A look at 350 years of physicians' fees in Quebec
CMAJ 1997;157:874
The earliest available records reveal that Estienne Bouchard, a master surgeon, came to Montreal (then Ville Marie) in 1653. He was to serve as physician to a military company for 5 years for 146 livres a year. In addition, he contracted with 42 families to provide treatment for an annual sum of 5 livres each. (Treatment of plague, smallpox, leprosy and epilepsy was not covered, nor was the provision of lithotomy.) He could take on 1 apprentice at a time for 150 livres per year. At the time, the annual salary of a young unskilled worker was 30 to 40 livres. Assuming that Bouchard had a trainee and earned an extra 120 livres a year from treating other individual patients, his annual income of around 500 livres would have been about 17 times that of the lowest salary of a young unskilled labourer.
About 70 years later, Michel Sarrazin of Quebec City, the first actual physician in New France, was earning 2000 livres per year. He also received an annuity of 400 livres that allowed his son to study medicine. At the time, the starting salary of unskilled labourers was 40 livres for local men and 50 livres for those engaged from France. Thus, his income of 2400 livres was 60 times that of a starting unskilled labourer.
In the 19th century many medical societies established recommended fee schedules to prevent physicians from undercutting each others' fees. In 1872 the one proposed by the Quebec College of Physicians and Surgeons listed $2 as the fee for a home visit within half a mile, with an additional 50 cents per mile. The fee was the same for an office visit, but rose to $4 between 9 pm and 8 am for home visits, and to $3 for office visits. Vaccinations, venesections, hypodermic injections and tooth extractions cost $1, and a first catheterization was $3. Health certificates were $5, routine deliveries $15. Fractures, dislocations and surgical procedures were relatively expensive; closed reduction of a thigh fracture cost $25 and of a dislocation $50, and a mastectomy was $50. At the time, a starting male labourer was lucky to make $5 a week. Thus, a visit from a physician would cost such a worker almost 2 days' wages. Counting only office or home visits, 10 visits a day during a 6-day week gave physicians an annual income 24 times that of a starting labourer.
Finally, consider the fees now paid to Quebec physicians, which are among the lowest in Canada. In my specialty (plastic and reconstructive surgery), consultations in the office earn $35, in the hospital $28. I receive $15 for routine office visits, $13.50 for hospital visits and $12 for hospital clinic visits. Principal examinations, allowed once a year, earn $30 in the office and $28 in the hospital.
In 1995 Quebec's minimum wage was $6.85 per hour. A routine office visit is reimbursed the equivalent of less than 2.5 hours' wages, compared with almost 2 days' wages in the 1870s. The income ceiling for almost all physicians in Quebec is $300 000. Someone working a 40-hour week at minimum wage would earn $14 250 a year. Thus, physicians reaching the ceiling earn about 21 times as much as someone earning minimum wage.
It is difficult to compare the incomes of physicians and nonphysicians over the last 350 years, but it is interesting to note that Sarrazin earned 60 times the wage of the lowest-paid labourers, whereas his present-day counterparts earn a maximum that is only about 21 times that of someone employed at minimum wage. It is also worth remembering that, until early this century, there was no income tax.
Jack Cohen, MD
Montreal, Que.
 |
Send a letter to the editor responding to this letter
Envoyez une lettre à la rédaction au sujet de cette lettre |
Letters