questions about Canada's health care system

[ruthless bastard]

I've got two questions regarding the health care program in Canada and was hoping someone could help me out with them.

1: About how much does a doctor make in Canada per year?

2: Does Canada have a separate tax to pay for it's health care or is it just paid
from income tax?

 

[sadangel]

1. Family Physicians make an average of $200,000 a year. This is 2006 + years before that, whic is before expenses.
(In 2008, Doctors in Ontario received a 12.25% Pay raise.)

2. It is paid from General Revenue which includes Income Tax.

http://en.wikipedia.org/wiki/Health_care_in_Canada

 

[ruthless bastard]

thank you

 

[rgraham666]

Fuller information here. My angel is correct though.

 

[alwayswantedto]

You should be aware that GP's make less than specialists, as in the US but all Cdn doctors pay much less insurance than in the US because it is far more difficult to sue a physician and the amounts are much smaller.

 

[Xelebes]

You should be aware that GP's make less than specialists, as in the US but all Cdn doctors pay much less insurance than in the US because it is far more difficult to sue a physician and the amounts are much smaller.

More difficult to sue or less people are willing to sue, possibly both.

 

[DeeZire]

More difficult to sue or less people are willing to sue, possibly both.

That's interesting. In the USA, restrictions on being able to sue a doctor would seem to be "unAmerican", since they would be a limitation on our personal freedoms. On the other hand, the conservatives in the USA are dying for tort reform - which would amount to a limitation on our personal freedoms. Have the conservatives in the USA actually pondered this situation beyond their usual knee jerk reaction? Do they realize, in one respect, they're trying to turn the USA into Canada? The horror! If I was a conservative, I'd be pretty pissed off at my fellow conservatives right about now.

 

[MzDeviancy]

More difficult to sue or less people are willing to sue, possibly both.

There's definitely much less of frivolous lawsuit culture here, for sure. Most of our frivolous lawsuits seem to be people claiming back injuries that they don't have from auto accidents.

I had heard that insurance premiums are relatively high for ObGyns here, although again, not as high as in the States.

 

[Tio_Narratore]

More difficult to sue or less people are willing to sue, possibly both.

Not more difficult to sue, but far more difficult to get enormous pay-offs. The courts attempt to keep the awards in malpractice cases reasonably related to the injuries sustained.

 

[JackLuis]

What is the ratio of Doctors to Lawyers in Canada?

I read that the number of Lawyers in the US is higher than anywhere else, don't remember the numbers.

Perhaps we need to increase the number of Doctors and reduce the number of Lawyers?

 

[stephen55]

Not quite...

You should be aware that GP's make less than specialists, as in the US but all Cdn doctors pay much less insurance than in the US because it is far more difficult to sue a physician and the amounts are much smaller.

It's true that in Canada, medical malpractice suits are settled in amounts far less than in the US. Up here, medical malpractice is always heard before a judge alone, never before a jury. If the judge finds the doc did something wrong the settlement is made on the basis of reasonable compensation for the injury suffered. So if you want to sue for megamillions because the surgeon who removed your gallbladder left a scar...go ahead.

I don't agree that it is far more difficult to sue a physician in Canada than in the US. Everyone is entitled to their day in court. One reason that medical malpractice suits are far less common in Canada is that lawyers up here know that the client actually has to have a case before they will proceed. The second reason is that docs up here don't carry malpractice insurance per se. They almost all belong to an organization called the CMPA. (Canadian Medical Protective Association) It's not an insurance company. It's a medical defense fund. It's wholly owned and operated by the Canadian Medical Association. That is, it's owned and operated by the docs of Canada. The CMPA tries to avoid going to court by two simple strategies. Every time a doc who is a member of the CMPA gets sued, it looks at the case and asks several experienced docs of similar background to have a look. (Obstetricians look at obstetrical cases etc.) If it is clear that the doc messed up, the CMPA offers an out of court settlement based on what similar cases have been settled for in the past. Lawyers dicker and a check is cut. If several docs (CMPA medical experts) say that the case is without merit or is frivolous, the CMPA has an unbreakable rule that they will not settle out of court for any amount. So the plaintiff's lawyer has to actually consider the likelihood of winning a case against the opinion of several medical experts, tried before a judge alone, all the while running up expenses, versus the chance that the CMPA will fold. That chance is zero, hence very few medical malpractice lawsuits in Canada. Those cases where the lawyer is convinced of the merits of the case, perhaps based on his or her own medical experts' opinions and the CMPA is not convinced...then they go to court.

 

[alwayswantedto]

Thank you Stephen55 for providing the accurate details of a Cdn doctor's protection and the reason for my statement that it is harder to sue a doctor in Canada. It is often the case in civil suits that the deeper pocket wins and the CMPA provides the deep pockets enabling a case to be fought over a long period and several appeals if necessary. By fighting almost all cases the CMPA has created the reputation you allude to, that it will not give in. Lawyers know that and advise their clients that the fight will be long and expensive, often the last thing anyone wants to be involved with after a traumatic medical injustice. Their reputation serves the CMPA and its clients well. I don't mean to imply that cases against doctors are always right, just that it is more difficult to win.

 

[JAMESBJOHNSON]

Makes you wonder why only our army deserters wanna live in Canada.

 

[stephen55]

One more time......

Thank you Stephen55 for providing the accurate details of a Cdn doctor's protection and the reason for my statement that it is harder to sue a doctor in Canada. It is often the case in civil suits that the deeper pocket wins and the CMPA provides the deep pockets enabling a case to be fought over a long period and several appeals if necessary. By fighting almost all cases the CMPA has created the reputation you allude to, that it will not give in. Lawyers know that and advise their clients that the fight will be long and expensive, often the last thing anyone wants to be involved with after a traumatic medical injustice. Their reputation serves the CMPA and its clients well. I don't mean to imply that cases against doctors are always right, just that it is more difficult to win.

I don't think you read the same post as the one that I wrote. The CMPA fights very few cases. Obvious cases where someone screwed up are quickly settled out of court to the reasonable standards that the patient's lawyer agrees to. Frivolous cases seldom proceed because there's nothing to gain. That leaves very few cases to go to court. In Canada, medical negligence cases that do go to court proceed quickly and if the CMPA loses, they seldom appeal unless their lawyers believe the judge made an error in law. If the CMPA lawyers feel the judge made a legally valid judgment against the doc, the CMPA pays up. What the CMPA refuses to do is cave to a lawyer with a frivolous case simply because it might save some time, energy and money. The operational qualifier is "frivolous case". That happens all the time in the US which is one of the reasons US docs pay so much in insurance. The other reason is that juries in the US have the habit of awarding settlements far in excess of reasonable damages, which is why similar cases in Canada are held in front of a judge alone.

In Canada, a medical negligence case that goes to court is settled on point of law, not on the basis of deep pockets. Because the CMPA is a branch of The Canadian Medical Association (CMA), it adheres to the CMA's Code of Ethics. You can read the CMA Code of Ethics here...

http://policybase.cma.ca/PolicyPDF/PD04-06.pdf

If you want to know more about the CMPA and how it operates...

http://www.cmpa-acpm.ca/cmpapd04/index.cfm

A patient in Canada who suffers because of medical negligence gets a much easier and quicker settlement than one in the US. The operational qualifier is "suffers because of medical negligence". Ending up with a scar after having your gallbladder taken out for good reason is not medical negligence. Having your gallbladder taken out when it wasn't medically necessary, or without informed consent, is medical negligence. The CMPA understands the difference. So do Canadian lawyers.

 

[Loring2]

How is that again

That's interesting. In the USA, restrictions on being able to sue a doctor would seem to be "unAmerican", since they would be a limitation on our personal freedoms. On the other hand, the conservatives in the USA are dying for tort reform - which would amount to a limitation on our personal freedoms. Have the conservatives in the USA actually pondered this situation beyond their usual knee jerk reaction? Do they realize, in one respect, they're trying to turn the USA into Canada? The horror! If I was a conservative, I'd be pretty pissed off at my fellow conservatives right about now.

Let me confess, I was a Lawyer for 10 years but I take it that you must teach Law somewhere in order to arrive at your conclusions. So if you would please, tell me how tort reform would effect limitations on personal freedoms. Second even if tort reform is affected, how does that turn the USA into Canada? Finally, can you please give me a recapitulation of your understanding of tort law and the difference between Canadian and American Tort Laws.

Eagerly awaiting your response.

Respectfully

Loring

 

[Loring2]

Monstrous Ratio

What is the ratio of Doctors to Lawyers in Canada?

I read that the number of Lawyers in the US is higher than anywhere else, don't remember the numbers.

Perhaps we need to increase the number of Doctors and reduce the number of Lawyers?

We've got so many lawyers here that they outnumber the rest of the people ... fortunately most of them work as news casters and securities salesmen/women ... no joke. Some even write books about "How to Succeed at (Fill in the Blank)". I was one for about 10 years, 5 years too long.

Seriously though, it isn't a matter of the number of Lawyers, it's our tort laws.
After all, there is a finite number of liability cases each year irrespective of the number of lawyers so 100,000 more or fewer lawyers wont make a difference.

What's wrong with our torts laws? Hell I don't know ... I was a bankruptcy lawyer and a good one but while I know torts laws better then you do, at least I probably do. I'm not qualified to recommend anything.

It needs a panel of honest lawyers who are not in congress to recommend change and don't give me this garbage about the dearth of honest lawyers.
Most lawyers are honest and highly ethical, much more so then the clients they represent. Now if you say lawyers in congress, then I'm with you.

It's just that in my opinion congress and honesty are anathema to one another.

Enough of my rant.

Loring

 

[cloudy]

Let me confess, I was a Lawyer for 10 years but I take it that you must teach Law somewhere in order to arrive at your conclusions. So if you would please, tell me how tort reform would effect limitations on personal freedoms. Second even if tort reform is affected, how does that turn the USA into Canada? Finally, can you please give me a recapitulation of your understanding of tort law and the difference between Canadian and American Tort Laws.

Eagerly awaiting your response.

Respectfully

Loring

Oh, sure...and I used to be the pope.

 

[alwayswantedto]

Stephen55, I definitely read the same post you did. My point was that the CMPA makes it easier for a doctor to be defended in court. If a patient or his/her family can't afford to last in court, right or wrong, then the deep pockets scenario definitely plays a role as in any other type of legal action. By your statements, you seem to believe that the CMPA is an altruistic and perfect organization. I don't agree; it wasn't set up to be an institution of justice, it was formed to defend doctors.

I am aware of a case in which an organ was removed by mistake; hardly a frivolous case. The family involved chose not to sue the doctors after being advised about the length of time involved and the low, eventual compensation by two separate lawyers both of whom retained medical consultants (doctors) who concurred on the occurence of gross negligence if not misconduct.

 

[Pure]

note to loring2

hi loring2

thank you for contributing your knowledge of US law. i believe you are reasonable in the concerns you expressed to DeeZire.

as somewhat of an expert on the US (pseudo) conservative mind, but NOT a lawyer, i THINK i can answer one question of yours, since I had it, myself. what's with US so-called conservatives and 'tort reform'?

loring tell me how tort reform would effect limitations on personal freedoms.
---

you have to realize the US conservatives, more than with personal freedoms, are concerned with CORPORATE and BUSINESS freedoms, as evidenced in the recent SC case re political advertising. these commercial "freedoms" are alleged to flow from individual freedoms, i.e., my freedom as a stockholder to make money. ANY restriction on these, EVEN if approved by Adam Smith himself, are cause for screaming. So a law saying "smokestacks cannot emit more than XX carbon" is an objectionable incursion: why, becuase it costs the business MONEY to install a filter/scrubber. The profits may be lessened. Same for 'pure food and drug laws', which reasonable persons including capitalists have accepted for years (indeed some food manufacturers CALLED for such laws: if you make pure Ketchup, you don't want to go up against those who adulterate.)

those of us NOT in this lunatic segment naturally think: what of the personal freedom of the family living nearby, whose child is afflicted with asthma. well, they say, surely you aren't, for the sake of an illness, going to instal socialism. why doesn't the family move?

i think you can see the problem with torts against businesses--and drs count as businesses. indeed some are incorporated as themselves, or in groups. the lawsuits against tobacco companies would be an example. well, their being forced to pay is an infringement on their *business freedom* and clearly affects the bottom line. same for a drug company that makes a defective drug or a car manufacturing company that makes a defective car that blows up in some situations (remember Pinto).

if the *market* is God, then it will provide. taking the Pinto case:
a) the people were free not to buy Pintos; caveat emptor applies. b) if anything is wrong with Pintos, the market will solve the issue; people will find out and stop buying them, at least until they are fixed.

so you can see why successful tort suits, sometimes beloved by lawyers (a 50-50 split of 5 million dollars is a lot) are a bugbear for conservatives. esp. with no ceilings.

it's odd that this 'conservative' ideology conflicts with such things as the Bill of Rights, allegedly a sacred document for conservatives. (isn't the 'liberty' of an asthmatic curtailed, if he's living near a dirty smokestack?). also, the BR does not mention corporations or businesses, and say, e.g., "there is freedom of expression for corporations and businesses [as well as individuals]". this doesn't bother the alleged advocates of 'strict construction'; they are happy to concur with a series of decisions, including the recent SC one, which grant businesses extensive "freedoms".

perhaps this clarifies the thinking; i'm sure you know most of these points.

thanks again for your contribution.

 

[MzDeviancy]

hi loring2

thank you for contributing your knowledge of US law. i believe you are reasonable in the concerns you expressed to DeeZire.

as somewhat of an expert on the US (pseudo) conservative mind, but NOT a lawyer, i THINK i can answer one question of yours, since I had it, myself. what's with US so-called conservatives and 'tort reform'?

loring tell me how tort reform would effect limitations on personal freedoms.
---

you have to realize the US conservatives, more than with personal freedoms, are concerned with CORPORATE and BUSINESS freedoms, as evidenced in the recent SC case re political advertising. these commercial "freedoms" are alleged to flow from individual freedoms, i.e., my freedom as a stockholder to make money. ANY restriction on these, EVEN if approved by Adam Smith himself, are cause for screaming. So a law saying "smokestacks cannot emit more than XX carbon" is an objectionable incursion: why, becuase it costs the business MONEY to install a filter/scrubber. The profits may be lessened. Same for 'pure food and drug laws', which reasonable persons including capitalists have accepted for years (indeed some food manufacturers CALLED for such laws: if you make pure Ketchup, you don't want to go up against those who adulterate.)

those of us NOT in this lunatic segment naturally think: what of the personal freedom of the family living nearby, whose child is afflicted with asthma. well, they say, surely you aren't, for the sake of an illness, going to instal socialism. why doesn't the family move?

i think you can see the problem with torts against businesses--and drs count as businesses. indeed some are incorporated as themselves, or in groups. the lawsuits against tobacco companies would be an example. well, their being forced to pay is an infringement on their *business freedom* and clearly affects the bottom line. same for a drug company that makes a defective drug or a car manufacturing company that makes a defective car that blows up in some situations (remember Pinto).

if the *market* is God, then it will provide. taking the Pinto case:
a) the people were free not to buy Pintos; caveat emptor applies. b) if anything is wrong with Pintos, the market will solve the issue; people will find out and stop buying them, at least until they are fixed.

so you can see why successful tort suits, sometimes beloved by lawyers (a 50-50 split of 5 million dollars is a lot) are a bugbear for conservatives. esp. with no ceilings.

it's odd that this 'conservative' ideology conflicts with such things as the Bill of Rights, allegedly a sacred document for conservatives. (isn't the 'liberty' of an asthmatic curtailed, if he's living near a dirty smokestack?). also, the BR does not mention corporations or businesses, and say, e.g., "there is freedom of expression for corporations and businesses [as well as individuals]". this doesn't bother the alleged advocates of 'strict construction'; they are happy to concur with a series of decisions, including the recent SC one, which grant businesses extensive "freedoms".

perhaps this clarifies the thinking; i'm sure you know most of these points.

thanks again for your contribution.

I didn't, so that was very edifying for me. Thanks, Pure.

 

[JAMESBJOHNSON]

LORING2

Twenty years of working with lawyers and judges convinced me that most lawyers are stupid, unprincipled, and go for the outcome they want regardless of the law. Plenty of state trial judges have no idea what jurisdiction means.

 

[stephen55]

It's complicated but not impossible to follow....

Stephen55, I definitely read the same post you did. My point was that the CMPA makes it easier for a doctor to be defended in court. If a patient or his/her family can't afford to last in court, right or wrong, then the deep pockets scenario definitely plays a role as in any other type of legal action. By your statements, you seem to believe that the CMPA is an altruistic and perfect organization. I don't agree; it wasn't set up to be an institution of justice, it was formed to defend doctors.

I am aware of a case in which an organ was removed by mistake; hardly a frivolous case. The family involved chose not to sue the doctors after being advised about the length of time involved and the low, eventual compensation by two separate lawyers both of whom retained medical consultants (doctors) who concurred on the occurence of gross negligence if not misconduct.

The CMPA was set up as an alternative to insurance company medical malpractice insurance. The CMA decided (correctly) that they could do a better and less expensive job that private insurance companies. It hardly makes it easier for a doctor in Canada to be defended in court. Any lawyer in Canada is able to take on a case of medical malpractice on a contingency basis (the plaintiff only pays the lawyer if the case is won). Deep pockets are thus, not a concern. (That's only the case if the lawyer feels the case has merit. When a case is questionable or downright frivolous, no lawyer will take the case on contingency. Three to four hundred dollars per hour is the usual.)

The CMPA was certainly not set up as an institute of justice. It never claimed to be in the first place. It is, as you said, set up to defend doctors in malpractice cases. But as I said earlier, if the CMPA feels the case has merit, it settles, preferably before going to trial.

As for...

I am aware of a case in which an organ was removed by mistake; hardly a frivolous case. The family involved chose not to sue the doctors after being advised about the length of time involved and the low, eventual compensation by two separate lawyers both of whom retained medical consultants (doctors) who concurred on the occurence of gross negligence if not misconduct.

...If this happened in Canada, the CMPA would have paid up, that is, if the case clearly was a case of negligence and gross misconduct. If a surgeon removes an organ because of a mistaken pathology report on a biopsy, it's the pathologists fault, not the surgeon's fault. If the biopsy was questionable in that the true nature of the pathology was uncertain (a common occurrence, "possibly malignant but not necessarily malignant") and the surgeon proceeds on the basis of "it's better to err on the side of caution than to leave a potentially lethal problem", then it's a question of judgment, not a question of malpractice.

I don't know the facts of your case but consider this example. Surgeons routinely remove an appendix at any genuine sign of appendicitis. If a surgeon has a record such that 100% of all appendices that are removed are shown to be diseased, you don't have a brilliant surgeon. What you have is a walking time bomb. It's called "index of suspicion". If you only operate on cases where you are 100% convinced of pathology, you are going to miss a lot of cases where appendicitis is present but is not 100% obvious. Leaving in a diseased appendix is far more dangerous than removing a healthy appendix. A surgeon must raise the index of suspicion (operate when doubt may exist) to ensure that all diseased appendices are removed, despite the certainty that some healthy appendices will be removed.

Having seen the results of waiting on appendicitis (the most miserable death known short of bowel obstruction), when I took my youngest daughter to Emergency with what I thought, as a GP, was clearly appendicitis and was told by surgeon A that it wasn't appendicitis, I picked up the phone and called surgeon B. One hour later, my daughter was on the table. Whether or not my daughter's appendix was diseased (it was), the point is that surgeon A had an index of suspicion that was not only dangerous low, it was potentially deadly. That said inappropriate index of suspicion was likely to kill my daughter was not part of my deference to specialist opinion.

So, removing a healthy organ is not always a mistake. It can be simply prudent medical judgment. Whether the organ is an appendix, a breast or a stomach is immaterial. If the surgery was a judgment call and the pathology report after surgery says "no pathology or non-malignant pathology" then if the surgeon exercised prudent judgment (a judgment that was in keeping with the decision that other reasonable surgeons would have made), no malpractice occurred. Had my daughter's appendix been healthy, I still would have given surgeon B a bottle of wine in appreciation of the proper judgment that occurred.

 

[jomar]

That reference said Canadian PCPs make $200,000 before expenses? What does that mean? It's the take home pay that counts.

 

[stephen55]

That reference said Canadian PCPs make $200,000 before expenses? What does that mean? It's the take home pay that counts.

Most Canadian docs work on what's called "Fee for Service". A Canadian GP gets paid a set fee for say, a regular office visit. If the doc chooses to see twenty patients that day, the income is twenty times the office visit fee. If the doc wants to work harder and see forty patients a day, the days income goes up double accordingly.

Everything the doc does gets paid a certain fee. Delivering a baby, suturing a laceration, assisting a surgeon with an operation and everything else is assigned a certain fee. Add it all up over a year and that's the docs annual income. That said, I think an average GP in Canada, working full time and taking a few weeks holiday (unpaid) makes more than $200,000 per year before expenses. But it all depends on how busy the doc chooses to be.

From that income the doc pays office expenses, professional dues, license fees and everything else it costs to run a practice. What's left is the net income. What that net turns out to be depends on how much work was done. Serious workaholics can clear $300,000. The ones who choose to go slower or work part time might clear $30,000. There is no real average GP income because there is no average workload. When you're in private practice as most Canadian GP's are, your income depends on your self chosen workload.

There are docs who choose to work in some kind of a salaried position and their income depends on what they're doing and the hours of work. Of course they don't pay any overhead and their income is fixed. If they want to earn some extra money, they're free to moonlight by working in the local hospital Emergency, at a walk-in clinic or at anything else they choose.

 

[jomar]

Most Canadian docs work on what's called "Fee for Service". A Canadian GP gets paid a set fee for say, a regular office visit. If the doc chooses to see twenty patients that day, the income is twenty times the office visit fee. If the doc wants to work harder and see forty patients a day, the days income goes up double accordingly.

Everything the doc does gets paid a certain fee. Delivering a baby, suturing a laceration, assisting a surgeon with an operation and everything else is assigned a certain fee. Add it all up over a year and that's the docs annual income. That said, I think an average GP in Canada, working full time and taking a few weeks holiday (unpaid) makes more than $200,000 per year before expenses. But it all depends on how busy the doc chooses to be.

From that income the doc pays office expenses, professional dues, license fees and everything else it costs to run a practice. What's left is the net income. What that net turns out to be depends on how much work was done. Serious workaholics can clear $300,000. The ones who choose to go slower or work part time might clear $30,000. There is no real average GP income because there is no average workload. When you're in private practice as most Canadian GP's are, your income depends on your self chosen workload.

There are docs who choose to work in some kind of a salaried position and their income depends on what they're doing and the hours of work. Of course they don't pay any overhead and their income is fixed. If they want to earn some extra money, they're free to moonlight by working in the local hospital Emergency, at a walk-in clinic or at anything else they choose.

Okay, what I thought, thanks. That's pretty much how it works in the US, though those in group practices are often salaried (pooled income) and expected to generate $X.