CUA 2018: Canadian Interprovincial Urological Economic Disparity

Halifax, Nova Scotia ( Despite a publicly funded, single-payer health system in Canada, there is significant interprovincial economic disparity in remuneration for urological services. At today’s CUA 2018 annual meeting, Dr. Nazif and colleagues presented results of their nationwide assessment, with the objective of the study to determine interprovincial economic disparity in remuneration for urologic services.

For this study, the Canadian Urological Association (CUA) Health Policy Committee (HPC) created a model to study interprovincial urological economic disparity. Subsequently, a subcommittee was formed with a representative urologist from each province to equate and validate fees. Arbitrarily, British Columbia was chosen as the base province for comparison among all 10 provinces. The BC Medical Services Plan Payment Data Series from 2016-2017 was used in the analysis, and urologist’s work fee-for-service and income was determined by the sum of the product of services and fees. The total income reported in the model was computed by extrapolation. The model assumed that urologists follow a similar practice pattern across the country, deliver the same number of services, and have a similar proportion of full-time-equivalent (FTE) physicians. Only urologists earning more than the FTE threshold of $84,700 CAD per year, as set-forth by BC government economics, were included in the study, resulting in inclusion of 91 urologists in BC. Gross income was calculated in the analysis, and interprovincial gross income variance was computed and stratified across the provinces. The fee-value data was accurate as of November 1, 2017.

The authors found that the top 20 fee items in BC comprise 84.7% of a BC urologist’s income. The economic disparity model yields gross income in Canadian dollars and variance stratified by province as follows:

  • Saskatchewan: $525,165 (variance 1.00)
  • New Brunswick: $516,104 (variance 0.98)
  • Alberta: $508,850 (variance 0.97)
  • Manitoba: $486,211 (variance 0.93)
  • Nova Scotia: $469,929 (variance 0.89)
  • Newfoundland: $447,363 (variance 0.85)
  • British Columbia: $445,758 (variance 0.85)
  • Quebec: $406,536 (variance 0.77)
  • Ontario: $397,340 (variance 0.76)
The authors grouped the provinces into three tiers of income:

  • Top: Saskatchewan, New Brunswick, Alberta, Prince Edward Island, and Manitoba
  • Middle: Nova Scotia, Newfoundland, and British Columbia
  • Bottom: Quebec and Ontario
Interestingly, the three most populated provinces have the lowest fees for urologic services.

The strength of the current study is that it provides, for the first time, economic analysis of urologist income across all provinces in Canada. A possible limitation is the assumptions that all urologists across the country follow a similar practice pattern and deliver the same number of services. Dr. Nazif concluded that Saskatchewan urologists have the highest fees and Ontario the lowest. Despite a mature single-payer healthcare system in Canada, there is significant interprovincial economic disparity in urologist compensation, likely secondary to the provincial-level delivery of health care resources despite a federal health act. The authors note that an annual study is recommended to track changes to further identify interprovincial economic disparity.

Presented by: Omar Nazif, MD, Department of Urologic Sciences, University of British Columbia, Surrey, BC, Canada; Health Policy Committee, Canadian Urological Association, Montreal, QC, Canada

Co-Authors: Keith Rourke2,7, Hassan Razvi2,3, Curtis Nickel2,8, Paul Weckworth6, Darrel Drachenberg5, John Kell2,9, Lorne Aaron2,10, Christopher French2,11, Gregory Bailly4.

2Health Policy Committee, Canadian Urological Association, Montreal, QC, Canada; 3Urology, University of Western Ontario, London, ON, Canada; 4Urology, Dalhousie University, Halifax, NS, Canada; 5Urology, University of Manitoba, Winnipeg, MB, Canada; 6Urology, University of Saskatchewan, Saskatoon, SK, Canada; 7Urology, University of Alberta, Edmonton, AB, Canada; 8Urology, Queen's University, Kingston, ON, Canada; 9Urology, University of Toronto, East York, ON, Canada; 10Urology, McGill University, Montreal, QC, Canada; 11Urology, Memorial University, St. John's, NL, Canada

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre Twitter: @zklaassen_md at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia

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