About Money

Eberhard Renner, MD Internal Medicine Department Head

The end of March marks the end of the fiscal year. We all received our income statements. On this occasion, I would like to share with you some aggregate level data on GFT income in the Department and would be very interested in your comments.

Facts:

• The average total professional income of the roughly 200 GFT physicians working fulltime in our Department during the entire year in 2018 was $582k (median $480k); the variation between individual GFTs was wide, total professional income ranging from $133k to $1.6 million. Not unexpectedly, there are large differences between sections. However, GFT incomes differed by more than 3- (and up to 6- fold) also within several of our sections, despite these faculty members all working full time in the same subspecialty.

• The average total professional income of female GFTs was $501k (median $454k, range $144k-$1.2 million), that of male GFTs $523k (median $611k, range $133k-$1.6 million).

• The Department paid $744k to protect research time for 16 GFT members with a total professional income over $500k. To put these numbers into perspective:

• The annual salary of our UMFA colleagues at U of M ranges at the full professor level from $104k to $156k.

• The average income of Internal Medicine physicians across Canada was $389k in 2015/16, that of all Medical Specialists combined (GIM and its subspecialties) $347k

(CIHI, https://secure.cihi.ca/free_products/Physicians_in_Canada_2016.pdf).

Comments and questions:

I acknowledge that all of the above aggregate numbers cannot and should not be taken at face value; they are not granular enough to allow a definite interpretation or conclusions – but they make me think:

• Yes, some subspecialties or sub-subspecialties come with the inconvenience and stress of requiring more urgent and after hour work than their (often less invasive/interventional) counterparts. But does this really justify a several fold income difference between subspecialties, even more so between GFT colleagues working full time in the same subspecialty?

• Granted, female physicians may be more prevalent in lower billing subspecialties, at least, in part, explaining the gender difference of incomes. But is this the full explanation, and if it is, why are women ending up more frequently in lower billing subspecialties?

• Sure, some may argue that every researcher’s protected time should be valued equally, regardless of their clinical earnings. But is it really justifiable for the Department to invest its limited salary resources for protecting research time for faculty who earns half a million dollar or more through billings for their (part-time) clinical activities?

• Sure, other professions such a lawyers may make comparable amounts of money, but aren’t our incomes high by national (and international) standards in Medicine? Even more so, if the cost of living (of housing, in particular) in Winnipeg vs. metropolitan areas such as Toronto or Vancouver is taken into account? BTW our GFT expenses are lower than elsewhere, as unlike at UHN/U of T’s Dept. of Medicine for example, there is support for travel of faculty, faculty members do not have to lease their office space from the hospital/university at an every year increasing “fair market price”, pay for their own administrative assistant’s salary, AND pay 25% overhead to the practice plan (which increases to 40% for those billing more than a certain amount).

Collectively, this all seems to me to illustrate how privileged our situation in Manitoba still is. Asking for more $ and for extra, additional re-imbursement for every single task that comes with an academic job such as participating in teaching and collaborating in innovation is, in my opinion, putting this privilege at risk.

Finally, and on a more general note: as academic physicians in the Canadian health care system we are paid by and accountable to the taxpayer. We need to be able to justify our income to this public. Would we really be in a position to do so – and with which argument(s)?

5 thoughts on “About Money”

  1. Your portrayal of physician reimbursement in the DOM is accurate.
    I do not think there is much to discuss. As in any workforce, the determinants of income are well defined. Our personal view of who is overpaid is not one of them.
    With respect to tax payer accountability, the primary responsibility falls on government and it’s agencies. As a physician, I am to be a good steward of resources but not to advocate for lowering of incomes. Nor to point out predatory pricing in the fee manual.
    Within the DOM itself one could aim to control the wage gap. A cap or an alternate funding agreement introduced. It might work in this jurisdiction as one would not have to worry much about people leaving. We may complain bitterly about the winter but we are homebodies at heart. Interesting question is how low the income potential would need to fall to get a Winnipeger to move elsewhere.

  2. I do not think it is difficult to justify physicians incomes to the general public when put into context of a) years of training , b) comparison to the earnings of other professionals including lawyers dentists and the financial services industry and c) the service that we provide. Is there anything more dear to an individual than their health? Is there any professional decision made by a service provider that can have a greater negative or positive impact on an individual ? Is there a professional who makes a decision that has a possible greater risk for the individual they are providing advice or a procedure on. As everyone dressed in white last week to celebrate the Jets, does it make sense in society that physicians make 500 percent less than athletes.
    If there are physicians making more than the median it should be discerned whether they are providing more than the median in service.
    We can enforce physicians to reduce their work hours to in turn reduce their reimbursement or we can stop paying researchers to do research but I don’t think that will leave us with a department we will be proud of

  3. Very interesting data. There is indeed large, and for a large part arbitrary, differences in incomes between specialties. While its not the job of the Department of Medicine to fix this, the data raises two important issues.
    The first issue is that of the departmental overhead which is much lower than that in the community and also at some other academic centres in Canada. Lower overhead should allow members to spend some time fulfilling the academic mission of the department with teaching, research and administrative activities without necessarily receiving identified stipends for each activity. Do department members pull an equal share of the load? Should members who are unwilling to contribute be invited to join community-based clinics instead?
    The second issue revolves around income for research-heavy individuals ( 60% or more) in low-billing specialties. The limited ability of those individuals to generate income beyond their small research salary means their total incomes fall well below the mean for all physicians in the Province. This makes recruitment and retention of clinician scientists in these specialties extremely difficult. An alternate funding plan comes with its own set of drawbacks but perhaps there needs to be a discussion around how money for protected time is allotted and reasonable minimum incomes within the department.

  4. Ebi, thanks for an introducing what will no doubt be an interesting and impactful discussion. That being said, it is unfortunate that the forum in which you posted this is suboptimal in its reach and in its conduciveness to continuing this important conversation. While I have some thoughts on this matter, (and likely, many others do as well) it is unlikely that 5 days after you originally posted this that anyone will be reading it (perhaps, outside of yourself)

    You may wish to consider an alternate forum, such as Slack to ensure this discussion is able to reach and engage across the department.

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