Physician reimbursement for strabismus surgery across provinces and territories in Canada

Inadequate financial reimbursements in pediatric ophthalmology and strabismus (POS) are held responsible for the declining interest of ophthalmology graduates, leading to serious workforce concerns. The purpose of this study is to review physician reimbursements for strabismus surgery across provinces and territories in Canada.

The manuals for physician remuneration for provinces/territories in Canada were reviewed in 2023 and 2024; strabismus surgery and routine cataract surgery billing codes with their respective compensation were extracted. The data were analyzed using appropriate statistical tests.

Physician reimbursement for 1-muscle strabismus surgery varied from $369 (Ontario and Newfoundland and Labrador) to $835 (Yukon) before April 2023 and from $369 (Newfoundland and Labrador) to $891 (Yukon) after April 2023. For 5-muscle surgery, the values were $502 (Prince Edward Island) to $1723 (Manitoba) before, and $512 (Prince Edward Island) to $2626 (Ontario) after April 2023 [ANOVA test statistically significant, p < 0.0001 for both]. Two out of 12 (17%) provinces/territories do not pay for adjustable sutures, 4/12 (33%) for reoperations, 7/12 (58%) for more complex strabismus procedures, at present. Before April 2023, mean reimbursement for 1-muscle strabismus surgery was $529 ± 149.7, and for cataract surgery, it was $489 ± 168.7; p = 0.5453. After April 2023, the values were $551 ± 151.4 and $496.4 ± 176.7, respectively; p = 0.4251. Four out of 12 (33%) and 3/12 (25%) provinces/territories paid more for cataract compared to 1-muscle strabismus surgery before and after April 2023, respectively.

There is high variability in payments for the same strabismus procedures across provinces/territories in Canada. Physician reimbursement issues may lead to POS workforce concerns and limit access to care.