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Fee practice medical service expenditures per capita, and full-time-equivalent physicians in British… Kazanjian, Arminée, 1947-; Fung, Patrick Wong; Barer, Morris Lionel, 1951- Nov 30, 1992

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FEE PRACTICE MEDICAL SERVICE EXPENDITURES PER CAPITA, ANDFULL-TIME-EQUIVALENT PHYSICIANS IN BRITISH COLUMBIA, 1989-1990HHRU 92:7Health Human Resources UnitCentre for Health Services and Policy ResearchThe John F. McCreary Health Sciences CentreThe University of British ColumbiaVancouver, British Columbia V6T lZ3Arminee KazanjianPatrick Wong FungMorris BarerNovember 1992ACKNOWLEDGEMENTSWe wish to thank the Medical Services Plan, B.C. Ministry of Health, and the B.C.College of Physicians and Surgeons, for providing access to the databases from which thetables and figures in this report are derived.T HE UNIV ERSLTY OF BRITIS H C OLU M BIAHeallh Human Resources UnitCentre for Health Services and Policy Research429 - 2194 Health Sciences MallVancouver. B.C. Canada V6T lZ3Tel: (604) 822-4810Fax: (604) 822-5690November 30, 1992Dr. Doug BigelowChairpersonHealth Human Resources Working GroupMinistry of Health1515 Blanshard StreetVictoria, B.C. V8W 3C8Dear Dr. Bigelow:It is our pleasure to submit to the Working Group the fifth edition of Fee PracticeMedical Service Expenditures Per Capita. and Full-Time-Eguivalent Physicians in BritishColumbia. 1989-1990. This version covers the period 1984-1985 to 1989-1990, and includesdata on physician full-time-equivalent supply, physician incomes, per capita medical carecosts, receipt of services by physician location and provision of services by location ofpatient, much like previous editions.The considerable amount of .tabular material in each section is preceded by some .explanatory text. The nature of queries and data requests received during the interim yearhelps shape our decisions about the presentation format of subsequent editions. We lookforward to comments and suggestions from you and other users of this report.Sincerely yours,At~'1Arminee Kazanjian, Dr.Soc.Associate Director2A Research Unit Funded by the Ministry of Health. British ColumbiaTABLE OF CONTENTSList of Tables iiList of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviiiIIIIntroduction .Methods and Data Sources .13A. Sources of Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3B. Adjustment of Supply Estimates and the Numerators ofPer Capita Expenditure Estimates, to Account forInter-regional Referrals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5C. Age-Sex-Adjusted Per Capita Medical Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11III Defmitions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14IV Full-Time-Equivalent Practitioners by Type of Practice 19V MSP Remuneration per Full-Time-Equivalent Practitioner by Type of Practice . . . . . . . . . . . . . 29VI Full-Time-Equivalent Fee-Practice Physicians by Type of Practiceand Regional Hospital District of Physician 41VII 'Effective' Full-Time-Equivalent Practitioners by Type of Practiceand Estimated Regional Hospital District of Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81VIII Estimated Fee-for Service Expenditures per Capita by Type of Practitionerand Regional Hospital District of Patient 121IX Distribution of Physician Fee Payments by Estimated Location of Patient 177X Distribution of Fee Payments on Behalf of Residents by Location of Service Provision . . . . . . . 219APPENDIXPopulation by Regional Hospital Districtil12(a)2(b)3(a)3(b)4(a)4(b)56(a)6(b)List of TablesPhysicians in British Columbia, by Type of Practice .Estimated Numbers of FIE Physicians in BritishColumbiaRemunerated by MSPBC by Type of Practiceby Full-Time Equivalent Method .Estimated Numbers of FIE Physicians per 10,000Population in British Columbia Remunerated by MSPBC,by Type of Practice by Full-TimeEquivalent Method .Estimated Numbers of FIE Physicians in MetropolitanBritish ColumbiaRemunerated by MSPBC, by Typeof Practiceby Full-Time Equivalent Method,1984-1985 and 1989-1990 .EstimatedNumbers of FIE Physicians per 10,000Population in Metropolitan British ColumbiaRemunerated by MSPBC, by Type of PracticebyFull-TimeEquivalentMethod. 1984-1985 and1989-1990 .Estimated Numbers of FIE Physicians in Non­Metropolitan British Columbia Remunerated by MSPBC,by Type of Practiceby Full-Time Equivalent Method,1984-1985 and 1989-1990 .EstimatedNumbers of FIE Physicians per 10,000Population in Non-Metropolitan British ColumbiaRemunerated by MSPBC, by Type of Practice byFull-TimeEquivalent Method, 1984-1985 and1989-1990 .Average Remuneration per FIE Physician in BritishColumbia Remunerated by MSPBC, by Full-TimeEquivalentMethodby Type of Practice, 1984-1985and 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansin British Columbia, by Type of Practice byFull-TimeEquivalentMethod. 1984-1985 and 1989-1990 .EstimatedNumbers of FIE Fee for ServicePhysiciansper 10,000 Population in British Columbia, by Typeof Practiceby Full-TimeEquivalent Method,1984-1985 and 1989-1990 .212223242526273143447(a)7(b)8(a)8(b)9(a)9(b)lO(a)10(b)11(a)11(b)List of Tables (eont.)Estimated Numbers of FIE Fee for ServicePhysiciansin Metropolitan British Columbia, by Type of Practiceby Pull-Time Equivalent Method, 1984-1985 and1989-1990 .Estimated Numbers of FIE Fee for ServicePhysiciansper 10,000 Population in Metropolitan BritishColumbia, by Type of Practice by Full-Time EquivalentMethod, 1984-1985 and 1989-1990 .Estimated Numbers of FIE Fee for ServicePhysiciansin Non-Metropolitan BritishColumbia, by Type ofPracticeby Full-TimeEquivalent Method, 1984-1985and 1989-1990 .Estimated Numbers of FIE Fee for Service.Physiciansper 10,000 Population in Non-Metropolitan BritishColumbia, by Type of Practice by Full-Time EquivalentMethod, 1984-1985 and 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansin British Columbia, by Regional Hospital District byFIE Defmition for Type of Practice ANAESTHESIA,Fiscal 1989-1990 .EstimatedNumbers of FIE Fee for ServicePhysiciansper 10,000 Population in British Columbia, byRegional Hospital District by FIE Definition forType of Practice ANAESTHESIA, Fiscal 1989-1990 .Estimated Numbers of FIE Fee for ServicePhysiciansin British Columbia, by Regional Hospital District byFIE Definition for Type of Practice DERMATOLOGY,Fiscal 1989-1990 .Estimated Numbers of PTE Fee for ServicePhysiciansper 10,000 Population in British Columbia, byRegional Hospital District by FIE Definition forType of PracticeDERMATOLOGY, Fiscal 1989-1990Estimated Numbers of PTE Fee for ServicePhysiciansin British Columbia, by Regional Hospital District byPTE Definition for Type of Practice GENERAL PRACTICE,Fiscal 1989-1990 .Estimated Numbers of PTE Fee for ServicePhysiciansper 10,000 Population in British Columbia, byRegional Hospital District by FIE Definition forType of Practice GENERAL PRACTICE, Fiscal1989-1990 .iii45464748495051525354iv12(a)12(b)13(a)13(b)14(a)14(b)15(a)15(b)16(a)List or Tables (cont.)Estimated Numbers of FIE Fee for Service Physiciansin British Columbia, by Regional Hospital District byFIE Defmition for Type of Practice GENERAL SURGERY,Fiscal 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansper 10,000 Population in British Columbia, byRegional Hospital District by FIE Definition forType of Practice GENERAL SURGERY, Fiscal1989-1990 ' .Estimated Numbers of FIE Fee for Service Physiciansin British Columbia, by Regional Hospital District byFTE Definition for Type of Practice INlERNAL MEDICINE,Fiscal 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansper 10,000 Population in British Columbia, byRegional Hospital District by FIE Definition forType of Practice INlERNAL MEDICINE, Fiscal1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansin British Columbia, by Regional Hospital Districtby FTE Definition for Type of Practice NEUROLOGY,Fiscal 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansper 10,000 Population in British Columbia, byRegional Hospital District by FIE Definition forType of Practice NEUROLOGY, Fiscal 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansin British Columbia, by Regional Hospital District byFIE Definition for Type of Practice NEUROSURGERY,Fiscal 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansper 10,000 Population in British Columbia, byRegional Hospital District by FTE Definition forType of Practice NEUROSURGERY, Fiscal 1989-1990 .Estimated Numbers of FTE Fee for Service Physiciansin British Columbia, by Regional Hospital District byFIE Definition for Type of Practice OBSTETRICS andGYNAECOLOGY, Fiscal 1989-1990 .55565758596061626316(b)17(a)17(b)18(a)18(b)19(a)19(b)20(a)20(b)List of Tables (cont)Estimated Numbers of FIE Fee for Service Physiciansper 10,000 Population in British Columbia. byRegional Hospital District by FIE Definition forType of Practice OBSTETRICS and GYNAECOLOGY,Fiscal 1989-1990 .Estimated Numbers of FTE Fee for Service Physiciansin British Columbia, by Regional HospitalDistrict byFIE Defmition for Type of Practice OPHTHAlMOLOGY,Fiscal 1989-1990 .Estimated Numbers of FTE Fee for Service Physiciansper 10,000 Population in British Columbia. byRegional HospitalDistrict by FIE Definition forType of Practice OPHTHAlMOLOGY, Fiscal 1989-1990Estimated Numbers of FTE Fee for Service Physiciansin British Columbia, by RegionalHospital District byFTE Defmition for Type of Practice ORTHOPAEDICSURGERY, Fiscal 1989-1990 .Estimated Numbers of FTE Fee for Service Physiciansper 10,000 Population in British Columbia, byRegional HospitalDistrict by FIE Definition forType of Practice ORTHOPAEDIC SURGERY, Fiscal1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansin British Columbia, by RegionalHospital District byFIE Defmition for Type of Practice OTOLARYNGOLOGY,Fiscal 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansper 10,000 Population in British Columbia, byRegional Hospital District by FIE Definition forType of Practice OTOLARYNGOLOGY, Fiscal 1989-1990 .Estimated Numbers of FTE Fee for Service Physiciansin British Columbia, by RegionalHospitalDistrict byFTE Defmition for Type of Practice PAEDIATRICS,Fiscal 1989-1990 .Estimated Numbers of FTE Fee for Service Physiciansper 10,000 Population in British Columbia. byRegional Hospital District by FIE Definition forType of Practice PAEDIATRICS, Fiscal 1989-1990 .v646566676869707172vi21(a)21(b)22(a)22(b)23(a)23(b)24(a)24(b)25(a)25(b)List of Tables (cont.)Estimated Numbers of FIE Fee for Service Physiciansin British Columbia. by RegionalHospitalDistrict byFIE Definition for Type of Practice PLASTIC SURGERY.Fiscal 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansper 10,000 Population in British Columbia, byRegional Hospital District by FIE Definition forType of Practice PLASTIC SURGERY. FlScalI989-1990Estimated Numbers of FIE Fee for Service Physiciansin British Columbia, by RegionalHospitalDistrict byFIE Definition for Type of Practice PSYCIDATRY,Fiscal 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansper 10,000 Population in British Columbia, byRegional HospitalDistrict by FIE Definition forType of Practice PSYCmATRY. 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansin British Columbia, by Regional Hospital District byFIE Definition for Type of PracticeTHORACIC SURGERY.Fiscal 1989-1990 ' .Estimated Numbers of FIE Fee for Service Physiciansper 10.000 Population in British Columbia, byRegional HospitalDistrict by FIE Definition forType of Practice THORACIC SURGERY. Fiscal 1989-1990Estimated Numbers of FIE Fee for Service Physiciansin British Columbia, by Regional HospitalDistrict byFIE Definition for Type of PracticeUROLOGY,Fiscal 1989-1990 .Estimated Numbers of FIE Fee for Service Physiciansper 10,000 Population in British Columbia, byRegional Hospital District by FIE Definition forType of Practice UROLOGY, Fiscal 1989-1990 .Estimated Numbers of 'Effective' FIE Fee for ServicePhysicians in Capital Regional HospitalDistrict, byType of Practice by Full-Time Equivalent Method,Fiscal 1989-1990 , .Estimated Numbers of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population in Capital RegionalHospitalDistrict, by Type of Practiceby Full-TimeEquivalentMethod, Fiscal 1989-1990 .73747576777879838426(a)26(b)27(a)27(b)28(a)28(b)29(a)29(b)30(a)30(b)List of Tables (cont.)Estimated Numbers of 'Effective' FTE Fee for ServicePhysicians in Greater Vancouver Regional HospitalDistrict, by Type of Practice by Full-Time EquivalentMethod, Fiscal 1989-1990 .Estimated Numbers of 'Effective' FTE Fee for ServicePhysicians per 10,000 Population in Greater VancouverRegional Hospital District, by Type of Practice byFull-Time Equivalent Method, Fiscal 1989-1990 .Estimated Numbers of 'Effective' FTE Fee for ServicePhysicians in Non-Metropolitan British Columbia, byType of Practice by Full-TIme Equivalent Method,Fiscal 1989-1990 .Estimated Numbers of 'Effective' FTE Fee for ServicePhysicians per 10,000 Population in Non-MetropolitanBritish Columbia, by Type of Practice by Full-TimeEquivalent Method, Fiscal 1989-1990 .Estimated Number of 'Effective' FTE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrictby FTE Definition for Type of PracticeANAESTHESIA, Fiscal 1989-1990 .Estimated Number of 'Effective' FTE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FTE Defmition forType of Practice ANAESTHESIA, Fiscal 1989-1990 .Estimated Number of 'Effective' FTE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FTE Definition for Type of PracticeDERMATOLOGY, Fiscal 1989-1990 .Estimated Number of 'Effective' FTE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FTE Defmition forType of Practice DERMATOLOGY, Fiscal 1989-1990Estimated Number of 'Effective' FTE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FTE Definition for Type of PracticeGENERAL PRACTICE, Fiscal 1989-1990 .Estimated Number of 'Effective' FTE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FTE Defmition forType of Practice GENERAL PRACTICE, Fiscal 1989-1990 .vii85868788899091929394viii31(a)31(b)32(a)32(b)33(a)33(b)34(a)34(b)35(a)35(b)List of Tables (cont.)Estimated Number of 'Effective' FfE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticeGENERAL SURGERY, Fiscal 1989-1990 .Estimated Number of 'Effective' FfE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Definition forType of Practice GENERAL SURGERY, Fiscal 1989-1990Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticeINTERNAL MEDICINE, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Definition forType of Practice INIERNAL MEDICINE, Fiscal 1989-1990Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticeNEUROLOGY, Fiscal 1989-1990 .Estimated Number of 'Effective' FfE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Definition forType of Practice NEUROLOGY, Fiscal 1989-1990 .Estimated Number of 'Effective' FfE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticeNEUROSURGERY, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population.in British Columbia,by Regional Hospital District by FIE Definition forType of Practice NEUROSURGERY, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticeOBSTETRICS and GYNAECOLOGY, Fiscal 1989-1990 .Estimated Number of 'Effective' FfE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FfE Defmition forType of Practice OBS1E1RICS and GYNAECOLOGY,Fiscal 1989-1990 .959697989910010110210310436(a)36(b)37(a)37(b)38(a)38(b)39(a)39(b)4O(a)4O(b)List of Tables (cont.)Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticeOPHTHALMOLOGY, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Definition forType of Practice OPHTHALMOLOGY, Fiscal 1989-1990Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticeORTHOPAEDIC SURGERY, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Defmition forType of Practice ORTHOPAEDIC SURGERY,Fiscal 1989-1990 . ' .Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticeOTOLARYNGOLOGY, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Defmition forType of Practice OTOLARYNGOLOGY, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticePAEDIATRICS, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Defmition forType of Practice PAEDIATRICS, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticePLASTIC SURGERY, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Defmition forType of Practice PLASTIC SURGERY, Fiscal 1989-1990ix105106107108109110111112113114xList of Tables (cont.)41(a)41(b)42(a)42(b)Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia. by Regional HospitalDistrict by FIE Definition for Type of PracticePSYCHIATRY, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Definition forType of Practice PSYCHIATRY, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia. by Regional HospitalDistrict by FIE Definition for Type of PracticeTHORACIC SURGERY, Fiscal 1989-1990 .Estimated Number of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Definition forType of Practice THORACIC SURGERY, Fiscal 1989-199011511611711843(a) Estimated Number of 'Effective' FIE Fee for ServicePhysicians in British Columbia, by Regional HospitalDistrict by FIE Definition for Type of PracticeUROLOGY, Fiscal 1989-1990 11943(b) Estimated Number of 'Effective' FIE Fee for ServicePhysicians per 10,000 Population in British Columbia,by Regional Hospital District by FIE Definition forType of Practice UROLOGY, Fiscal 1989-1990 12044 Fee for Service Payments per Capita in BritishColumbia for 1989-1990 12345 Fee for Service Payments per Capita in MetropolitanRHOs for 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. "12446 Fee for Service Payments per Capita in Non-MetropolitanRHOs for 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12547 Fee for Service Payments per Capita in ALBERNI-CLAYOQUOTfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12648 Fee for Service Payments per Capita in BULKLEY-NECHAKOfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12749 Fee for Service Payments per Capita in CAPITALfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12850 Fee for Service Payments per Capita in CARIBOOfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1295152535455565758596061626364656667List of Tables (cont.)Fee for Service Payments per Capita in CENTRAL COASTfor 1989-1990 ' .Fee for Service Payments per Capita in CENTRAL FRASER VALLEYfor 1989-1990 .Fee for Service Payments per Capita in CENTRAL KOOlENAYfor 1989-1990 .Fee for Service Payments per Capita in CENTRAL OKANAGANfor 1989-1990 .Fee for Service Payments per Capita in COLUMBIA-SHUSWAPfor 1989-1990 .Fee for Service Payments per Capita in COMOX-SlRATIICONAfor 1989-1990 .-Fee for Service Payments per Capita in COWICHAN VALLEYfor 1989-1990 .Fee for Service Payments per Capita in DEWDNEY-ALOUETIEfor 1989-1990 .Fee for Service Payments per Capita in EAST KOOTENAYfor 1989-1990 .Fee for Service Payments per Capita in FRASER-CREAMfor 1989-1990 .Fee for Service Payments per Capita in FRASER-FORT GEORGEfor 1989-1990 .Fee for Service Payments per Capita in GREATER VANCOUVERfor 1989-1990 .Fee for Service Payments per Capita in KITIMAT-STIKINEfor 1989-1990 .Fee for Service Payments per Capita in KOOTENAY BOUNDARYfor 1989-1990 .Fee for Service Payments per Capita in MOUNf WADDINGTONfor 1989-1990 .Fee for Service Payments per Capita in NANAIMOfor 1989-1990 .Fee for Service Payments per Capita in NORTH OKANAGANfor 1989-1990 .xi130131132133134135136137138139140141142143144145146xiiList of Tables (cont.)68 Fee for Service Payments per Capita in OKANAGAN-SIMll..KAMEENfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14769 Fee for Service Payments per Capita in PEACE RIVERfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14870 Fee for Service Payments per Capita in POWELL RIVERfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14971 Fee for Service Payments per Capita in SKEENA-QUEEN CHARLOTIEfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15072 Fee for Service Payments per Capita in SQUAMISH-LILLOOETfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15173 Fee for Service Payments per Capita in STIKINEfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15274 Fee for Service Payments per Capita in SUNSHINE COASTfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15375 Fee for Service Payments per Capita in THOMPSON-NICOLAfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15476 Fee for Service Payments per Capita in FORT NELSONILIARDfor 1989-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15577 Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15678 Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice GENERAL PRACTICE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15779 Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice SPECIALISTS 15880 Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice ANAESTHESIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15981 Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice DERMATOLOGY 16082 Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice GENERAL SURGERY 16183848586878889909192939495List of Tables (cont.)Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice IN'IERNAL MEDICINE .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice NElJROLOGY .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice NEUROSURGERY .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice OBSTETRICS and GYNAECOLOGY .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice OPHTHALMOLOGY .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice ORTHOPAEDIC SURGERY .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice OTOLARYNGOLOGY .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice PAEDIA1RICS .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice PATHOLOGY and BAC1ERIOLOGY .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice PLASTIC SURGERY .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice PSYClllATRY .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice RADIOLOGY and NUCLEAR MEDICINE .Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice THORACIC SURGERY .xiii162163164165166167168169170171172173174xiv96979899100101102103104105106List of Tables (cont.)Fee for Service Payments per Capita in 1989-1990, byRegional Hospital District by Age and Sex for Typeof Practice UROLOGY .Percentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient .Percentage Distribution of Fee-for-Service Payments,1989-1990. by Location of Physician over EstimatedLocationof Patient for Type of Practice ANAESTHESIAPercentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocationof Patient for Type of Practice DERMATOLOGY .Percentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice GENERALPRACTICE .Percentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice GENERALSURGERy .Percentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice INTERNALMEDICINE .Percentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice NEUROLOGYPercentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice NEUROSURGERYPercentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice OBSTETRICSand GYNAECOLOGY .Percentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of PracticeOPHTHALMOLOGY .175180182184186188190192194196198107108109110111112113114115116117List of Tables (cont.)Percentage Distribution of Fee-far-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of PracticeORTIIOPAEDICSURGERy .Percentage Distribution of Fee-far-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of PracticeOTOLARYNGOLOGy .Percentage Distribution of Fee-far-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice PAEDIATRICSPercentageDistribution of Fee-far-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice PATIIOLOGYandBAC1IrnUOLOGY .Percentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice PLASTICSURGERy .PercentageDistribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice PSYClllATRYPercentage Distribution of Fee-far-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of PracticeRADIOLOGYand NUCLEAR MEDICINE .Percentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of PracticeTIlORACICSURGERy .Percentage Distribution of Fee-for-Service Payments,1989-1990, by Location of Physician over EstimatedLocation of Patient for Type of Practice UROLOGY .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocation of Patient .Percentage Distribution of Fee-for-Service Payments,1989-1990. over Location of Physician by EstimatedLocation of Patient for Type of Practice ANAESTIlESIAxv200202204206208210212214216222224xvi118119120121122123124125126127128List of Tables (coot)Percentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocation of Patient for Type of Practice DERMATOLOGY .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Locationof Physician by EstimatedLocationof Patient for Type of PracticeGENERALPRACTICE .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Locationof Physician by EstimatedLocation of Patient for Type of Practice GENERALSURGERy .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocationof Patient for Type of Practice IN1ERNALMEDICINE .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocationof Patient for Type of Practice NEUROLOGYPercentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocation of Patient for Type of PracticeNEUROSURGERY .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Locationof Physician by EstimatedLocationof Patient for Type of PracticeOBSTETRICSand GYNAECOLOGY .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Locationof Physician by EstimatedLocation of Patient for Type of PracticeOPlfIlIALMOLOGY .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Locationof Physician by EstimatedLocationof Patient for Type of PracticeORTIIOPAEDICSURGERy .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Locationof Physician by EstimatedLocation of Patient for Type of Practice OTOLARYNGOLOGYPercentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocation of Patient for Type of PracticePAEDIAlRICS226228230232234236238240242244246129130131132133134List of Tables (cont.)Percentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocation of Patient for Type of Practice PATHOLOGYand BACfERIOLOGY .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocation of Patient for Type of Practice PLASTICSURGERy .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocation of Patient for Type of Practice PSYCIllATRYPercentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocation of Patient for Type of Practice RADIOLOGYand NUCLEAR MEDICINE .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocation of Patient for Type of Practice THORACICSURGERy .Percentage Distribution of Fee-for-Service Payments,1989-1990, over Location of Physician by EstimatedLocation of Patient for Type of Practice UROLOGY .xvii248250252254256258xviii12345678910111213141516List of FiguresAlgoritlun to Estimate PatientLocation Using ReferralInformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Distribution of Physicians by FFS Payments. 1989/90for Type of Practice ANAESTHESIA .Distribution of Physicians by FFS Payments. 1989/90for Type of Practice DERMATOLOGY .Distribution of Physicians by FFS Payments. 1989/90for Type of Practice GENERAL PRACTICE .Distribution of Physicians by FFS Payments. 1989/90for Type of Practice GENERAL SURGERY .Distribution of Physicians by FFS Payments. 1989/90for Type of Practice INTERNAL MEDICINE .Distribution of Physicians by FFS Payments. 1989/90for Type of Practice NEUROLOGY .Distribution of Physicians by FFS Payments. 1989/90for Type of Practice NEUROSURGERY .Distribution of Physicians by FFS Payments, 1989/90for Type of Practice OBSTETRICS and GYNAECOLOGYDistribution of Physicians by FFS Payments, 1989/90for Type of Practice OPHlHALMOLOGY .Distribution of Physicians by FFS Payments, 1989/90for Type of Practice ORlHOPAEDIC SURGERY .Distribution of Physicians by FFS Payments, 1989/90for Type of Practice OTOLARYNGOLOGY .Distribution of Physicians by FFS Payments, 1989/90for Type of Practice PAEDIATRICS . . . . . . . . . . . . . . . . . . . . . . . .Distribution of Physicians by FFS Payments, 1989/90for Type of Practice PHYSICAL MEDICINE .Distribution of Physicians by FFS Payments, 1989/90for Type of Practice PLASTIC SURGERY .Distribution of Physicians by FFS Payments, 1989/90for Type of Practice PSYCHIATRY .8323233333434353536363737383839171819List of FiguresDistribution of Physicians by FFS Payments, 1989190for Type of Practice THORACIC SURGERY .Distribution of Physicians by FFS Payments, 1989190for Type of Practice UROLOGY .Distribution of Physicians by FFS Payments, 1989/90for Types of Practice in Figs. 2 through 18 .xix394040I. INTRODUCTIONThis is the fifth in a series of biennial reports produced by the Health HumanResources Unit (HHRU) on physician supply and medical care costs per capita, for BritishColumbia. The present report covers the period 1984-85 to 1989-90. It includes data onphysician full-time-equivalent supply, physician incomes, per capita medical care costs,receipt of services by location of physician, and provision of services by estimated location ofpatient. Some of the data are reported only for 1989-90, in the interests of space. Other data,such as those on physician supply and incomes, are provided for 1984-85 and 1989-90.The tables and figures in this report are based largely on data provided by theMedical Services Plan of B.C., in the form of the statistics master (payment) magnetic tapes,containing in excess of 35 million payment records for each fiscal year. This databaseincludes payments for all medical services provided to B.C. residents by B.C. physicians, andrepresents the only published source of information on inter-regional patterns of medical carefor B.C.In the following section of the report we provide more detail on data sources andmethods of data manipulation. Section III contains the various definitions necessary toaccurate interpretation of the data. Then Sections IV through X contain the 'results' of ouraggregations, cross-tabulations and other data processing. This is not meant as an interpretivedocument. The data are presented, largely without comment, for the use of researchers,planners and policymakers.2In Section IV, we present a number of measures of practitioner supply by type ofpractice. Section V looks at practitioner earnings over the five-year period (both gross andadjusted for overall fee schedule increases), while Section VI disaggregates the data inSection IV by regional hospital district based on each practitioner's practice location. InSection VII we re-examine physician supply by estimating the location of patients and'allocating' practitioners to the regions of the patients they serve. Section vm reports regionand specialty specific fee-for-service payments per capita based on estimated location ofpatients. Finally, in Sections IX and X we provide two views of the implied flow ofpayments between regions of practitioners and estimated regions of patients. Section IXshows the source of patients for practitioners in each region. Section X shows the source ofcare for patients in each region.n. METHODS AND DATA SOURCESA. Sources of DataPhysician data were drawn from two sources - the College of Physicians andSurgeons of B.C. (CPSBC), and the Medical Services Plan of B.C. (MSP). From the former,information was gathered on numbers of registered physicians, by College specialtydesignation and location. The MSP statistics master (payment) files were supplemented bypaper records provided by the MSP on salaried and sessional payments for the same periods.The MSP data reflect payments to the subset of College-registered practitionersinvolved in clinical practice. Each such practitioner receives payment in one or more of threeforms - fee-for-service, salary, or sessions. Some of the tables in the following sectionsincorporate all three, others (e.g. those based on estimating patient location), use only feepayments.The data in this report are exclusively medical services. Thus, although MSP makespayments to dental surgeons, physiotherapists, chiropractors and other health careprofessionals, none of these other groups are incorporated in the report. Furthermore,payments made on behalf of B.C. residents, but made to medical practitioners outside theprovince, are not included in any of the data in this report.From the MSP statistics master files came the following data and identificationfields: MSP practitioner number of attending physician and of referring physician (if any),fee schedule item, amount paid, patient age and sex.34The regional hospital district (RHD) of each physician was determined using CPSBCdata by comparing RHDs of record on April I of year 't' and March 31 of year 't+1'. If theywere identical, the physician was presumed to have remained in the RHO for the entire periodcovered by the payment fiscal year, and it became the designated RHD. If a physician had avalid B.C. RHD for only one of the two period end-points, it was adopted. If a physicianhappened to be out-of-province at both end-points, but provided service in B.C. and was paidby the MSP during the fiscal year, (s)he was assigned to the 'Unknown' RHD. Finally, if theRHOs associated with the two period end-points were different, the date of address changewas established using the CPSBC database, and the physician's service activity was allocatedon a pro rata time basis to each of the RHDs.1 These RHD identification rules are believedto accurately handle most practitioner movement. Multiple changes of location during asingle year are not incorporated in these RHO allocation rules, but inspection of CPSBCrecords for those physicians with different end-point RHDs in any year indicated nointervening third RHD.Regional age-sex population data for 1984 were June 1 post-censal estimates; the1989 population estimates were based on Projection #16 from the Planning and StatisticsDivision, BiC. Ministry of Finance and Corporate Relations, again for June 1.1 Change of address information is self-reported by practitioners to the CPSBC. The date of record ofchange of address used here as the basis of allocation need not necessarily coincide with that of the actualchange of address. In most instances, however, the discrepancies are likely to be minimal.B. Adjustment of Supply Estimates and the Numerators of Per Capita ExpenditureEstimates, to Account for Inter-regional ReferralsSections VII through X of this document focus on the relationship between patients'residence and location of the practitioners from whom they receive ambulatory medical care.A large segment of the population of B.C. enrols in the Medical Services Plan throughemployer groups. Furthermore, no special effort is made by MSP to ensure the accuracy ofaddresses for individual enrollees. Taken together, these two characteristics of the populationdatabase maintained by MSP imply that we cannot currently obtain reliable patient locationinformation.This situation has dictated the development of an algorithm for estimating patientlocation on the basis of information on the location of a patient's primary care physician.The reliability of the algorithm as a method of proxying actual patient location has not beenestablished, for precisely the reason that patient location is not used directly - the MSP dataon patient address either do not exist or are not validated. Short of undertaking a costlyrandom survey to confmn patient location, there seems no direct way to establish thealgorithm's 'reliability.Thus, the major potential weakness in the algorithm is that it equates patient addresswith location of the primary care physician. This is compounded by difficulties inestablishing the identity of any given patient's 'first contact' physician. Where there are noreferrals, there is no problem - the patient address is assumed to be the address of theattending physician. In cases of a single clearly demarcated referral, again the assignment ofa proxy location is straightforward. The more difficult cases were those of multiple referral,56or situations where (because of ambiguity in the information on direction of referral capturedon magnetic tape) it was not clear who was the referring physician and who was the attendingphysician.The algorithm is portrayed in Figure 1. Blocks of records for each patient-practitioner combination are grouped, scanned for location of a referring physician, and thenallocated en masse to the school district (SO) of that referring physician. The presentation ofthese data, however, is made at the regional hospital district level to facilitate legibility. Inthis way, an original referred consultation plus subsequent specialist services will all beallocated to the SO of the initial referring physician. In addition, we make a number ofassumptions designed to deal with the "referred by"l"referred to" ambiguity.Location of referring or attending physician itself will be an inappropriate indicatorof residence of patient in a number of situations:(i) where a patient resides in a SO different from that of the referring physician (or, inthe case of no referral, different from that of the attending physician);(ii) where a physician renders services in regions physically other than the SO of hislherofficial office address.As Figure 1 indicates, blocks of records representing a patient's contact with anattending physician are read and sorted by date of occurrence and first checked for referringphysicians. If there are none, the patient is assumed to have resided in the SO of theattending physician. In the 1989-90 fiscal year, 34.8 percent of all billings fell into thiscategory. Where the SO of the referring and attending physician are identical, the patient is .similarly assumed to have resided in that SD. This accounted for a further 39.5 percent of1989-90 billings.It is the remaining billings (26% in 1989-90) that require the more complex set ofdecision rules. If at least one record contains non-equivalent attending and referringphysician numbers, the algorithm first checks the type of practice of the attending physician.Where that physician was a general or family practitioner, but the apparent referring physicianwas a specialist, we assume that the attending general practitioner (OP) had "referred to" thespecialist rather than the reverse. Services thus classified (1.2% of billings in 1989-90) wereallocated to the SD of the attending general or family practitioner as the proxy for patient SD.In instances where both the referring and attending practitioners were OPs but fromdifferent SDs, and where the first fee item in the temporal sequence was 0110 (generalpractice consultation), that service and all subsequent services provided to the same patientwere allocated to the SD of the referring OP (0.1% of billings in 1989-90). Where the firstfee item was not 0110, the "referred in" vs. "referred out" ambiguity made any decision rulesomewhat arbitrary. In these instances the referring physician could truly have been such,although we could think of few situations that might have induced the recording on a billingcard of a referring OP number by an attending OP. Certainly such a procedure is notrequired for payment. We thought it somewhat more likely that these indicated "referred to"situations, so allocated those services to the SD of the attending physician (in any event thisconstituted only 1.7% of total 1989-90 billing).7Figure 1: Algorithm to Estimate Patient LocationUsing Referral InformationSortTo DateOf Service00Allocate To SDOf InstitutionAllocate To SDOf AttendingPhysicianAllocate To SDOf AttendingPhysicianAssume "Referred Out"To 'Referring' SpecialistAnd Allocate To SD OfAttending PhysicianAllocate To SDOf AttendingPhysicianAllocate To SDOf ReferringPhysicianSet All ReferringPractitioner FieldsContaining '00000'To Last PreviousNon-'OOOOO' Ref.Pract Field ValueAssume "Referred Out"To 'Referring' SpecialistAnd Allocate To SD OfAttending PhysicianSet ReferringPractitioner =AttendingPractitionerAllocate To SDOf ReferringPhysicianAllocate To SDOf ReferringPhysician1010In the situation in which the SDs of attending and referring physicians differed andin which the attending physician was a specialist, if the referring physician was a GP (orunknown specialty), then all services rendered to that patient by that attending specialist wereallocated to the SD of the referring physician. Where a patient was referred by more thanone GP and the referring GPs were from different SDs, blocks of services were allocated tothe SD of the last identified referring physician. In total, the situation of GPs as referringphysicians in SDs different from those of the attending specialists accounted for 16.4 percentof 1989-90 billings.The final combination is one in which both the referring and attending physicianwere specialists, but from different SDs. In this case, if the first fee item associated with thiscombination of practitioners is an item from the "General Practice" section of the paymentschedule, we assume the referring specialist was in fact someone to whom the patient wasreferred ("referred out"), and allocate the service to the SD of the attending physician. Sincethe attending specialist could have billed a specialist fee only if the patient had been "referredin", and since that specialist in fact billed a generalist fee, we assume there is no referral in.This situation was rare indeed (0.01% of 1989-90 billings). In all other situations (6.3% of1989-90 billings) we assume the referring physician was just that, and allocate the services tothe SD of the referring physician. One could question the logic of this treatment, since asituation of referring and attending physicians both being specialists could equally indicate"referred in" or "referred out". But without sorting the entire master files into patient orderand scrutinizing entire patient service blocks (a capability requiring more tape drives than theUniversity of B.C. can provide), one cannot hope to improve precision. Since specialtypayment requires a referring physician, we assume that more often than not, this fieldrepresents the source rather than the destination of referral.The resulting allocations of payments to estimated SDs of patients were used directlyas the basis of the age-sex specific per capita expenditure results in Section VIII. But theywere also used somewhat less directly to allocate shares of practitioners to the SDs theyserved, in estimating "effective" full-time-equivalent (henceforth FfE) physician supply bytype of practice and region (Section VII). In the latter application, the distribution of eachpractitioner's payments to estimated patient SDs was applied to the nine FfE values for thatpractitioner. Thus, if a practitioner was .6 FfE by definition 3, and that practitioner'spayments were estimated to have been for services rendered to patients in SDs 17 (one-thirdof payments) and 23 (two-thirds of payments), then by that FfE definition, .2 PTE would beallocated as effective supply to SD 17, and .4 PTE similarly to SD 23.Sections VII through X are based on the 1989-90 statistics master file. This filecontains the detail on each payment made during that fiscal year. Those payments includesome payments for services rendered during 1988-89; the 1989-90 file does not representpayments for services rendered exclusively during the 1989-90 fiscal year.C. Age-Sex-Adjusted Per Capita Medical ExpendituresIn general, payments allocated for each age-sex patient category to each region,using the algorithm described above, were divided by the estimated population for that regionand age-sex group, as of June 1989.1112. But special treatment was required of payments on behalf of patients of unknownage or sex. This was not a trivial issue. The proportion of payments for which either or bothof age and sex was unknown was about 3.6 percent. It seemed clearly preferable to allocatethose payments across categories rather than to leave them out. Accordingly, payments ineach region for patients with 'known sex and unknown age' were allocated across the agecategories for that sex according to the actual distribution of payments (the pre-adjustmentdistribution (pAD)) in that region for patients with b.oth fields known. Payments for patientswith 'known age and unknown sex' were allocated between sexes according to the PADbetween sexes of regional payments in the appropriate age category; and payments on behalfof patients with 'unknown age and sex' were allocated across all age-sex categories accordingto the PAD of payments in the region.Fee payments per capita at the sub-provincial level (RHD and metro/non-metroaggregations) have been age-sex adjusted to facilitate inter-regional comparisons. LetEijk = fee payments to type of practice i on behalf of patients ofage-sex group j residing in (estimated) RHD kPjk = population in age-sex group j in RHD kPj' = provincial population in age-sex group jP.. = provincial populationThen,~&~ • = age-sex adjusted type of practice i fee paymentsP·t per capita in RHD k~ Eijk Pj •= j Pjk P..and,u·~ * = total age-sex adjusted fee payments per capitaP·t in RHD k~ E'jk Pj•= j Pjk P..This amounts to estimating what a region's per capita expenditure experience would havebeen, had it had the overall provincial (rather than its own) age-sex population mix. In thisway one avoids misinterpreting extremely high or low use rates as inappropriate orinsufficient servicing when in fact those rates may be a function of nothing more complexthan differential population structures.1314m. DEFINITIONSDirectory Active PhysiciansDirectory Active Physicians are physicians registered in British Columbia by theCollege of Physicians and Surgeons of British Columbia (CPSBC) who at the date of record,15th September of each year, were licensed to practice medicine. They include physicianswho are on the full, special or temporary registers (temporary includes those who are inpostgraduate training or who have a temporary licence to practice). Table 1 includes thosephysicians who, at the date of record, were Directory Active and had a B.C. address.Non-Postgraduate Directory Active PhysiciansNon-Postgraduate Directory Active Physicians are Directory Active Physicians who,according to the records of the CPSBC at the date of record, were not involved inpostgraduate work.MSC SpecialtyMSC Specialty is used by the Medical Services Plan of B.C. to indicate the primaryfield of practice of a physician. The specialties are listed below:AnaesthesiaDermatologyEar, Nose & ThroatEmergency MedicineEye, Ear, Nose & ThroatGeneral PracticeInternal MedicineMedical MicrobiologyNeurologyNeuropsychiatryNeurosurgeryNuclear MedicineObstetrics & GynaecologyOphthalmologyOrthopaedic SurgeryOsteopathyPaediatricsPathology & BacteriologyPhysical MedicinePlastic SurgeryPsychiatryPublic HealthRadiologySurgery - GeneralThoracic SurgeryUrologyMSC Type of PracticeMSC Type of Practice is used by MSP to indicate the type of practice in which thephysician is primarily engaged, because some physicians do not restrict their practice to theirMSC specialty. Most billing items are grouped within an MSC specialty designation in theprovincial benefits (fee) schedule. Each physician's MSC Type of Practice is then that MSCSpecialty category within which his/her greatest proportion of billings fell in the previouspayment fiscal year.HHRU Type of PracticeThe MSC type of practice has historically been updated on a rather ad hoc basis byMSP staff. At the very least, it is always one fiscal year 'out-of-date', in the sense that aphysician's designated type of practice on the MSP payment tapes for 1989-90 will be basedon 1988-89 billing patterns.In contrast, all tables in the present report providing data by "type of practice", arebased on our own internal ex post determination of each practitioner's type of practice duringthe payment year in question. Thus, a physician's 1989-90 type of practice is precisely thatThe decision rules employed in determining a type of practice for each physician are asfollows:(i) group all payments for each physician into categories based on benefit schedulebroad specialty headings (e.g. general practice, obstetrics, anaesthesia);(ii) determine, from among these broad specialty headings, that category which containsthe single largest share of 1989-90 payments to each practitioner. That becomes thepractitioner's type of practice for 1989-90;1516(iii) if a practitioner received no fee payments (i.e. only salary or sessional payments) in1989-90, assign the MSC type of practice (see above);(iv) practitioners with MSC type of practice "Osteopathy" were assigned that type ofpractice.Certain specialties with small numbers of physicians, (e.g. Eye, Ear, Nose & Throatand Neuropsychiatry), were grouped with similar specialties: Eye, Ear, Nose & Throat withEar, Nose & Throat, and Neuropsychiatry with Psychiatry. Four specialties with smallnumbers of physicians, viz. Osteopathy, Nuclear Medicine, Medical Microbiology and PublicHealth, could not be embodied with similar specialties and were thus omitted. In the percapita results of Section VITI, however, Nuclear Medicine and Radiology are combined, andOsteopathy and Public Health are included only in the provincial (and metro vs. non-metro)figures. The specialties of Pathology & Bacteriology and Radiology were not tabulated inSections IV through vn of this report because of the diversity of billing patterns foundamong these practitioners. In particular, billings associated with individual practitioners arenot necessarily indicative of individual activity levels, and so form an unreliable basis forPTE calculations. These types of practice are, however, included in the per capitaexpenditure results of Section VITI.PTE DefinitionsIn the tables in Sections IV and V, PTE calculations are based on all MSP payments(fee-for-service, salary and sessional). Sections VI through X are based on fee-for-servicepayments only. In the definitions that follow, "payments" or "receipts" refer to fee-for-serviceonly, or the all-inclusive payments, depending on the section of the report in which theyappear.Nine alternative methods were used to compute FIE measures of physician supply,and the numbers used to identify them in the tables of the report are those that follow:17Definition Number123456Method of Supply EstimationEach physician receiving payments greater than $49,409 (in1984-85 fee-adjusted dollars') =1 FfE; all others arecounted as the proportion of their receipts to the meanreceipts of their FfE peers.Each physician receiving payments greater than $49,409 (in1984-85 fee-adjusted dollars') =1 FfE; all others are countedas the proportion of their receipts to the FfE cutoff for thatyear (i.e. to $49,409 in 1984-85 fee-adjusted dollars).Each physician receiving payments equal to or greater thanone-half the payment mean for his/her peer type of practice =1 FfE; all others are counted as the proportion of theirreceipts to the mean receipts of their full-time type of practicepeers.Full-time practitioners determined as in 3; all others arecounted as the proportion of their receipts to one-half thepayment mean (the full-time cutoff) for their peer type ofpractice.Each physician receiving payments equal to or greater thanone-half the payment median for his/her peer type of practice=1 FfE; all others are counted as the proportion of theirreceipts to the mean receipts of their full-time type of practicepeers.Full-time practitioners determined as in 5; all others arecounted as the proportion of their receipts to one-half thepayment median (the full-time cutoff) for their peer type ofpractice.:Pee-adjusted nominal payment cutoffs are as follows:1984-85 - $49,4091989-90 - $55.04618789Each physician's FrE value is determined as the ratio ofhis/her total receipts to the mean of his/her full-time peers'receipts as computed in definitions 3 and 4 (equivalent toFfE definition 3 for province as a whole).Each physician's FrE value is determined as the ratio ofhis/her total receipts to the mean of his/her full-time peers'mean receipts as computed in definitions 5 and 6 (equivalentto FfE definition 5 for province as a whole).Each physician's FrE value is determined as the ratio ofhis/her total receipts to the payment mean for his/her peertype of practice.IV. FULL-TIME-EQUIVALENT PRACTITIONERS BY TYPE OF PRACTICEThis short section contains four tables that provide physician supply data by type ofpractice for 1984 and 1989. Table 1 shows the numbers of directory active and non­postgraduate directory active physicians (CPSBC classifications), as well as the number ofpractitioners receiving any remuneration from MSP in each of the two related fiscal years.Physicians remunerated by MSP during a fiscal year need not have been (althoughpredominantly were) non-postgraduate directory active (or even, for that matter, directoryactive) at the date of determination of College status. While the figures for "non-postgraduatedirectory active" and "remunerated by MSPBC" are in fact quite comparable, the College- ·based count is at a point in time, whereas the MSP-based count is over a period of onepayment year. A practitioner may not provide service during a fiscal year but may receivepayment during that year for services rendered in previous periods. While one would expectthis to be balanced by practitioners providing service only toward the end of the fiscal yearfor which they are not paid until the following fiscal year, the net effect on supply isunknown. If, in fact, a practitioner is non-postgraduate directory active on the date of recordbut renders no service during the fiscal year, (s)he will be counted under both defmitions ifany remuneration was received during that fiscal year for services rendered earlier. Inaddition to this date of service vs, date of payment slippage, a practitioner could even moreeasily be counted by one method but not by the other, simply because of the particular pointduring the fiscal year that is chosen to determine College status. A practitioner may renderand be paid for service some time during a fiscal year, but not be non-postgraduate directoryactive, or be out-of-province (or both) at the College-based date of record. These phenomena1920would tend to have the effect of producing a higher MSP-based than College-based (non-postgraduate) count of practitioners. On the other side are those non-postgraduate directoryactive physicians who are exclusively involved in non-clinical practice (teaching, research,administration, etc.),Tables 2 through 4 present FIE clinical practitioners by Type of Practice, based onall MSP payments (fee, salary and sessional) and for the nine FIE defmitions described in theprevious section. Note that, for the province as a whole, FIE definitions 3 and 7, and 5 and8 are pairwise equivalent. Because the payment means are based on provincial distributions,however, these FIE values do differ for sub-provincial counts.' Each of these three tablescomes in two parts, one showing absolute counts, the other, FIE supply per 10,000population. Tables 3 and 4 are for metropolitan and non-metropolitan RHDs respectively.3 For example, physicians with incomes above their peer type of practice full-time mean income arecounted as more than 1 FfE by definition 7, but are 1 FfE by definition 3. If they fall disproportionatelyin particular regions, FfE7 > FfE3 for those regions, and vice versa for other regions.Table 1 Physicians in British Columbiaby Type of Practice lDirectory Active' Non-PG& Directory Active' Remunerated by MSPBC'Type of Practice" Av annual Av annual Av annual1984 1989 " change 1984 1989 " change 1984-1985 1989-1990 " changeAnaesthesia 298 3i5 1. 12 288 305 1. 15 303 323 1.29Dermatology 48 58 3 .86 47 58 4 .30 47 54 2.82General Practice 3,577 4.153 3 .03 3,079 3,557 2 .93 2,998 3,617 3.83General Surgery 261 266 0 .38 254 260 0 .47 246 259 1.04Internal Medicine 386 456 3 .39 379 447 3.36 370 431 3 .10Neurology 48 60 4 .56 48 59 4 .21 49 56 2.71Neurosurgery 24 28 3 .13 24 28 3 .13 28 24 -3.04Obstetrics & Gynaecology 153 155 0 .26 151 154 0.39 151 156 0.65Ophthalmology 155 179 2 .92 154 179 3.05 156 177 2.56Orthopaedic Surgery 125 143 2.73 125 142 2.58 120 136 2 .53Otolaryngology 71 74 0 .83 71 74 0 .83 71 76 1.37Paediatrics 155 i70 1.86 155 168 1.62 154 167 1.63Physical Medicine 24 30 4 .56 23 30 5.46 24 29 3.86Plastic Surgery 41 46 2 .33 41 45 1.88 38 44 2.98Psychiatry 308 373 3.90 308 370 3.74 312 368 3.36Thoracic Surgery 33 36 1. 76 32 36 2.38 33 39 3.40Urology 59 62 1.00 58 62 1.34 57 62 1. 70TOTAL 5,768 6,604 2.75 5,237 5,974 2.67 5,157 8,018 3.14I See text for explanation of classification of each physician's type of practice ." This does not include Pathology and Bacteriology, Radiology, Medical Microbiology, Nuclear Medicine. Public Health or Osteopathy., Date of record is September 15 for each year.& Non Postgraduate.• This includes all physicians receiving fee for service, salaried or sessional payments during the fiscal year .Prepared by:Health Human Resources UnitThe University of British Columbiatv....Table 2(b) Esttlllated rudJers of FTE Phystctans per 10 ,000 Populatton tn Brtttsh Coll.ldJta Renunerated by MSPBC Iby Type of Practtce' by FUll-Ttme Equtvalent Method1984-1985 and 1989-1990TyPe of Practtce Full -Ttme Eq.ltvalent MethodActual' FTE 1 FTE 2 FTE3 FTE4 ~5 FTE6 FTE 7 FTE 8 FTE 91984-1985Anaesthes i a 1.06 0.86 0.93 0.86 0.92 0 .85 0.9 i 0 .86 0 .85 1.06Dermatology 0 .17 0.15 0.15 0.14 0 .15 0.13 0 .15 0.14 0 .13 0.17General Pract ice 10 .53 8 .38 8 .98 8.31 8.93 8.26 8 .88 8 .31 8 .26 10 .53Genera1 Surgery 0 .86 0 .65 0 .70 0.63 0 .68 0.62 0.67 0.63 0 .62 0 .86Internal Med1c1ne 1.30 1.10 1.17 1.00 1. 11 1.01 1.12 1.00 1.01 1.30Neurology 0 .17 0 .13 0.14 0.13 0.14 0.13 0.14 0 .13 0.13 0 .17Ne.rosurgery 0.10 0.07 0.08 0.07 0 .08 0.07 0 .08 0 .07 0.07 0 .10Obstetrics & Gynaecology 0 .53 0 .46 0.48 0.44 0.46 0.44 0.46 0 .44 0 .44 0 .53~halmology 0.55 0.50 0 .52 0.45 0.49 0.47 0 .50 0 .45 0 .47 0.55Orthopaedic Surgery 0 .42 0 .38 0 .39 0 .36 0 .38 0.36 0.38 0.36 0.36 0 .42Otolaryngology 0 .25 0.22 0.23 0.21 0.22 0.21 0 .22 0.21 0 .21 0.25Paediatrics 0 .54 0 .44 0 .48 0.43 0 .48 0.45 0 .49 0 .43 0 .45 0 .54Phys ical Medicine 0.08 0.06 0 .07 0.06 0 .07 0 .06 0.07 0.06 0.06 0 .08Plastic Surgery 0 .13 0 .13 0.13 0.13 0.13 0.13 0.13 0.13 0 .13 0 .13Psychiatry 1.10 0 .98 1.02 0 .97 1. 0 1 0.96 1.01 0 .97 0 .96 1. 10Thoracic Surgery 0 .12 0.10 0 .11 0 .09 0 .10 0.10 0 .10 0 .09 0 .10 0 .12Urology 0 .20 0. 18 0 .19 0 .18 0.18 0 .18 0 .18 0 .18 0 .18 0 .20lOYAL- 18 .11 14 .81 15.79 14 .45 15.54 14.42 15 .50 14.45 14 .42 18.111989-1990Anaesthes i a 1.06 0.89 0.93 0.88 0 .93 0.87 0.92 0.88 0 .87 1. 06Dermatology 0 .18 0.16 0.17 0.15 0.16 0.15 0.16 0.15 0 .15 0.18General Practice 11.85 9 .35 10.08 9 .28 10. 01 9 .28 10 .02 9 .28 9 .28 11.85Genera1 Surgery 0 .85 0 .62 0.68 0.59 0 .65 0.58 0.64 0.59 0 .58 0 .85Internal Medicine 1.41 1.15 1. 24 1.07 1.18 1.09 1.18 1.07 1.09 1.41Neurology 0 .18 0.16 0.17 0.15 . 0.17 0.15 0 .17 0.15 0.15 0 .18Ne.rosurgery 0 .08 0.07 0 .07 0 .07 0.07 0 .07 0.07 0.07 0 .07 0 .08Obstetrics & ~ecology 0.51 0.44 0 .47 0.42 0 .45 0.42 0 .44 0 .42 0 .42 0 .51Ophthalmo logy 0 .58 0.51 0 .54 0.46 0 .50 0.47 0.51 0 .46 0.47 0 .58Orthopaedic Surgery 0 .45 0.38 0 .40 0 .38 0.39 0.37 0 .39 0.38 0 .37 0 .45otolaryngology 0 .25 0 .22 0.23 0.21 0.22 0.21 0 .22 0.21 0.21 0.25Paediatrics 0 .55 0 .43 0 .47 0 .42 0 .47 0 .44 0.48 0 .42 0 .44 0 .55Physical Medicine 0 .09 0 .08 0.08 0.08 0 .08 0.08 0 .08 0.08 0 .08 0 .09Plastic Surgery 0 .14 0 .14 0 .14 0 .13 0.14 0.13 0 .14 0 .13 0 .13 0.14Psychiatry 1.21 1.05 1.11 1.04 1.11 1.04 1. 11 1.04 1.04 1.21Thoracic Surgery 0 .13 0 .10 0.11 0 .10 0.10 0 .10 0.11 0.10 0 .10 0.13Urology 0 .20 0.19 0.20 0 .18 0 .19 0.18 0 .19 0 .18 0 .18 0 .20TOTAL- 19.71 15 .95 17 .09 15.61 18 .81 15 .63 18.82 15.81 15.63 19.71All fee for service, salaried and s ess i a18 l payments are inclUded in the determination of each physiCian'S FTE status.See text for explanatiQ"\ of classification of each physician's type of practice.IUrber rem..nerated by MSPBC .- Th is does not include Pathology and Bacteriology, Radiology, MedIcal MicrobIology, Nuclear Medicine , Plblfc Health or Osteopathy .Prepared by:Health Human Resources UnftThe Unfversfty o f Brftfsh Columbfat..,)1MTable 3(a) Esttlllilted IUlbers of FTE Phystctans tn Metropolitan' Brtttsh COl\Jld)ta Renamerated by MSPBCt ~by Type of Practtce' by Full-Ttme Equtvalent Method1984-1985 and 1989-1990TYpe of Practtce Full-Ttme EqJtvalent MethodActual" FTE 1 FTE2 FTE 3 FTE 4 FTE 5 .---..m 8 FTE 7 FTE 8 FTE91984-1985Anaesthes ia 228 .8 186.0 199.8 184.7 198.0 184.1 195.9 182.4 180.6 226 .2Dermatology 39.0 35.3 36.4 31.9 34.6 31.9 34. 1 32.4 31.9 39.0General Practice 1,855.8 1,428.8 1,547 .2 1,416.6 1,536.9 1,405.9 1,527.4 1,373.9 1,364.8 1,739.6General Surgery 142.0 103.8 114.2 100.3 109.5 98 .3 108.3 104.1 101.4 142.4Internal Medicine 300.0 250 .0 268.1 224 .4 .253.7 227.7 256 .0 216.0 218.5 279.9Neurology 41.0 31.3 35.1 30.6 33 .2 30 .6 33. 1 29 .0 29 .0 38 .9Neurostrgery 24.0 18.0 21.1 16.5 19.4 16.5 19.1 15.8 15.8 22.6Q:lstetrtcs & Gynaecology 107.0 87.3 94 .3 81.8 88.6 81.8 88.4 84.2 84.2 102.2Ophthalmology 116.0 105.0 108.7 92 .7 102.4 96.5 103.9 94.7 97 .9 115.2orthopaediC Surgery 82.0 73.0 76 .0 69 .8 73 .5 69 .2 73 .2 70.0 69.6 81 .6ato1aryngo logy SO.O 47 .1 47.4 43 .9 46 .4 43.9 46 .4 40.9 40.9 48.3Paediatrics 120.0 90 .7 103.5 89 .4 102.1 95 .4 105.5 90.5 95 .5 113.6Physical Medfcfne 19.0 12.7 15.3 13.4 15.7 13.4 15.6 12.5 12.5 17.2Plastic Surgery 30 .0 30 .0 30.0 28 .3 29 .6 28.3 29 .7 28.6 28 .6 29.9Psyd'lfatry 265 .0 239 .4 248.5 235 .2 246 .9 233.5 246 .1 231.1 229.7 261.8Thoracic Surgery 32.0 29 .3 30.4 25 .8 28 .5 27.1 29.1 25.8 27 .1 33.0Urology 39.0 36 .3 37 .5 35.1 36.5 35 .1 36.5 34.7 34 .7 39.2TOTAL' 3,490.8 2,804.2 3,013.7 2,720 .3 2,955.8 2,719.1 2,948.4 2,&68.4 2,&62.5 3,330.41989-1990Anaesthes ia 234 .0 200 .4 209 .3 199.2 207 .9 196.3 206 .3 198.9 196.7 238.8Dermatology 45 .0 40.6 42.6 36 .3 39.5 36.3 39 .6 36.7 36.7 43.8General Practfce 2,268.4 1,747.3 1,896.5 1,735.1 1,883.5 1,735.1 1,883.6 1,671.1 1,671.1 2.134.2Genera1 Surgery 152.0 111.2 123.2 105.5 117.7 103.5 116.0 103.5 101.9 149.5Internal Medicfne 348 .6 277.5 301.9 254 .8 284 .4 257 .5 286 .1 243.7 247 .1 320 .4Neurology 44.8 39.9 42.3 36 .6 40 .3 36 .6 40.4 35.7 35.7 42.8Neurostrgery 21.0 19.0 19.0 19.0 19.0 19.0 19.0 18.3 18.3 19.9Q:lstetrfcs & Gynaecology 108.0 90.8 96.1 85.4 91.6 85.4 91.3 86.9 86.9 106.1Opht halmo1ogy 130.5 114.9 122.0 103.9 112.8 105.3 114.7 106.0 107.5 132.3Orthopaedfc Surgery 92 .2 75.9 80 .8 74 .1 78 .2 72.3 77 .4 73 .9 72.3 87 .7eto1aryngo1ogy 55.0 51.4 52.7 47 .9 50 .4 47.9 50.3 45.4 45.4 54.3Paedfatrics 135.0 99 .5 111.9 98 .8 111.3 103.0 114.9 98.7 102.3 127.4Physfcal Medfcine 23.0 17.4 19.2 18.0 19.5 18.0 19.8 16.4 16.4 19.8Plastic Surgery 34 .9 33 .1 33.7 31.3 33.0 31.3 32.9 30.7 30 .7 33.4Psyd'lfatry 320.0 278.4 294 .8 275 .4 293.1 276 .0 293 .6 272.3 272 .8 314 .7Thoracic Surgery 38.0 30.8 33.2 29.3 31 .6 29.3 32 .2 29.3 29.3 39.0Urology 41.0 36 .5 38 .6 35 .8 36 .8 35 .8 36 .8 37.6 37.6 41.6TOTAL' 4 ,091.4 3,284.8 3,517.8 3,188.8 3,450.7 3 ,188.7 3,454.7 3,105.0 3 ,108.8 3,905.7, The regfal8l hospftal dfstrfct is that of the attendfng physfcian. 'Metropol ftan' consists of the RHOs capftal and Greater Vancouver.I All fee for service. salaried and sessia'l8l payments are included in the determination of each physician'S FTE status ., See text for explanation of classificatiOn of each physician 'S type of practice.•~ rem.nerated by MSPBC.• This does not include Pathology and Bacteriology, Radiology, Medical Microbiology, Nuclear Medicine , Plbl1c Health or Osteopathy .Prepared by:Hearth Human Resources UnitThe University of Brit ish ColumbiaTable 3(b) Esttlllated IUIbers of FTE Phystctans per 10,000 Populatton tn Metropolitan' Brtttsh ColudJta Renunerated by MSPBC'by Type of Practtce' by Full-Ttme Equtvalent Method1984-1985 and 1989-1990TYpe of Practtce Full-Ttme Ecp tvalent MethodActual" FTE 1 FTE 2 FTE 3 FTE 4 FTE 5 FTE 8 FTE 7 --ffi 8 rn 91984-1985Anaesthesta 1.48 1.20 1.29 1. t9 1.28 1.19 1.26 t.18 1.17 1.46Dermatology 0.25 0 .23 0 .24 0 .21 0.22 0 .21 0 .22 0 .21 0.2t 0 .25General Practfce 11.98 9 .22 9.99 9 .14 9 .92 9.08 9 .86 8.87 8 .81 11.23Genera f Surgery 0.92 0 .67 0 .74 0.65 0 .71 0.63 0 .70 0.67 0.65 0 .92Internal Medtctne 1.94 1.61 1.73 1. 45 1.64 1.47 1.65 1.39 1.41 1.81Neurology 0.26 0 .20 0.23 0.20 0.21 0.20 0.21 0 .19 0 .19 0 .25NeurOS\rgery 0.15 0 .12 0 .14 0.11 0.13 0 .11 0 .12 0.10 0 .10 0 .15Cbltetrtcs & Gynaecology 0.69 0 .56 0 .61 0.53 0 .57 0 .53 0 .57 0.54 0.54 0 .66~thaIllDlogy 0.75 0 .68 0 .70 0 .60 0 .66 0 .62 0 .67 0.61 0.63 0 .74Orthopaedfc Surgery 0.53 0 .47 0 .49 0.45 0.47 0.45 0.47 0.45 0 .45 0.53otoIaryngology 0.32 0.30 0 .31 0.28 0.30 0.28 0.30 0.26 0.26 0 .3tPaed1atr fcs 0.77 0.59 0 .67 0.58 0.66 0.62 0 .68 0.58 0 .62 0 .73Phystcal Medtcfne 0.12 0 .08 0 .10 0.09 0.10 0 .09 0.10 0.08 0.08 0 .11Plasttc Surgery 0.19 0 .19 0 .19 0.18 0.19 0 .18 0.19 0.18 0.18 0 .19Psychiatry 1. 71 1.55 1 .60 1.52 1.59 1.51 1.59 1.49 1.48 1.69Thoracfc surgery 0.21 0 .19 0 .20 0.17 0 .18 0.17 0 .19 0 .17 0.17 0 .21Urology 0.25 0.23 0 .24 0.23 0.24 0 .23 0 .24 0 .22 0.22 0 .25lOTAL" 22.53 18.10 19 .48 17.58 19.08 17.55 19.03 17.21 17.19 21.501989-1990Anaesthesfa 1.35 1.16 1.21 1.15 1.20 1. 14 1.19 1.15 1 .14 1.38Dermatology 0.26 0 .24 0 .25 0.21 0 .23 0 .21 0 .23 0.21 0.21 0.25General Practice 13 .13 10 .12 10 .98 10.05 10.91 10.05 10 .91 9.68 9.68 12 .36Genera1 Surgery 0.88 0.64 0 .71 0 .61 0 .68 0.60 0.67 0.60 0.59 0 .87Internal Medfcfne 2.02 1.61 1.15 1.48 1.65 1.49 1.66 1.41 1.43 1.86Neurology 0 .26 0 .23 0 .25 0.21 0.23 0 .21 0 .23 0.21 0.21 0 .25Neurosurgery 0 .12 0 .11 0 .11 0.1 t 0.11 0.11 0.1 1 0. 11 0.11 0 .12Cbltetrics & Gynaecology 0.63 0.53 0.56 0 .49 0.53 0.49 0 .53 0.50 0.50 0.61OphthalllDlogy 0 .76 0 .67 0.71 0.60 0.65 0 .6i 0 .66 0.61 0 .62 0 .77Orthopaedic SUrgery 0.53 0.44 0.47 0.43 0.45 0 .42 0.45 0 .43 0.42 0 .51otolaryngology 0.32 0.30 0.31 0 .28 0.29 0 .28 0 .29 0.26 0.26 0.31Paedtatrics 0.78 0.58 0.65 0 .57 0.64 0 .60 0.67 0 .57 0.59 0.74Physical Medfctne 0.13 0 .10 0.11 0.10 0 .11 0 .10 0.11 0 .10 0 .10 0.11Plast1c Surgery 0. 20 0.19 0.20 0 .18 0 .19 0.18 0.19 0 .18 0 .18 0 .19Psychtatry 1.85 1.61 1. 71 1.59 1. 70 1. 60 1.70 1.58 1.58 1.82Thorac1C surgery 0 .22 0.18 0 .19 0 .17 0 .18 0 .17 0.19 0 .17 0.17 0 .23Urology 0.24 0 .21 0 .22 0 .21 0.21 0 .21 0.21 0 .22 0 .22 0 .24TOTAL" 23.89 18.90 20.37 18.45 19.98 18 .48 20.00 17.98 18 .00 22.81The regfal81 hospftal dtstrtct ts that of the attendfng physfctan. ' Met r opolt tan , calSfsts of the RHOs Capital end Greater Vancouver .All fee for servfce. salaried and sessiCJ'l81 payments are tncluded fn the determfnatfon of each phystctan's FTE status.See text for e>cplanatfon of classfftcatfon of each phystc'fan's type of practfce.•~ rellU1erated by MSPBC.I Thfs cb!s not fnclude Pathology and Bacteriology. Radfology, Medfcal Mfcrobfology, Nuclear Medfctne . Plbltc Health or Osteopathy .Prepared by:Health Human Resources UnitThe University of British ColUmbiat-.)VITable 4(a) Estimated rurbers of FTE Physicians in Non-MetropoIttan , Brittsh COlurrbta Rl!l'IIlner8ted by MSPBC'N0\by Type of Practice' by Full-Time Equivalent "ethod1984-1985 and 1989-1990TyPe of Practice FUll-Til'lll! Ecpivalent MethodActual' FTE 1 FTE 2 FTE 3 FTE4 FTE 5 FTE 6 FTE 7 __FTE 8 FTE91984-1985Anaesthesia 74 .2 59 .6 65.2 59.6 64 .6 57.8 63 .5 61.9 61.3 76.8Dermato1ogy 8 .0 7 .1 7.4 7 . i 7 .2 6 .5 7 .2 6 .7 6 .6 8 .0General Practice 1,142 .2 957 .6 1,011.4 951.2 1,006.6 946.2 1,002 .2 993 .9 987 .3 1,258 .4Genera1 Surgery 104.0 80 .9 86.0 79 .4 83 .7 76 .9 83 .1 75.7 73 .7 103.6Interna l Medicine 70. 0 63 .3 64 .0 61.2 63 .0 61.2 63 .2 69 .5 70 .4 90 . iNeurology 8 .0 6.0 6.1 6.0 6.0 6 .0 6.0 7 .6 7 .6 iO. 1Neurosurgery 4 .0 3 .0 3.0 3 .0 3 .0 3 .0 3 .0 3.7 3 .7 5 .4Cl:Jstetrics & Gynaecology 44.0 43 .2 43 .7 42 .6 43 .3 42 .6 43.3 40.2 40 .2 48.8Ophtha1Il1Ology 40 .0 38 .3 39.3 35 .4 37.4 36.0 37.7 33.5 34 .7 40.8Orthopaedic Surgery 38 .0 35 .0 35.1 33 . i 34 .6 33 .1 34 .5 33 .0 32 .8 38 .4Oto1aryngo1ogy 21.0 16.3 17.3 f6 .3 16 .8 16.3 16.8 19.3 19.3 22 .7Paediatrics 34 .0 33 .3 33.9 33.3 33 .9 34 .0 34 .0 32.2 33.9 40.4Physical Medicine 5 .0 4 .1 4.2 4 .1 4 .2 4.1 4 .2 5.0 5 .0 6 .8P1ast ic Surgery 8.0 8 .0 8.0 8.0 8.0 8 .0 8 .0 7.7 7.7 8 . fPsychiatry 47.0 40.3 42.1 40 .3 41.9 40 .3 41.8 44.4 44 .1 50.2Thoracic Surgery 1. 0 0 .0 0.2 0 .0 0 .1 0 .0 0 .1 0 .0 0 .0 0 .0Urology 18.0 16. 2 16.9 i5.4 16.0 15.4 16.0 15.8 15.8 17.8TOTAL I 1,888.4 1,412.2 1,483.8 1,398 .0 1,470 .2 1,387.4 1,484.5 1,449.9 1,444.0 1,828.81989-1990Anaesthes ia 89 .0 70 .4 75 .9 69 .7 75 .0 69 .7 74.2 70.1 69 .3 84 .2Dermato logy 9 .0 9 .0 9.0 9 .0 9 .0 9.0 9 .0 8.6 8.6 10.2General Practice 1,348.6 1,108 .3 1,181.0 1,097 .1 1,174 .4 1.097.1 1,174.4 1,161. 1 1.161. 1 1,482.8Genera1 Surgery 107.0 76.6 83.8 73 .7 80.8 73 .0 79 .8 75 .7 74 .6 109 .5Internal Medicine 82.4 74.9 76.3 73 .0 75 .5 74.8 75.6 84.1 85.3 110.6Neurology 11.2 10.0 10.2 10.0 10.1 10.0 10.1 11.0 11.0 13.2Neurosurgery 3.0 3 .0 3 .0 3 .0 3 .0 3 .0 3 .0 3.7 3.7 4 .1Cl:Jstetrics &Gynaecology 48.0 44.6 46.2 42 .5 44.6 42.5 44.4 40.9 40 .9 49.9Ophtha 1Il1Ology 46 .5 42 .3 43.5 37 .8 40 .5 38 .4 41.0 35.8 36 .3 44.7Orthopaedic Surgery 43.8 41.1 41.5 40 .5 41.3 39.9 41.1 40.7 39.9 48.3Oto1aryngo1ogy 21.0 16 .5 17.8 15 .7 16.7 15.7 16.6 18.1 18.1 21.7Paediatrics 32 .0 30 .5 3 1.3 30 .5 31.3 3 1.2 31.5 30 .7 31.8 39 .6Physical Medicine 6.0 6.0 6.0 6.0 6 .0 6 .0 6.0 7.6 7 .6 9.2Plastic Surgery 9 .1 9 .1 9.1 9 . i 9.1 9.1 9 .1 9.8 9 .8 10.6Psychiatry 48 .0 43.0 44 .5 43 .0 44 .3 43 .0 44.4 46.2 46.3 53 .3Thorac1c Surgery 1.0 0 .0 0.0 0 .0 0.0 0.0 0.0 0.0 0 .0 0 .0Urology 21.0 21.0 21.0 20 .3 20 .6 20 .3 20 .6 18.4 18.4 20 .4TOTAL I 1,928.8 1,808.3 1,700.1 1,580.9 1,882.1 1 ,582.8 1,880.8 1,682.5 1,882.8 2,112.3I The regional hospital district is that of t he attending physician. ' Na H o1e t r opo l i t an ' CQ'lsists of all B.C. With the excepticns ofthe RHOs Capi ta1 and Greater Vancouver .• All fee for servfce, salaried and sess fonal payments are fncluded in the determfnatloo of each phys ician 's FTE status .• See text for explanatioo of classificatloo of each I=hysician 's type of practice.I NlJlt)er rel1lJl'lE!rated by MSPBC .I This does not incllJde Pathology and Bacteriology , Radiology , Medical Microbiology , Nuclear Medic ine, Publtc Health or Osteopathy.Prepared by :Health Human Resources Un itThe University of British ColumbiaTable 4(b) Estl_ted rurbers of FTE Physicians per 10,000 Population In Non-Metropolitan' British ColUIIGla Renunerated by MSPBC'by Type of Practice' by FUll-Time Equivalent Method1984-1985 and 1989-1990Type of Pract tee FUll-Time Ecplvalent MethodActual" FTE 1 FTE 2 FTE 3 FTE 4 FTE 5 __FTE 8 fTE7 FTE 8 FTE 91984-1985Anaesthesia 0 .57 0 .46 0 .50 0 .46 0 .50 0.44 0.49 0.48 0 .47 0 .59Dermatology 0 .06 0 .05 0 .06 0.05 0.06 0.05 0 .06 0 .05 0.05 0 .06Genera1 Pract Ice 8 .80 7 .37 7.79 7.32 7 .75 7 .29 7 .72 7.65 7.60 9 .69Genera1 Surgery 0 .80 0.62 0 .66 0.6i 0 .64 0 .59 0 .64 0.58 0.57 0 .80Internal Medicine 0 .54 0 .49 0 .49 0.47 0.49 0.47 0 .49 0 .54 0 .54 0 .69Neurology 0 .06 0 .05 0 .05 0 .05 0.05 0 .05 0 .05 0 .06 0 .06 0 .08Neurosurgery 0 .03 0 .02 0.02 0.02 0.02 0.02 0.02 0.03 0 .03 0 .04Cb;tetrics & Gynaecology 0 .34 0.33 0 .34 0 .33 0.33 0 .33 0 .33 0.31 0 .31 0 .38Ophtha lmology 0 .31 0 .29 0 .30 0 .27 0.29 0 .28 0.29 0.26 0.27 0 .31Orthopaedic Surgery 0 .29 0 .27 0 .27 0 .25 0.27 0.25 0 .27 0.25 0.25 0 .30Otolaryngology 0 .16 0. 13 0 .13 0 .13 0 .13 0 . 13 0 .13 0.15 0. 15 0 .18Paediatrics 0 .26 0.26 0 .26 0 .26 0 .26 0.26 0.26 0 .25 0 .26 0 .31Physical Medicine 0.04 0.03 0 .03 0 .03 0.03 0 .03 0 .03 0 .04 0.04 0 .05P1ast Ic Surgery 0 .06 0.06 0 .06 0 .06 0 .06 0 .06 0 .06 0.06 0.06 0.06Psychiatry 0 .36 0 .31 0 .32 0 .31 0 .32 0 .31 0 .32 0 .34 0.34 0 .39Thoracic Surgery 0 .01 0.00 0.00 0.00 0.00 0 .00 0 .00 0 .00 0 .00 0 .00Urology 0.14 0. 12 0.13 0 .12 0.12 0 .12 0 .12 0 .12 0 .12 0.14TOTAL" 12.83 10.87 11.43 10.75 11.32 10.88 11 .28 11.18 11.12 14.081989-1990Anaesthesia 0.67 0. 53 0.57 0 .53 0.57 0.53 0 .56 0 .53 0 .52 0 .63Dermato logy 0 .07 0.07 0 .07 . 0.07 0.07 0 .07 0 .07 0 .06 0 .06 0 .08General Practice 10 .17 8.36 8 .91 8 .27 8.86 8 .27 8.86 8.76 8 .76 11.18Genera1 Surgery 0.81 0.58 0.63 0 .56 0.61 0 .55 0 .60 0 .57 0 . 56 0 .83Internal Mediclne 0 .62 0. 56 0 .57 0 .55 0.57 0 .56 0 .57 0 .63 0 .64 0 .83Neurology 0.08 0 .08 0 .08 0 .08 0.08 0.08 0 .08 0.08 0 .08 0 .10Neurosurgery 0 .02 0.02 0 .02 0.02 0.02 0.02 0.02 0.03 0 .03 0 .03Cb3tetrics & Gynaecology 0 .36 0.34 0 .35 0 .32 0.34 0.32 0 .34 0 .31 0 .31 0.38Ophthalmology 0 .35 0 .32 0 .33 0.28 0 .31 0.29 0 .31 0 .27 0 .27 0 .34Orthopaedic Surgery 0.33 0.31 0 .31 0 .31 0.31 0 .30 0 .31 0.31 0 .30 0 .36Otolaryngology 0.16 0.12 0 .13 0 .12 0 .13 0 .12 0 .13 0 .14 0 .14 0 .16Paecl1atrlcs 0.24 0.23 0 .24 0 .23 0.24 0 .23 0 .24 0.23 0 .24 0 .30PhySical Medicine 0 .05 0.05 0 .05 0 .05 0.05 0 .05 0 .05 0 .06 0 .06 0 .07Plastic Surgery 0 .07 0.07 0 .07 0 .07 0 .07 0 .07 0 .07 0 .07 0 .07 0 .08Psychiatry 0.36 0.32 0 .34 0.32 0.33 0.32 0 .33 0.35 0 .35 0 .40Thoracic Surgery 0.01 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0 .00 0 .00Urology 0 .16 0 .16 0 .16 0 .15 0 .16 0 .15 0 .16 0 .14 0 .14 0.15TOTAL" 14.53 12.11 12 .82 11.92 12.68 11.93 12.87 12 .54 12.54 15 .93I The regional hospital district is that of the attending phYSician. ' Na1- Met r opo l1 tan , eons tsts of all B.C . With the exceptla"lS ofthe RHOs capital and Greater Vancouver.• All fee for service, salaried and sessional payments are IncllJded In the determination of each physician'S FTE status., See text for e><planatlon of classification of each phyS ician'S type of pract ice ."~ rellUlerated by MSPBC." This does not include Pathology and Bacteriology, Radiology, Medical Mlcroblol~, Nuclear Medicine, Publtc Health or Osteopathy.Prepared by:Health Human Resources UnitThe University of British Columbiat1V. MSP REMUNERATION PER FULL-TIME-EQUIVALENT PRACTITIONER BYTYPE OF PRACTICEThis section presents data on the distribution of MSP payments to practitioners in1984-85 and 1989-90. In Table 5, total MSP remuneration to each type of practice wasdivided by each of the nine PTE counts for that type of practice to compute average paymentsper PTE practitioner. These average payments are 'deflated' by general changes in MSP feelevels to derive constant (1984-85) dollar average payments per PTE practitioner, in the lastof the three columns for each type of practice. The fee index used for this purpose was aseries based on average fee levels in effect in each payment fiscal year.Since it takes an average of about six weeks for a claim for payment to be processed(this then being the average lag between date of service and date of payment), and since wewere using payment fiscal year data, each fee level change was incorporated into our feeindex six weeks after its effective date. Thus, if a practitioner provided a service on August28 of a fiscal year in which there was a fee change on September 1, one attempts with thisadjustment to ensure that payment for that service is 'deflated' by the fee levels in effect onthe date of service rather than on the date of paymentIt should also be noted that no attempt was made to estimate specific fee indexes foreach type of practice. Thus, the data in the final column for each type of practice in Table 5reflect the results of using a common index. The value of the index used to deflate 1989-90payments was .8976.2930Figures 2 through 19 go beyond a simple presentation of averages to attempt toportray somewhat more of the distributional detail. Based only on fee-for-service payments,each figure shows the distribution of physician incomes for the 1989-90 payment year.Table !5FTElilethadF~FTE 2FTE 3FTE 4FTE 5FTE 6FTE 7FTE 8FTE9FTElilethadF~FTE 2FTE 3FTE 4FTE5FTE6FTE 7FTE 8FTE 9FTElilethadF~FTE 2FTE 3FTE 4FTE 5FTE 6FTE7FTE 8FTE 9FTElilethad~FTE 2FTE 3FTE 4FTE 5FTE6FTE 7FTE 8FTE 9Average Renuneratfon per FTE Phystctan in Brtttsh ColurtJfa Renunerated by MSPBC', 1984-1985 and 1989-1990by Full-Ttme Equtvalent Method by Type of Practfce'Anaesthesfa Dermatology Genera1 Praet tce Genera1 SlrgerY Internal Medtcfne1984-85 1989-90 1989-90 1984-85 1989-90 1989-90 1984-85 1989-90 1989-90 1984-85 1989-90 1989-90 1984-85 1989-90 1989-90Actual Actual Fee-adj' Actual Actual Fee-adj' Actual Actual Fee-adj' Actual Actual Fee-adj' Actual Actual Fee-adj'132,661 145,493 130.593 210,226 233.973 210.011 131,622 147,937 132.786 185.370 211,042 189,429 177.414 208,240 186,914122,941 138,171 124,021 203.612 224,911 201.877 122.762 137,272 123.214 170.986 191 .498 171,886 167.347 194.044 174,172133,366 146,500 131,497 228,610 256,153 229.920 132,660 149,161 133,885 190.482 221,161 198.511 194,667 223,852 200,927124 ,098 139,278 125.014 213,100 239.200 214.703 123.489 138.153 124.004 177.236 199.640 179,194 175,532 203.825 182,951134,721 148,131 132.961 232,045 256,153 229,920 133.544 149.161 133.885 195.462 224.593 201,592 192,420 .220 ,733 198,127125 ,614 140,473 126.087 215,841 239,080 214.595 124 ,173 138,146 123.998 178.890 202,461 181,727 174,151 202 ,814 182 .043133,366 146,500 131,497 228,610 256,153 229.920 132,660 149,161 133,885 190.482 221,161 198,511 194,667 223 ,852 200,927134.721 148,131 132 ,961 232.045 256,153 229.920 133,544 149.161 133.885 195,462 224,593 201,592 192,420 220,733 198,127107,540 121,984 109.491 189,769 214,993 192.975 104.771 116,796 104 .835 139.169 153,037 137,364 150,241 170.230 152.796NeIra logy NelraS1rgl!l'"Y (J)stetrtcs & Gynaecology ~thallDOlogy (H!topaedtc SI.rgery197,868 205 .642 184.582 196,787 223.154 200,300 200.280 216,210 194.067 229.004 264,033 236,993 193 .375 203.211 182,400179,138 195,588 175,557 171,618 222,989 200,152 189.426 205,723 184.654 221.744 250,762 225,081 188,101 194 ,372 174,466201,713 219,990 197.460 212,013 223.154 200.300 210,183 228.991 205.540 256,086 292,862 262,869 203.030 207.544 186.289187,954 203,594 182,744 184,944 223,089 200.242 198.072 214.896 192 ,888 234 ,683 270.744 243,017 193.251 199.067 178.680201,713 219.990 197.460 212,013 223,154 200,300 210,183 228,991 205.540 247,494 288,819 259,240 204.191 211.890 190,190188,635 203.528 182.684 187,338 223,090 200,243 198.345 215.697 193.607 231.738 266,564 239,265 193,985 200,664 180.114201,713 219.990 197 ,460 212,013 223,154 200,300 210,183 228.991 205,540 256,086 292,862 262,869 203,030 207.544 186.289201,713 219,990 197 ,460 212.013 223,154 200.300 210 ,183 228,991 205.540 247.494 288,819 259 ,240 204,191 211,890 190,190150,653 183,409 164,626 147,886 204,607 183.653 173.044 187,623 168.408 210,360 234,506 210.490 174,114 174,809 156,906otolaryngology Paedtatrfcs PhYstcal Medtcine Plast fc 5U"gl!rY189,193 216,348 194,191 132.370 147.075 132.013 127.021 121.663 109,203 168,584 178,004 159,774185.471 208,301 186,968 119,456 133.462 119,794 109,386 113.287 101,685 168,584 175.644 157,656199,521 231,128 207,458 133,788 147.827 132 ,688 122,041 118.680 106,526 176.679 186 ,016 166.966190,197 218,865 196,451 120,803 134.142 120,404 106.798 111,866 100.410 170.202 178,557 160,271199,521 231,128 207,458 126,874 142,554 127.955 122,041 118,680 106,526 176,679 186,016 166,966190,055 219,423 196.951 117,706 130.591 117.217 107,294 110.583 99,258 169,864 179,047 160,710199,521 231,128 207,458 133,788 147.827 132 .688 122 ,041 118,680 106.526 176,679 186,016 166,966199,521 231.128 207.458 126,874 142,554 127.955 122,041 118,680 106.526 176,679 186,016 166 ,966169,084 193,295 173,499 106.632 114,490 102,765 88,558 98,365 88,291 168,584 170.949 153.442Psychtatry Thoracfc Stl"gerY lrology Total"121,180 134.311 120,556 226,735 230,409 206,812 224,557 262.502 235,619 148,489 165,416 148 .475116,592 127.259 114,226 217,668 213,452 191,592 216,646 253,571 227,602 139,208 154,423 138,608123,016 135,587 121,701 257,770 241,590 216.848 233,394 269,430 241,837 152,101 169 ,012 151,703117.372 127,969 114,863 232,391 224,489 201.499 224,717 263.383 236,409 141,463 156,982 140,905123,794 135,333 121,473 245,193 241,590 216,848 233,394 269,430 241,837 152,465 168,872 151,577117,698 127.773 114,687 227,524 220,368 197 ,800 225.079 263,398 236,423 141,877 156 ,897 140,829123,016 135,587 121,701 257,770 241,590 216,848 233,394 269.430 241,837 152,101 169,012 151.703123,794 135,333 121,473 245.193 241,590 216,848 233.394 269,430 241,837 152,465 168,872 151.577108.613 117 ,334 105,318 201,609 181,804 163,185 207,006 243,625 218,675 121,406 133,891 120,179I All fee for serVice, salar1ed and sess1a"l8l payments are included in the determinatial of each physician'S FTE status and in totalI See text for explanatial of classificatial of each physician'S type of practice., At 1984-85 overall medical serVices fee levels. See text." This does not include Pathology and Bacteriology, Radiology, Medical Microbiology, Nuclear Medicine. Public Health or Osteopathy.Prepared by:Health Human ResOUrces UnitThe University of British Columbiarem..nerat i01.\,0)....3220OF> 15~I::0or;.LJ 10::l..QOr;l.;.LJtI1or;5QoFig. 2.Income in $JO,OOODistribution of Physicians by FFS Payments, 1989/90for ~pe of Practice ~ESTHESIA.20OF> 15~I::0or;.LJ 10::l..Qor;l.;.LJtI1or;5Q0.LI.................Income in $JO, 000Fig. 3. Distribution of Physicians by FFS Payments, 1989/90for ~e of Practice DERMATOLOGY.20~ 15~I::Qor;.u 10::s..Qor;\..i.utilor;5QoIncome in $10,000'"..,In..,33Fig. 4. Distribution of Physicians by FFS Payments, 1989/90for ~e of Practice GENERAL PRACTICE.~ 15~I::Qor;.u 10::s.Qor;\..i.utilor;5Qo~Income in $10,000'".., In..,Fig. 5. Distribution of Physicians by FFS Payments, 1989/90for ~e of Practice GENERAL SURGERY.3420rjp 15~I::0Or-!.LJ 10::l.Qor-!H.LJfI1'r-j 5QoFig. 6.Income in $10,000Distribution of Physicians by FFS Payments, 1989/90for 1Y,pe of Practice INTERNAL MEDICINE.20rjp 15~§'r-!.LJ 10::l.Q'r-jH.LJfI1'r-! 5QoC)'"C)..,'"..,Fig. 7.Income in $10, 000Distribution of Physicians by FFS Payments, 1989/90for 1Y,pe of Practice NEUROLOGY.350..&-1 ____20dp 15~a'r;.LJ 10::s..Q'r;J..i.LJfJl'r; 5QIn..,Q'"In'"Q.., In.., +Q..Income in $10,000Fig. 8. Distribution of Physicians by FFS Payments, 1989/90for 1jrpe of Practice NEUROSURGERY.In..,Q..,~Income in $10,000o20en> 15~I::0'r;.LJ 10::s.Q'r;J..i.LJfJl'r; 5QFig. 9. Distribution of Physicians by FFS payments, 1989/90for 1jrpe of Practice OBSTETRICS and GYNAECOLOGY.3620Op 15~s:::0'r-i.LJ 10::s..Q0r-il-i.LJtI1'r-i 5QoIncOlJll! in $10.000Fig, 10, Distribution of Physicians by FFS Payments, 1989/90for ~pe of Practice OPHTHALMOLOGY.20,0.0 15~s:::00r-i.LJ 10::s..Q0r-il-i.LJtI10r-i 5QoQ'"IncOlJll! in $10.000Fig, 11. Distribution of Physicians by FFS Payments, 1989/90for ~e of Practice ORTHOPAEDIC SURGERY.20dp 15~l::0Or-!.u 10::s.QOr-!\..i.utQor-!5Qo37Income in $10,000Fig. 12. Distribution of Physicians by FFS Payments, 1989/90for ~pe of Practice OTOLARYNGOLOGY.200.0 15~l::0Or-!.u 10::s.QOr-!\..i.utQor-!5Qo'"..,IncO/lle in $10,000Fig. 13. Distribution of Physicians by FFS Payments, 1989/90for ~e of Practice PAEDIATRICS.3820d,o 15~I:lQor;,I.J 10::l.Qor;\.i,I.JtI1or;5QoInc...e in SIO ,OOO'".., In..,Fig. 14. Distribution of Physicians by FFS Payments, 1989/90for 2YPe of Practice PHYSICAL MEDICINE.200.0 15~§or;,I.J 10::l.Qor;\.i,I.JtI1or;5Q0 ............---........'"...In... '"'"Inc...e In S10,000'".., In..,Fig. 15. Distribution of Physicians by FFS Payments, 1989/90for 2YPe of Practice PLASTIC SURGERY.20Op 15~I::0'r;oW 10::s..Qor;\..ioWtI1or;5Qo39Income in $10,000Fig. 16. Distribution of Physicians by FFS Payments, 1989/90for ~e of Practice PSYCHIATRY.20~o 15~I::0or;oW 10::s..Q'r;\..ioWtI1or;5Qo..o..Income in $10,000Fig. 17. Distribution of Physicians by FFS Payments, 1989/90for ~e of Practice THORACIC SURGERY.4020dP J5~§..,.w 10:::3.Q..,I-;.wfJ1..,5Q0 ..................•<>...Income in $10 ,000Fig. 18. Distribution of Physicians by FFS Payments, 1989/90for ~pe of Practice UROLOGY.20dp 15~§..,.w JO:::3.Q..,I-;.wfJ1..,5QoIncome in $10,000Fig. 19. Distribution of Physicians by FFS Payments, 1989/90for 1YPes of Practice in Figs. 2 through 18.VI. FULL-TIME-EQUNALENT FEE-PRACTICE PHYSICIANS BY TYPE OFPRACTICE AND REGIONAL HOSPITAL DISTRICT OF PHYSICIANThe tables in this section represent both a narrowing of focus and at the same time,supplementation of detail provided in Section N. While Section IV provided nine estimatesof PTE practitioners by type of practice, for metropolitan and non-metropolitan regions, attwo points in time (1984-85 and 1989-90), the tables in the present section provide the samenine FTE estimates for each type of practice and the same two years, but now based only onfee-for-service payments, and by specific RHD.With the FTE estimates in this section excluding provision of service on a salary orsessional basis, one might expect the PTE values to be lower than those based on totalservices reimbursed by all three methods. This is true in general. However, the methods forcomputing FTEs provide the possibility of finding more fee-for-service PTEs than fee +salary + sessional FTEs. To illustrate, consider the following two practitioners in the sametype of practice, and assume they are the only two in that type of practice:41$ 50,000Practitioner 1Practitioner 2Fee-for-Service(FFS) Salary$ 50,000$150,000Sessional$ 50,000Total$ 50,000$250,000In this extreme example, and using definition 4 (anyone earning at least one-half themean is 1 PTE; those earning less are the ratio of their earnings to one-half the mean),practitioner 1 would be counted as 1 PTE on the basis of FFS payments only, but only 0.67PTE on the basis of all MSP payments . Thus, salaried and sessional payments to42practitioners with fee-for-service practices as well may have the effect of raising the full-timecutoff (1/2 mean earnings) so as to reduce the FfE value of practitioners paid fees only.In actual fact, there are few instances of higher FfE counts using the more restricted(FFS only) base, and in all such cases the differences have been small. The more commoncase is for the FfE totals based on fee payments only to be lower than the all-types-of-MSP­income FfEs. Differences are particularly pronounced for general practice, paediatrics andpsychiatry, where there are significant numbers of individuals paid partially or wholly onsalary or by sessions.Tables 6 through 8 of this section present FfE counts by type of practice. Eachtable is comprised of two parts, one showing actual numbers for each FIE definition, theother, numbers per 10,000 population. Table 6 is for the entire province, while Tables 7 and8 break out metropolitan and non-metropolitan RHDs respectively. Recall that in this section,the RHD of each physician is based on