# Doctor's annual "fee" for "uninsured" services



## pnky (Jul 16, 2012)

Just got a letter from my doctor. They have started a new scheme by which if we deposit $190 annually (for a family of 3), we will not have to pay for a list of services (mainly letters, prescription renewals, forms) which would otherwise attract a fee since they are not insured by OHIP.

When i read through the list of services, it did not look like stuff I would normally use, so my first instinct is to not pay it.

One fear though - will my doctor treat me differently since I am on the list of "people who did not pay me upfront" ?

What would this forum advise?

To be honest, i felt somewhat let down to receive that letter - to me it is an indication of deteriorating levels of values in service, but that may be just me.


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## andrewf (Mar 1, 2010)

Sounds like they are offering insurance for some items not covered by OHIP. I doubt they would treat you differently as a patient.


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## Spudd (Oct 11, 2011)

My doctor does the same thing, and I don't pay it (for the same reason -- I would rarely use those services, so I figure I'll pay as I need them instead). I haven't noticed any difference in the service I receive. I suspect most people don't pay this fee - I think the doctor is just trying to make a few extra bucks.


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## uptoolate (Oct 9, 2011)

The doctor probably wouldn't know one way or the other. All those things would be billed by a clerk or the office manager. Even if they did know, I seriously doubt that you would be treated differently. Agree with Spudd's approach - tally up how many of the things you would use and the total potential cost and then decide. Personally, I wouldn't pay it either as I would very seldom use any of the services on offer.


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## bayview (Nov 6, 2011)

My family doctor gave me the heads up early this year when his clinic office was implementing the fee collection for letters, photocopying etc. He advised me to ignore it when I get the letter. I never received the letter in the end although I know the collection plan was not scraped. My family has only been with him for about 4 months then. From Day 1 he has been extremely helpful, patient and always cooperative. We have visited him quite a number of times this year on average 1-2x a month and we have never been asked to pay a single cent although I know he has to do some documentation in some cases.


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## cjk2 (Sep 19, 2012)

My family doctor is fantastic, I've never received any letter for extra fees before. Even if I did, I don't think he would treat me any different. It'd be unethical to do so.

Kind of off-topic but I _have_ had some bad experiences with clinics before. Once I got vaccinated at a walk-in clinic--I needed the documentation for this (requirement for university), and they basically refused to fax over the form unless I mailed them a cheque for $40 or something. That was ridiculous, $40 to pull up a form and fax it?? $10 I would understand, maybe...at any rate I refused to do it and just ended up getting the shot again (since the shot itself is free). Pretty backwards--I'm sure the health system lost more money by me getting the duplicate shot. Anyways, few years down the road when I was leaving school, I wanted to have all my records transferred over to my family doctor...only to be told I'd be once again charged some ridiculous fee. Well, forget it then.


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## kcowan (Jul 1, 2010)

We have been offered extra insurance for four years. I have never paid it and I have never incurred any extra fees either.


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## stardancer (Apr 26, 2009)

Please don't call it 'insurance'. It is NOT insurance. It is an annual charge for extra administrative services that used to be done for free. I would hate to think anyone new or green to the system would get the impression that it is an 'insurance' that they must have. It is not illegal for medical clinics to charge for administrative services, but it is illegal for them to refuse to treat you if you refuse to pay for them. Completing a report for $50 has nothing to do with treating you for high blood pressure.


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## Square Root (Jan 30, 2010)

this is becoming more common. I think I pay $80/yr for these services. Bottom line is that family doctors earn so little and are continually squeezed by gov't so the have resorted to this. Seems reasonable to me if you think you will use those services. If you don't think you will-don't pay. I doubt very much whether the doc will know or care.


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## pnky (Jul 16, 2012)

uptoolate said:


> The doctor probably wouldn't know one way or the other. All those things would be billed by a clerk or the office manager. Even if they did know, I seriously doubt that you would be treated differently. Agree with Spudd's approach - tally up how many of the things you would use and the total potential cost and then decide. Personally, I wouldn't pay it either as I would very seldom use any of the services on offer.


In this case, there is a company who is managing this "service" probably on behalf of a group of doctors. The cheque is to be issued in the doctor's name.


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## pnky (Jul 16, 2012)

Square Root said:


> this is becoming more common. I think I pay $80/yr for these services. Bottom line is that family doctors earn so little and are continually squeezed by gov't so the have resorted to this. Seems reasonable to me if you think you will use those services. If you don't think you will-don't pay. I doubt very much whether the doc will know or care.


Do they really "earn so little" ? An average Ontario doctor earns #385K a year - 10 times of what the average Ontarian earns. There's got to be some fine line beyond which it becomes "greed"

http://news.ontario.ca/mohltc/en/20...-community-care-for-families-and-seniors.html


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## MoneyGal (Apr 24, 2009)

pnky said:


> Do they really "earn so little" ? An average Ontario doctor earns #385K a year - 10 times of what the average Ontarian earns. There's got to be some fine line beyond which it becomes "greed"
> 
> http://news.ontario.ca/mohltc/en/20...-community-care-for-families-and-seniors.html


An average doctor BILLS $384K per year according to that source. You realize they are running their entire offices from that income stream.


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## cjk2 (Sep 19, 2012)

pnky said:


> Do they really "earn so little" ? An average Ontario doctor earns #385K a year - 10 times of what the average Ontarian earns. There's got to be some fine line beyond which it becomes "greed"
> 
> http://news.ontario.ca/mohltc/en/20...-community-care-for-families-and-seniors.html


I think doctors are compensated fairly well but I just want to point out, the 385k figure is not what they earn--it's the amount doctors _bill_ the government. Aka that's the amount they pull in before subtracting out all their expenses (paying the nurse, receptionist, rent/office expenses, etc).

Now I have no idea how much of the money these expenses would eat up, or how taxes work in their situation (not sure if they are taxed as a business or individual?) but to say they earn 385k is an exaggeration. Probably still a very good salary though.


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## MoneyGal (Apr 24, 2009)

Also - just went and got median figures (because averages are meaningless in this context) - median OHIP billings in 2010 per physician were under $300K. Source: http://www.ices.on.ca/file/ICES_PhysiciansReport_2012.pdf - table 3.1


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## Square Root (Jan 30, 2010)

If you exclude specialists the amount is much lower. It is my understanding that the median GP net income is around $125k after expenses. Yes, I think this is very low in relation to their educational requirements, responsibility, lack of benefits, and how hard they work. Compared to what senior execs make? Insulting.


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## pnky (Jul 16, 2012)

Wow, what a healthy discussion ! Good point MoneyGal and others - did not realize that $385K can be a misleading figure.

I come with a lot of baggage...where I come from, doctors are very corrupt, earn in millions and dont think twice before suggesting a few major surgeries just to make that extra buck - irrespective of whether the patient needs it or not. We went through some very painful real-life incidents involving the treatment of my parents and my wife too and it has led me to have a general lack of trust of doctors in general. I think it is time to shed that baggage.

Thank you everyone for your views and comments.


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## MoneyGal (Apr 24, 2009)

I have a GREAT quote from an actuary (but I've never pulled it out, because I can't source it -- I'm breaking my own rule here) that says when you look from the perspective of total earnings over a lifetime, TTC collectors outearn doctors hands-down. 

Why? Because they start at age 18, retire early, and get indexed DB pensions as long as they live. 

Doctors, in contrast, go through a minimum of 9 years of PSE (and it is 17 full years for the highest-earners, radiologists), they often rack up tremendous medical debt, they essentially have to run full-time businesses to practice, and they retire with no pension.


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## bayview (Nov 6, 2011)

And yet so many of the collectors are grumpy most of the time, sigh!


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## Square Root (Jan 30, 2010)

Yes, I am constantly surprised why so many people want to be doctors. Obviously, many(most) just want to help people and aren't motivated as much by money as some here(myself included). Good for them.


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## bayview (Nov 6, 2011)

I know a guy in his early 30s who is a portfolio manager with a major invt co in Bay Street which he joined 2-3 years ago. And he isnt covering anything sexy like biotech and pharma. Prior to that he was a GP in Manitoba. He did say being a GP doesnt pay as well here as elsewhere.


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## Dmoney (Apr 28, 2011)

Square Root said:


> If you exclude specialists the amount is much lower. It is my understanding that the median GP net income is around $125k after expenses. Yes, I think this is very low in relation to their educational requirements, responsibility, lack of benefits, and how hard they work. Compared to what senior execs make? Insulting.


I can tell you for a fact that the average GP's net income is substantially more than $125K. From my understanding, figures in this range are reflective of GP income in the USA, which believe it or not, are actually lower than here in Ontario. The reasoning is that GP's in the US can be avoided by patients going directly to specialists, whereas in Canada, you have to see the GP first. As a result, GP's in the states see significantly fewer patients, and earn less. 

Most GP's in Ontario are incorporated in some way, and can write off all expenses (secretary, nurse, rent etc.) and are then taxed at corporate rates. Dividends are then pulled out of the corporation and are eligible for tax credits. Also, those who are in clinics make substantially more (aggressive billing) and pay much less overhead proportionally (common secretary for multiple docs etc.).

I do agree that when you compare the earnings of a doctor vs. many other public sector employees there is a huge disconnect. Teachers work a fraction of the hours doctors do, have half the educational credentials (not to mention you can teach with a history degree, which doesn't even compare to med school) and have no benefits. Teachers retire with a pension worth well north of a million which would require significant savings for a doctor to realize.

Yet, doctors' pay has been slashed by a reported $65K annually on average (CMA's numbers so take with a grain of salt), while teachers are complaining about a freeze for a couple of years.


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## Square Root (Jan 30, 2010)

I could be wrong but I typed the question into google and got $124,688 for general docs in Ontario. Current data too. In any event I tnink we all agree that they are under paid. i don't think the legal form of a doctors practice is an issue, as amy professional working on their own can create a corp as the last poster described. When I was working, my associates and I made made many multiples of what doctors made and I always thought this was wrong. (Not so much what I made.....but you know)


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## kcowan (Jul 1, 2010)

stardancer said:


> Please don't call it 'insurance'. It is NOT insurance. It is an annual charge for extra administrative services that used to be done for free. I would hate to think anyone new or green to the system would get the impression that it is an 'insurance' that they must have. It is not illegal for medical clinics to charge for administrative services, but it is illegal for them to refuse to treat you if you refuse to pay for them. Completing a report for $50 has nothing to do with treating you for high blood pressure.


It is imsurance. It is paid optionally to avoid potential real charges. Don't confuse this with compulsory items. Insurance is always optional (unless you drive a car).


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## MoneyGal (Apr 24, 2009)

Median GP income in Ontario was just under $300K in 2009/10 - source is chart 4.1 of the same doc I linked to earlier: http://www.ices.on.ca/file/ICES_PhysiciansReport_2012.pdf


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## Square Root (Jan 30, 2010)

Thanks MG. That chart is before expenses, right? If so their net income after expenses would be quite a bit lower. Any doctors in the house?


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## MoneyGal (Apr 24, 2009)

That's just income from OHIP. After-tax income would vary widely - GP is a huge subset of the medical practice. Some GPs work in emergency rooms on staff, some will be incorporated, others work on salary for community health centres; GPs are more likely to work fewer hours/part-time, some will focus narrowly on a speciality (sports medicine, counselling) - it is very hard to generalize.


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## cheech10 (Dec 31, 2010)

I've been lurking for a while, but decided to post since I'm a physician in Toronto.

MoneyGal's numbers are pretty much right: a family MD in Toronto typically bills $300K or so (there is wide variability though). From this, deduct the office lease, administrative staff, billing agent, office supplies and expenses, continuing education costs, malpractice insurance, and our College dues, which are $60 to $100K per year in total expenses, depending on office size and sharing administrative staff, primarily. This leaves $220K or so of income, less taxes, or about $150K after tax. A good income, even in the GTA, but not exorbitant.


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## Dmoney (Apr 28, 2011)

MG is correct in that the numbers vary a ton. I have a few GPs in my family, and gross billing numbers from $300-400K make sense. This is for private practice, which comes with office overhead (rent, secretary, supplies etc.). I can't see those coming to much more than $100K, leaving pre-tax income somewhere in the $200K-$300K range.

Have also heard that in clinics, expenses are lower (though can be higher as they are generally a % of amount billed) per doc and earnings can be much higher as the doc's time is used much more efficiently and billing is maxed out. I'm not sure if there is still a cap on GP earnings (max allowable billing on a yearly basis used to be in effect, think it might have been abolished though) but to get significantly above $400K you'd need to work like crazy or have some creative billing.

Square Root: I didn't know any profession could start a corp and thought one of the big advantages available to docs was their ability to incorporate. Also thought it was only recent that this became an option. The GPs I know recently (last 5-10 years) incorporated, and it seems that it made a massive difference in terms of after tax income. 

Before the recent salary cuts, I think docs were very well paid, and the GP's I knew felt the same. Mixed bag of emotions after the cuts. Something definitely needs to be done to reduce healthcare/education/public service costs, but I'm not sure if this is the right way to do it.


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## Square Root (Jan 30, 2010)

Thanks Dmoney. Interesting and useful.


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