Geriatrician and General Internist Clinical Payments in Canada 2022-2023: Fee for Service and Alternative Payment...

A Comprehensive Geriatric Assessment (CGA) completed by a geriatrician assessing an older person living with frailty and multiple comorbidities involves longer visit durations than standard General Internal Medicine (GIM) consultations, reflecting the need for detailed evaluation. Medical trainees have little formal education about how they will be remunerated as specialists or that there are different methods of clinical payments between provinces of Canada, including Fee for Service (FFS) and Alternative Payment Plans (APP). GIM is a reasonable comparator to Geriatric Medicine because, while not using CGA, GIM residents are also trained to assess medically complex patients who often have comorbidities. The goal of this paper was to provide transparency for medical trainees about differences in the proportion of FFS or APP and the average clinical payments made to geriatricians and general internists between the provinces of Canada. Using data from the Canadian Institute for Health Information (CIHI), we show mean, mean trimmed to $100,000 and median clinical payments to geriatricians across Canada. Average payments were generally lower in provinces with predominantly an APP as the main source of payments compared to provinces with a split model of APP and FFS where payments demonstrated larger variances. The clinical payments to general internists were higher than for geriatricians. In addition to increasing transparency in specialist payments, Provincial Medical Associations and Sections or Divisions of Geriatric Medicine, could use these data to advocate for comparable remuneration between geriatricians and general internists when renegotiating clinical payments funding agreements.