The pay gap widens between doctors and nurses

In 10 years, the proportion of the Quebec health budget allocated to physicians has increased, while that of nurses has decreased. A unique situation among the Canadian provinces and at a time when the health network is facing significant human resource challenges. Analysis.

From 2006 to 2016, the proportion of the Quebec health budget allocated to physicians increased from 14% to 19%. Meanwhile, that of all employees in the health and social services network (doctors are not considered as employees) dropped from 43% to 37%.

“Health services are composed of a set of interdependent staff. It must be viewed in an integrated and not isolated way, “explains Professor Carl-Ardy Dubois, Director of the Department of Management, Evaluation and Health Policy at the School of Public Health of the Université de Montréal. This is why the CBC conducted an analysis to understand the increase in physician remuneration in the broader context of Quebec’s health care system.

There are significant changes in the allocation of financial resources of the Department of Health and Social Services.

From 2006 to 2016, the proportion of the Quebec health budget allocated to physicians increased from 14% to 19%. Meanwhile, that of all employees in the health and social services network (doctors are not considered as employees) dropped from 43% to 37%.

“Health services are composed of a set of interdependent staff. It must be viewed in an integrated and not isolated way, “explains Professor Carl-Ardy Dubois, Director of the Department of Management, Evaluation and Health Policy at the School of Public Health of the Université de Montréal. This is why the CBC conducted an analysis to understand the increase in physician remuneration in the broader context of Quebec’s health care system.

There are significant changes in the allocation of financial resources of the Department of Health and Social Services.

From 2006 to 2016, the proportion of the Quebec health budget allocated to physicians increased from 14% to 19%. Meanwhile, that of all employees in the health and social services network (doctors are not considered as employees) dropped from 43% to 37%.

“Health services are composed of a set of interdependent staff. It must be viewed in an integrated and not isolated way, “explains Professor Carl-Ardy Dubois, Director of the Department of Management, Evaluation and Health Policy at the School of Public Health of the Université de Montréal. This is why the CBC conducted an analysis to understand the increase in physician remuneration in the broader context of Quebec’s health care system.

There are significant changes in the allocation of financial resources of the Department of Health and Social Services.

However, it must be taken into account that the Régie de l’assurance maladie du Québec (RAMQ), which is responsible for the remuneration of physicians, estimates that the office expenses of most specialists represent 35% of their gross income (60% at radiologists).

The salary ratio between general practitioners and nurses seems even more pronounced when compared to that of other countries. According to a 2013 Nursing Services Research and Management Research Center Comparative Study, this ratio was 1.65 in France, 1.8 in Norway and 3 in England. In Quebec in 2013, this ratio was almost 4. A difference with other health systems described as huge by Carl-Ardy Dubois.

More trained and better paid nurses

The researcher, who participated in the study cited above, offers an explanation, however. “The gap with physicians is narrowing with university training for nurses, a requirement that is often associated with salary enhancement and provides access to greater opportunities for career advancement.”

Indeed, some countries, such as Norway, have been forcing all hospital nurses to obtain a university degree for several years now.

It is a model to which Quebec is getting closer, where the number of nurse practitioners or clinicians has increased by 77% between 2006 and 2016 to reach 20,300. During the same period, the number of regular nurses is from 32,300 to 25,900, a decline of 20%.

That being said, despite a slightly better situation than their colleagues who have only a college diploma, the remuneration of clinical nurses and practitioners, who must have studied at university, is still much slower than that of physicians.

We also learn that the remuneration of a doctor could pay the salary of almost 9 attendants to the beneficiaries. Guy Laurion, Vice-President of the CSN Health and Social Services Federation, who represent nearly 30,000 of these attendants, considers that “there should be a reduction in this gap”, but especially that, as the remuneration of the doctors, that of all the workers in the system should be better adapted to the changes of the clientele and the heaviness of the acts rendered. Mr. Laurion blames salary inequalities, but also a too hierarchical work climate to explain the important shortage of paratechnique and auxiliary labor force in the health network.

The negotiating table

How do doctors manage to appropriate this growing share of the cake? For researcher Carl-Ardy Dubois, part of the answer lies in the prestige associated with them.

The bargaining structure gives medical federations a better chance of having their applications heard, adds the University of Montreal professor. “Physician salaries are negotiated separately from other groups with common parameters set for the public service,” he says.

An analysis shared by Guy Laurion of the CSN, while the members of his union just a wage increase of 2% per year. Since government employees often come to bargain as a common front with tens of thousands of employees, the total payroll in question is large enough to shake public opinion. “When there are so many employees who negotiate, the government’s discourse on the state’s ability to pay and the risk of increasing taxes succeeds in breaking through,” says the unionist.

While Minister Barrette has just made generous pay increases to Quebec medical specialists, it is expected that the trends described in this analysis will increase in the coming years.

Sarah Brown (RN) is the Lead Editor at Health News Tribune where she covers mental health and emotional wellness. Sarah graduated with a degree in nursing from Ryerson in Toronto. She currently lives in Toronto. Prior to becoming a journalist, Lindsay worked as a health professional in Cambridge Ontario.

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