09/26/2013 03:12 EDT | Updated 11/26/2013 05:12 EST

Number of doctors rising, as is payment for services - $22 billion last year

TORONTO - The number of doctors in Canada is at an all-time high and payment for their services has continued to rise in lock-step, hitting a jaw-dropping $22 billion last year, the latest figures show.

Canada had more than 75,000 physicians working in 2012, up almost four per cent from the previous year, says a report by the Canadian Institute for Health Information (CIHI).

Overall payments to physicians by provinces and territories rose by nine per cent in 2011–2012, surpassing the growth rate of six and eight per cent, respectively, in the previous two years.

Canadian doctors were paid an average of about $328,000 before taxes and expenses in 2011–2012 — a five per cent increase over 2010–2011. The average gross clinical payment per physician ranged from $258,000 in Nova Scotia to $376,000 in Ontario.

While most doctors are paid through fee-for-service agreements with provinces and territories, alternative forms of payment are increasingly being used for reimbursement. Some physicians receive an annual salary as part of a team practice, for instance, or are paid by the hour or day for providing a basket of services.

Last year, almost 28.7 per cent, or $6.3 billion, of the overall $22 billion in payments came through alternative modes of payment, said Walter Feeney, program lead for CIHI's physician databases.

"To put that in perspective, 10 years ago, alternative payments made up about 10 per cent of overall clinical payment, and now we're up to about 30 per cent," he said Thursday from Ottawa.

Fee-for-service billings accounted for 71 per cent of overall physician paycheques last year; the average cost per service was $56.99. Family physicians billed an average cost per service of $41.94, while specialists received $77.42 per service on average.

The report suggests physician numbers will likely continue to rise in the coming years, in part because more doctors are graduating from medical schools.

Last year, more than 2,600 new Canadian MDs earned their white coats, a jump of almost five per cent from 2011 and 25 per cent higher than five years ago.

The country's physician workforce was also swelled by growth in the number of doctors with international medical degrees, who now make up one-quarter of Canada's doctors, Feeney said.

Family doctors continue to account for about half of the workforce, while specialists make up the other half.

And more and more, it is female practitioners who are checking blood pressure and writing out prescriptions in primary-care offices or wielding scalpels in operating rooms, said Feeney.

Between 2008 and 2012, the number of female physicians leaped by almost 24 per cent, while the number of male doctors rose by 10 per cent. Last year, about 37 per cent of doctors were women, compared with 35 per cent four years earlier.

Women made up 42 per cent of family medicine physicians last year and 32 per cent of specialists.

The report also found that since 2008, the number of doctors working in rural Canada had gone up five times faster than the rural population. There were almost 6,400 physicians practising in non-urban areas last year.

"More doctors working in rural areas may be a sign that Canadians' access to physician services in rural areas may be improving," said Geoff Ballinger, CIHI’s manager of physician information.

"Even so, it is important to ask not just how many doctors are needed, but where they are most needed and in what areas of specialty."

Feeney noted that although the overall number of doctors in Canada has risen — even outpacing population growth — it's still common to hear people say: "I don't have a physician. I can't find a doctor."

That may be because doctors just starting out don't have their practices fully up and running, he said. As well, there is a tendency for younger MDs to seek a healthier work-life balance by seeing fewer patients during shorter work weeks compared with their older counterparts, who may have graduated 25 or 30 years ago.

"Over the years, you've heard, 'We need more doctors; we need more front-line workers,'" said Feeney. "The big picture of the story is they're coming, they're getting into the system. So perhaps that will ease some access to care in the future.

"But given the way they choose how to practise and how to work, the best way for predicting what will happen is to say 'time will tell.'"