Sixteen Manitoba doctors billed the province more than $1 million for their services last year as public demand to treat everything from skin problems to vision issues continued to rise.
The numbers show what's needed to pay such specialists so they don't leave the province.
The top three billers were Winnipeg gastroenterologist Dr. Allan Micflikier, Brandon general surgeon Dr. Sonny Dhalla and dermatologist Dr. Shane Silver. The amounts were included in Manitoba Health's 2011-12 annual report.
"It's the same for any specialty or any doctor," Silver said Friday. "We have an aging population. There's more demand on the health-care system. As we get older, unfortunately, more people have more ailments and will require more physician visits."
Silver said his practice is so busy he's scheduling new patients for a first visit in May.
A decade ago, Micflikier was the only Manitoba physician to exceed $1 million in fees a year. Since then, the number of physicians making more than $500,000 has nearly quadrupled, with 124 doctors billing the province for a half million or more last year.
Included in the list are eight ophthalmologists in Winnipeg and Brandon who specialize in retina and cataract surgery. The number of ophthalmologists as top billers has increased over the past decade as eye problems such as glaucoma and macular degeneration have become more treatable.
Dr. Lorne Bellan, head of ophthalmology at the University of Manitoba, said one reason so many eye specialists have cracked the $1-million mark in billing is because there are so few of them in a province.
He said Manitoba has the second-worst ratio of ophthalmologists to population in Canada after Newfoundland.
"That means everybody who is here is super, super busy. Even with doing lots (of surgeries), the wait lists are still not being brought under control."
Ophthalmologists have high overhead costs compared to other physicians because of the expensive equipment they require to practise, he added.
Experts say there will be a 100 per cent increase in all eye conditions over the next 15 to 20 years as the number of people 65 and older increases.
The U of M, the Buhler Eye Centre of Excellence at Misericordia Health Centre and the Winnipeg Regional Health Authority said in February more eye specialists are to be trained to meet that demand.
A provincial spokeswoman said under fee-for-service not all the payments go directly to the doctors. Some cover overhead costs, including clinic space and staff salaries, and pay for equipment such as needles and gloves. Expense amounts vary depending on the type of medical facility.
The province also said the fee-for-service payments to all doctors are a reflection of an aging population needing greater medical care.
"Additionally, some doctors perform procedures that have extraordinary supplies and other costs, which the province has agreed to supplement through fees," the spokeswoman said.
"Fees are regularly reviewed and determined in relation to the fees in neighbouring provinces both to ensure we are competitive and attract more doctors to Manitoba, but also to ensure we are paying fair and reasonable compensation for services."
The Canadian Institute for Health Information said in a report last year Manitoba is in the middle of the pack in terms of physician salaries in Canada.
Manitoba doctors received an average $298,119 gross fee-for-service payment in 2010. That's about $9,000 more than doctors in Ontario and $12,000 less than doctors in Saskatchewan.
Alberta had an average pay of $377,368 per physician. Quebec's average was lowest at $250,000 a year.
It cost the province almost $1 billion ($972,807,000) to pay for its doctors in 2011-12. That includes lab tests, dental surgery and chiropractic and optometric services.
That cost is up only one per cent from the year before, but 28 per cent from 2007-08 when medical expenditures were about $759 million.
Dr. Malcolm Doupe, a researcher with the Manitoba Centre for Health Policy, said trends in health-care treatment show there is more testing done now -- from blood work to CT scans -- than was done in the past, adding to the cost of health-care delivery.
"A little bit of it is the intensity and volume of treatment for a given disease now versus in the past," Doupe said. "It's not just as simple as a growing number of older adults.
"Our health-care costs have doubled in the last few years. I don't know how much our population has grown, but it certainly hasn't doubled."
Manitoba's medical expenditures were up only one per cent last year primarily due to the Selinger government's renewed master agreement with Doctors Manitoba, which represents the province's fee-for-service physicians.
Manitoba doctors who billed more than $1 million to the province for their services last year:
DOCTORAMOUNT BILLED 2010-11 AMOUNT BILLED 2009-10
Dr. Allan Micflikier (gastroenterologist) $1,904,053 ($1,912,886)
Dr. Sonny Dhalla (general surgeon) $1,528,118 ($1,369,082)
Dr. Shane Silver (dermatologist)$1,516,642 ($1,501,229)
Dr. Victoria Taraska (dermatologist) $1,354,386 ($1,177,106)
Dr. G. A. M. Gdih (ophthalmologist) $1,278,017 ($431,420)
Dr. Richard Leicht (ophthalmologist) $1,272,129 ($1,182,470)
Dr. Frank Stockl (ophthalmologist) $1,216,715 ($1,125,782)
Dr. R. Dookeran (ophthalmologist) $1,201,979 ($1,066,289
Dr. Adrian Long (ophthalmologist) $1,195,061 ($1,336,770)
Dr. Daniel Chin (ophthalmologist) $1,163,258 ($1,070,704)
Dr. Guillermo Rocha (ophthalmologist) $1,158,148 ($1,048,315)
Dr. Edward Buchel (plastic surgeon) $1,130,843 ($850,213)
Dr. Robert Beldavs (ophthalmologist) $1,134,679 ($1,174,559
Dr. Richard Hayday (dermatologist) $1,076,460 ($1,004,912)
Dr. John Rabson (cardiologist) $1,074,162 ($1,086,091)
Dr. Loris Cristante (neurosurgeon) $1,045,972 ($853,609)
Fee-for-service is a method of payment where physicians bill for each service rendered, according to a pre-arranged schedule of fees and services. Physicians who are paid on a fee-for-service basis file a claim for each service performed and are responsible for their operating costs.
Not all doctors bill fee-for-service. Doctors, such as emergency-room physicians, are paid on an annual or sessional salary.
The amounts only record gross payments made by Manitoba Health to the practitioner. They do not reflect earnings. A physician's net income may vary from the gross payments shown as costs of operating a practice must be paid from these gross payments.
-- source: Manitoba Health annual report 2011-12