The ways physicians are paid and their attitudes toward these payment methods are evolving rapidly, a CMA survey indicates. It shows that doctors who prefer fee-for-service (FFS) payments, the principal payment method used since medicine was first practised in Canada, are now part of what appears to be a rapidly dwindling minority.
The CMA's 2001 Physician Resource Questionnaire (PRQ), a tool that has been used to track doctors' attitudes since 1982, indicates that 35% of physicians now cite remuneration based solely on FFS as their preferred payment method, compared with 50% in 1995. (The proportion of respondents favouring FFS declined steadily between 1995 and 1999 before rising slightly in 2000 and then declining again this year. — Ed.) Since 1995, the proportion of physicians who would prefer to be paid by salary rose by 32;, from 18.3% to 24%.
Change is also apparent in the proportion of physicians who receive 90% or more of their professional income via FFS. This has fallen below 60% for the first time, standing at 59% in 2001 — a 13; drop from the 68% recorded in the CMA's 1990 physician questionnaire.
The 2001 PRQ was the first to ask physicians to expand upon a stated preference for blended remuneration, which is the preferred payment method for 27% of PRQ respondents; the majority of respondents prefer FFS plus salary. “I believe one of the biggest stresses is being able to earn a sufficient amount while balancing family and personal time,” explained one doctor. “A salary would afford a doctor security and benefits while fee-for-service would reward those who do put in the extra hours.”
The 2001 PRQ indicates that physician incomes have improved. One-quarter of respondents reported that their net income rose in the past year, a 56% increase from the 16% of respondents who reported higher incomes in 1998. Meanwhile, 26% reported that their net income had decreased, a 39% decline from the 43% of respondents who reported a decrease in 1998.
Although 71% of those reporting a higher net income also said that their workload increased, 29% reported that they were earning more even though their workload had remained the same or decreased during the past year.
Slightly more than half (54%) of physicians reported an increased workload in 2001, while only 9% reported a decrease; the results are similar to those from previous years.
The latest PRQ indicates that Canada's physicians work an average of 53.4 hours per week, excluding call. Female physicians continue to work fewer hours than males (49.1 hours per week v. 55.3 hours).
Almost two-thirds (64%) of physicians agree or strongly agree that their workload is heavier than they would like, up slightly from 62% in 1998. Well over half (58%) agree or strongly agree that their family or personal life has suffered because they chose medicine as a profession. One respondent reported: “I can never make up the time that I spent away from my family when my children were growing up; I would never have chosen another career, but I'm glad my children have not followed me in my profession.”
Surgical specialists appear to be most affected, with 66% agreeing or strongly agreeing that their family/personal lives have suffered, compared with 58% of medical specialists and 56% of GP/FPs. Male physicians are more likely than females to indicate that their choice of career has been detrimental to their family or personal life (60% v. 54%).
This year's survey included a new set of questions about physicians' future plans. Most respondents (83%) indicated that they were highly or somewhat likely to continue to practise in the same place for the next 2 years, while only 8% said they were highly or somewhat unlikely to remain in their current practice. Physicians younger than 35 (19%) and rural physicians (12%) were somewhat more likely to consider leaving their current practice location in the next 2 years.
The PRQ is Canada's largest annual survey of physicians' professional activities. The 2001 survey was mailed to a random sample of 7756 doctors, and the response rate was 42%. Results at the national level are considered accurate to ± 1.8%, 19 times out of 20. Additional Tables from the 2001 PRQ are available at www.cma.ca/cmaj/vol-165/issue-5/prq/index.