half million or more last year.
Included in the list are eight ophthalmologists in Winnipeg and Brandon who specialize in retina and cataract surgery. The number of ophthalmologists as top billers has increased over the past decade as eye problems such as glaucoma and macular degeneration have become more treatable.
Dr. Lorne Bellan, head of the ophthalmology at the University of Manitoba, said one reason so many eye specialists have cracked the $1-million mark in billing is because there are so few of them in a province — with so many patients.
He said Manitoba has the second-worst ratio of ophthalmologists to population in Canada after Newfoundland and Labrador.
“That means everybody who is here is super, super busy,” he said. “Even with doing lots (of surgeries), the wait lists are still not being brought under control.”
He added that ophthalmologists have high overhead costs compared to other physicians because of the expensive equipment they require to practice.
Experts say there will be a 100 per cent increase in all eye conditions over the next 15 to 20 years as the population of people 65 and older increases.
A provincial spokeswoman said under fee-for-service not all the payments go directly to the doctors. Some goes to overhead costs such as clinic space and staff salaries, and for equipment like needles and gloves. Expense amounts vary depending on the type of medical facility.
The province also said the fee-for-service payments to all doctors is a reflection of an aging population needing greater medical care.
“Additionally, some doctors perform procedures that have extraordinary supplies and other costs, which the province has agreed to supplement through fees,” the spokeswoman said.
“Fees are regularly reviewed and determined in relation to the fees in neighbouring provinces both to ensure we are competitive and attract more doctors to Manitoba, but also to ensure we are paying fair and reasonable compensation for services.”
The Canadian Institute for Health Information said in a report last year that Manitoba ranked in the middle of the pack in terms of physician salaries in Canada.
Manitoba doctors received an average $298,119 gross fee-for-service payment per doctor in 2010. That’s about $9,000 more than doctors in eastern neighbour Ontario and $12,000 less than doctors in western neighbour Saskatchewan, but less than Alberta which had an average pay of $377,368 per physician. Physicians’ pay in Quebec was lowest at $250,000 a year.
In total, it cost the province almost $1 billion ($972,807,000) to pay for its doctors in 2011-12. That number includes and lab tests, dental surgery and chiropractic and optometric services. That cost is up only one per cent from the year before, but 28 per cent from 2007-08 when medical expenditures were about $759 million.
The main reason Manitoba’s medical expenditures saw only a one per cent increase last year is mainly due to the Selinger government’s renewed master agreement with Doctors Manitoba, which represents the province’s fee-for-service physicians.
The NDP gave them a 10.6 per cent fee boost over four years, but to kick in mainly in the last two years, in keeping with “wage pauses” other public-sector employees have seen. Fees will rise 6.4 per cent in the third year (2013) and 4.2 per cent in the final year on the contract, which was retroactive to April 1, 2011.
The province says the deal ups provincial funding of medical services by about $125 million over the four years, including $80 million in fee increases — a necessary cost to retain doctors and help fulfil an NDP election pledge to provide a family doctor to each Manitoban by 2015 by increasing the number of doctors in the province.
» Winnipeg Free Press
Republished from the Brandon Sun print edition October 13, 2012