2 Tiers, 2 Careers: Should You Work In Public Or Private Health Care?


In January 2010, there were 69, 267 physicians in Canada.

You can always add yourself to that number, but before you do, consider whether a career as a dentist, a cosmetic surgeon or an optometrist might not interest you more.

While going into medicine for purely altruistic reasons is admirable, considering what kind of environment you want to work in is important  when taking your future sanity and finances into account.

While going into medicine for purely altruistic reasons is admirable, considering what kind of environment you want to work in is important when taking your future sanity and finances into account.

Canada’s health care system is split into two, rather distinct spheres: public and private, and planning for a career in one can mean closing yourself off from the other.

The Canada Health Act allows and funds necessary (“primary”) care: the services you would receive in a hospital or attending your family doctor for health concerns.

While Canada’s health care system is known as “universal,” it is actually a 70/30 split: 70% public sector-funded and 30% paid for by private insurance or out-of-pocket.

Major “out-of-pocket” expenses include dental care, prescribed drugs, nursing homes and other institutions , and vision care. Pharmaceuticals and dental care account for 67% of all out-of-pocket health care spending for Canadians, which means they account for a lot of money to be made.

Here, a few professions are clarified, their salaries exposed, and their work conditions, forecasts and options enumerated.

Questions to think about

  • What are the main benefits and drawbacks of private and public places of work?
  • Do privately-paid doctors earn more than publicly-funded ones? Do dentists, optometrists and pharmacists earn more than diagnosticians, family doctors and nurses?
  • Do public or private environments impact your working conditions? Is there room to excel? Is it hospitable to newcomers?
  • Which sector needs more workers?

Private healthcare

“Uninsured” fields pay practitioners on a case-by-case basis. You go for a teeth cleaning? You get charged. You go to get your eyes checked because you’re going blind from studying? You get charged, but only because they are not considered as primary services – things you would pay extra for, like bacon, or high-quality nail polish.

“In Ontario, most regulated health care practitioners (e.g., physicians, pharmacists, optometrists, and dentists) are required, when providing health care products to a patient, to charge the patient the costs incurred for the material plus a fee,” explains the College of Optometrists of Ontario‘s website.

Education plays a critical role affecting future income in private health care: the more you know, and the more specialized your knowledge, the more you earn.

“I didn’t want to work in a hospital setting.  I worked in a hospital as a clerical associate and saw how nurses are underpaid and overworked.” —Antoinette Torchia, dental hygienist

Antoinette Torchia, currently a hygienist at a Markham dentist’s office but with 10-years of experience in clerical work at a hospital, says that when she went back to college for this two-year diploma, she knew it was private health care she wanted to work in.

“I didn’t want to work in a hospital setting.  I worked in a hospital as a clerical associate and saw how nurses are underpaid and overworked,” she says. “The nurses were making more bartending than nursing.  And their high rate of pay is my starting rate.”

Dentists, optometrists or others with a “private practice” are well paid because they have to make professional judgment calls about the services they provide as well as providing specialized, “non-critical” and personalized services.  Also, there’s no “cap” to how much they can make because it’s not based on government funds but on services provided.

As for working environments, Torchia says, “Family practice is best for private medicine; better than corporation, because it’s more like a family than a business.”

  • Pharmacist: Starting salary of at least $73,000 with a possibility of earning $103,000 per year
  • Optometrist: Starting salary of $61,000 with a possibility of earning $102,000 per year
  • Dentist: Starting salary of $78,000 with a possibility of earning $110,000 per year.
    *Specializing in cosmetic dentistry bumps salary to a possible $170,000 per year while orthopedic surgery bumps salary from $86,000 at the entry-level to a whopping $250,000 per year at the height of one’s career.

Public healthcare

graduating nurses 300x225 2 Tiers, 2 Careers: Should You Work In Public Or Private Health Care?But if public practitioners are the ones that take on the responsibility of assessing, diagnosing and treating patient conditions, shouldn’t they be paid more?

Family physicians usually work under the fee-for-service system, where they bill the provincial or territorial health insurance plan (such as OHIP) for each insured patient service they provide.

While more registered nurses (RNs) are entering the profession with bachelor of science in nursing degrees, there is a shortage of RNs with nursing education at the masters, doctoral, and post-doctoral levels, and an increasing demand for new, young nurse practitioners.

Often, they blend both fee-for-service and an alternative method like salary, hourly, or contracts, which give family physicians a gross average income of $244,581 in 2005-2006.

But your pay can also depend on where you live and whether you’re a family doctor or a specialist, with the highest pay going to specialists in Alberta and the lowest to family doctors in Prince Edward Island.

However, while physicians are the third-largest expense in health spending, coming after hospitals and drugs at 15% of the $130 billion Canada spent on healthcare in 2004, the proportion of health care dollars going to physician services has decreased over the years, meaning less jobs available for newcomers in the profession.

Nurses are among the most required health practitioners in the public medical field (“And the lowest paid,” mumbles Torchia), which Health Canada reaffirms when it states that retirement projections along with general problems filling nursing positions creates a need for 3,673 masters-prepared nurses annually.

While more registered nurses (RNs) are entering the profession with BScN (bachelor of science in nursing) degrees, there is a continuing shortage of RNs with nursing education at the masters, doctoral, and post-doctoral levels. There is a constant and increasing demand for new, young nurse practitioners.

Also, new fields are being developed in the primary care industry, one of which is a cross between physicians and nurses, called physician assistants.  The position has been integrated into the practices of many doctors, and although PAs need to be supervised, these two-year program graduates are filling the need for more “hands on deck” at clinics and hospitals.

“All of our graduates now have jobs: eight are working in emergency departments, four in family medicine, five in medicine, two in surgery and one in ICU,” says John Cunnington, assistant dean of the physician assistant program at McMaster University, about the graduates from the first PA program in Canada.

The introduction of PAs is designed to help reduce wait times and ensure that care is provided effectively and efficiently. “For example, in an emergency department, a PA working with a medical practitioner will allow people to be assessed, managed and discharged more quickly,” says Cunnington.

  • Family physician: Starting salary of $80,000 with the possibility of earning $148,000 per year.
    *Specializing in oncology bumps “high” salary expectations to a possible $183,000 per year while cardiologists can earn $98,000 at the start to a whopping $198,000 at the height of their careers.
  • Registered nurse: Starting salary of $52,000 with the possibility of earning $74,000 per year.
    *Specializing or working in the emergency room as an RN increases the forecasted high to a possible $83,000.
  • Physician assistant: Starting salary of $38,000 with the possibility of earning $83,000 per year.

Overview

Cunnington says that, “in 40 years [the demand] in the United States for this profession [physician assistant] has gone from six to 70,000. We will see a similar (proportional) development in our country.”

But most public sector medical positions need filling in higher proportions than they are currently – meaning more jobs for more highly-educated graduates.

Torchia adds that working in the public sector is more stable because “you have a retirement plan, you have benefits.  There’s a union to back you up.  That’s what’s missing from private. No structure, no union, nothing to protect you, although you do have more flexibility and choice regarding where you work.”

However, being a private-sector employee can have its perks as well, such as the possibility of asking for raises that depend on your employer’s revenue rather than patchwork government funding.

All in all, achieving the right balance is up to you.

If public service strikes you as more endearing, remember that it’s possible to earn big bucks there too, if that’s what’s important to you. Some nurses go into “agency nursing,” for example, which pays twice as much and is much more flexible.

But if private is your poison, remember that it’s possible to put a little family into your profiteering as well.

focus on healthcare incubator banner 2 Tiers, 2 Careers: Should You Work In Public Or Private Health Care?

Photo credits:
Canada’s the Best by Andrew Aliferis on Flickr
Fun Shot by Amy the Nurse on Flickr