Why do ophthalmologists make so much money in BC?
Doctors and physicians are some of the highest-paid professions in the Lower Mainland. This makes sense as those who work in hospitals and clinics are in high-stress situations where one wrong move or hesitation can result in life or death for their patients. As such, many medical specialists are in school for years at a time, honing their skills and perfecting their field. For this, they are handsomely rewarded financially and frankly, ought to be.
So, with all this in mind, what would be the highest-paid medical specialty in BC? Perhaps some think it would be a general surgeon? Maybe a family doctor? Emergency doctor? Could it be a narrower field, like a neurosurgeon? But the answer is a surprise to many.
Ophthalmologists are the highest earners in BC, analysis finds
Analyzing the top 200 highest-earning medical BC practitioners using the provincially government-released BC Medical Services Plan Blue Book, which details billings made under the BC MSP to medical institutions and practitioners, found that of the top ten highest-earning practitioners for the 2023/2024 fiscal year, nine of the ten were in the field of ophthalmology.
The top ten medical practitioners in BC by MSP earnings.
Looking at the total sample of 200, over 40 percent were in ophthalmology alone, while the remaining other fields, internal medicine, surgical specialties, primary care, and others made up the rest. These groups included cardiologists, general surgeons, otolaryngologists, and family doctors, among many other fields.
In terms of total earnings, ophthalmologists easily earn more than every other field, both in earnings from 2023/2024 and total cumulative earnings from 2019 to 2024.
Combined earnings of every practitioner in their respective fields. Notice the disparity between ophthalmology and every other field.
However, it is important to note that this is not the net income but gross earnings. Many practitioners have overhead costs to pay for office space, staff, necessary equipment, and other miscellaneous costs associated with running a medical office. It also does not include income from other sources, like teaching or contracts from hospitals. These are just billings to each practitioner made under the BC Medical Services Plan.
BC is also not the only province to have this problem. In 2016, a report by Global News found that in Ontario, among the medical practitioners billing over a million dollars, 154 were diagnostic radiologists, 85 were ophthalmologists, and 57 were cardiologists. The top five billers were two ophthalmologists, two radiologists, and one anaesthesiologist, with one ophthalmologist billing $6.6 million.
Billing code at fault
So, why are ophthalmologists making the most money? Well, the billing code.
Let’s take a look at one of the most common medical procedures an ophthalmologist can do, cataract surgery. Cataract surgery is a procedure that makes one’s eyesight clearer by replacing a faulty eye lens with a new, clear one. This procedure falls under two billing codes, S02188 and S02190. Together, under the current billing guidance, an ophthalmologist can charge the province $372.20. It can be done by a skilled ophthalmologist in about 10 to 15 minutes.
By contrast, for a cardiac surgeon, a common procedure is the implantation of an endocardial pacemaker. A cardiac surgeon can bill $426.30 for this procedure, more than cataract surgery. But the total procedure can take one to two hours, limiting the number of times a cardiac surgeon can bill in a day.
The bottom line is that ophthalmologists can do procedures quicker than most other physicians and surgeons, and get paid more due to the billing code.
Now, let’s cost this out. Say an ophthalmologist only did one eye cataract surgery for a whole year, and they could complete it in say 20 minutes, so about three patients an hour. Using this rate, assuming they worked seven and a half hours a day, taking 30 minutes for lunch, worked five days a week, and took four weeks' vacation, they would earn around $2 million a year in gross MSP billings.
Estimated earnings for an ophthalmologist if they just did cataract surgery for one eye for an entire year.
That is really close to the average we got when we calculated the top 89 Ophthalmologists' average MSP earnings, which was $1.97 million.
Even if 40 percent of that went to overhead and then the remaining half went to taxes, they would still take home several hundred thousand a year.
Now, while it is readily apparent that ophthalmologists are punching above their weight in earnings, it was not designed to be this way. Ophthalmologic procedures like cataract surgery used to take a lot longer in time, and so did the recovery for patients. In the 1980s, the average ophthalmologist could see only three to five patients a day. But due to medical advances in their field, both in treatment and equipment, ophthalmologists can now see upwards of 20 patients a day, and the billing code just has not caught up.
Change is perhaps in order
Fundamentally, this is not a criticism of ophthalmology as a whole. Having great eyesight is key to living life to the fullest, and many of these ophthalmologists have families and other people in their lives to take care of.
However, it is a question for the province as to whether ophthalmologists should be earning more than other medical professionals, especially when the province is trying so hard to recruit more care providers. Perhaps a rebalancing is in order.
