College budgets continue to balloon

The budgets for Canada’s medical regulatory colleges continue to grow at an astonishing rate, a Medical Post investigation has revealed. In 2011 the combined budgets of the provincial colleges of physicians and surgeons were $134.1 million but the most recent numbers (mostly 2023) show expenditures of $227.2 million. That’s a 69.4% hike when inflation was 31% between 2011 and 2023 according to the Bank of Canada.But the expanding budgets raise an important question: Are these quasi-judicial bodies guiding Canada’s medical profession—without much independent oversight—operating efficiently, or are they spiraling out of control?New Brunswick’s rose a whopping 600% since 2011 while Alberta’s went up 141% and Manitoba’s up 140%. For the other colleges the budget increases were all above but more in line with inflation.Asked to explain how expenditures went from $1 million annually in 2011 to $7 million, Dr. Laurie Potter, registrar and CEO of the College of Physicians and Surgeons of New Brunswick, wrote in an email that each college is unique but N.B. has three trends impacting its budget. “The first trend is a substantial increase in the number and complexity of complaints or concerns received by the college. . . . The second trend is an increase in the number of physicians. . . . The last significant trend is the increase in the number of pathways to licensure. As the population ages and grows, Canada has found itself in a position where we have not trained enough physicians to meet our needs. As a result, the college has been asked to expand our pathways to licensure so internationally trained physicians can be assessed and safely licensed more expeditiously,” she wrote.Cost controlStill, despite rising budgets, the colleges highlighted their efforts to control costs to working doctors: A rep for Alberta’s college noted the practice permit annual renewal fee was $2,200 in 2024 but has been cut to $2,000 for 2025. Ontario’s college noted that since 2018 the annual membership fee for all classes of physician registration (except post-graduate education) has remained unchanged at $1,725. The rep also pointed out that though Ontario has 49,435 licensed doctors, some aren’t practising.College statsThe colleges of physicians and surgeons fall into two groups (the large provinces—Ontario, Quebec, B.C. and Alberta—with lower annual fees; and the six smaller provinces with larger annual fees). The two groups are not easily comparable. Below are current, 2024 or 2023 numbers depending on most recent availableProvinceNumber of doctors licensedAnnual feeNewly licensed full practice doctors per year*Annual expenditures# of full-time staff# part-time staffOntario49,435$1,7252,252$85.7 M35810Quebec26,396$1,930959$51.7 M1730British Columbia15,993$1,900976$41.0 M2018Alberta11,738$2,000806$40.9 M14214 Nova Scotia3,534$2,300143$7.8 M483Manitoba3,334$2,220227$10.1 M4216Saskatchewan2,962$2,170408$9.1 M394New Brunswick2,600$2,300176$7 M21.7 FTE**--Newfoundland and Labrador1,762$2,300132$3.9 M15 FTE**--Prince Edward Island943$2,300103n/a40* This number refers to a recent year or average of the last four or five years.** Full-time equivalentSource: Annual reports, college-provided responses Understanding budget rises at colleges The Medical Post regularly checks on the status of the colleges of physicians and surgeons. Our last examination compared 2011 to 2004 metrics and budgets for the colleges. (A rep for P.E.I. declined to give expenditures and that college’s annual report is not publicly available—even though the Medical Post was able to obtain its budget in 2011: $0.5 million.)Here’s a summary of the reasons various colleges of physicians and surgeons across Canada give for their expanding budgets:1. Growing complexity of workRegulatory work is becoming more complex and demanding, and cost comparisons based only on inflation don’t reflect this.Colleges must respond to evolving healthcare challenges, legislation and public expectations.2. More physicians and pathways to licensureThe number of registrants (physicians) is rising, increasing the costs of:Registration and annual renewalsQuality assurance and practice reviewsComplaint investigations and disciplineColleges are expanding licensure pathways, particularly for international medical graduates (IMGs), requiring new programs and assessments (e.g., PRA-NB in New Brunswick, accelerated pathway in Alberta).3. Surge in complaintsSeveral provinces (e.g., Alberta and New Brunswick) report a dramatic rise in the number and complexity of complaints—up 600% in N.B.—which drives up costs related to investigations, hearings and resolutions.4. Modernization and digital transformationColleges (e.g., Ontario and New Brunswick) are undergoing digital modernization, replacing paper-based processes with online portals, improving cybersecurity and investing in data systems and analytics.5. Expanded regulatory scopeSome colleges, like Manitoba, also regulate physician assistants and clinical assistants, adding to their mandate and costs.Alberta runs a facility accreditation program and a Prescription Monitoring Program (TPP).6. Public and government expectationsColleges are responding to new mandates from government and heightened public expectations for transparency, safety, and accountability.They must demonstrate evidence-based decision-making and engage in partnerships to address access to care and system-wide risks.In short, increasing physician numbers, regulatory complexity, public expectations, complaints, and modernization efforts are all key cost drivers for Canada’s medical regulatory colleges.Details from the collegesRepresentatives from the colleges noted the workload grows more complex and demanding each year so just comparing to inflation misses things. Here are some detailed responses:MANITOBA“Each jurisdiction is different and it is complex to make comparative or generalized observations from all provinces. Each jurisdiction falls under different provincially legislated frameworks, which creates unique challenges but also allows for unique solutions.“In Manitoba, there are several drivers to cost:An increasing number of registrants impacts the cost of, and resources required for registration and annual renewal processes. Physician shortages affect all jurisdictions, and we must remain competitive by expanding pathways to licensure in a manner that does not compromise patient safety. This means programs, processes, and policies are regularly evaluated.As the number of registrants increases, so do the associated costs for Quality Assurance and Quality Improvement, which are crucial for achieving our mandate to protect the public.IT, data analytics, and cybersecurity costs have increased over time as we address current issues and plan for mitigating potential cyber risks.“Manitoba also regulates physician assistants and clinical assistants, which are recent additions in other jurisdictions.”ALBERTA “Self-regulation ensures that medical standards—and the decisions that uphold them—are guided by medical expertise and evidence, not external influences. While self-regulation has existed for centuries, regulatory bodies like CPSA must continuously adapt to new legislation, evolving healthcare challenges and the growing complexity of patient care to ensure Albertans receive safe, high-quality care. In addition to regulated member growth, Alberta has experienced a significant increase in the number and complexity of complaints over the last decade. For example, in 2011, CPSA expenditures on complaints and discipline was $2.93 million. In 2023, expenditures on complaints and discipline were $7.36 million. Over the last several years, CPSA has been working on improving and streamlining our complaints process to ensure complaints are resolved in a timely and efficient matter, recognizing the stress they place on both the complainant and the regulated member.“Another significant change has been the increased need to support access to care. CPSA has been focused on creating new pathways for international medical graduates that provide expedited processes while ensuring safeguards are still in place to protect patients. CPSA has traditionally administered the highest number of Practice Readiness Assessments across the country and launched an accelerated pathway in 2023 to further support these efforts. We recognize that patients are the ultimate benefactors of having access to care, but these efforts also support physicians and physician assistants who are currently being stretched thin across the system.“CPSA also operates a facility accreditation program that has been in operation since 1968. While included in our expenditures, fees for this program are collected outside of the regulated member annual fee. In addition, we are the only regulatory body in Canada to have an in-house Analytics, Innovation and Research team, focused on evaluating existing programs through a lens of evidence-based medical regulation. Some of the outcomes of this department include individualized prescribing reports with additional resources to support regulated member prescribing practices and potential quality improvement initiatives. The department also contributes to health and regulatory-focused research, and administers the Triplicate Prescription Program (TPP) Alberta—a partnership between several Alberta healthcare organizations that monitors the use of prescription drugs prone to misuse and uses the data to educate and improve patient care.“While I’ve only touched on a few of the initiatives that fall under our expenditures, you can read more about the work we’re doing under our 2022-2026 strategic plan and our annual reports, which can be found here.”N.B.“While each College’s situation is unique, we’d like to provide some additional information on the College of Physicians and Surgeons of New Brunswick’s expenses in recent years.“In general, there are three major trends impacting the college’s budget, and every one of those trends is tied to something that the public wants from us as a medical regulator, and that government has asked us to deliver. “The first trend is a substantial increase in the number and complexity of complaints or concerns received by the college. Our complaint volume has increased by 600% in recent years. This is likely influenced by the increasing demand and strain on the healthcare system. The role of the college is to protect the public, so significant resources are spent on investigating, resolving, and, sometimes, discipling registrants because of these complaints.“The second trend is an increase in the number of physicians. The job of the college is to regulate physicians, and so costs go up as the number of physicians go up to cover things like quality assurance programs and practice reviews.“The last significant trend is the increase in the number of pathways to licensure. As the population ages and grows, Canada has found itself in a position where we have not trained enough physicians to meet our needs. As a result, the college has been asked to expand our pathways to licensure so internationally trained physicians can be assessed and safely licensed more expeditiously. While the level of competence required of physicians has not changed, the number of ways to demonstrate that competence has increased, and we have introduced new programs, processes and policies to make this happen. This includes the Practice Ready Assessment New Brunswick (PRA-NB) program, as well as licensing for other types of medical professionals like clinical assistants. Our annual budget includes the costs of administering these new programs. “In addition, the college has prioritized modernization of our processes and registrant database. In recent years, we have implemented an online physician portal to replace previous paper-based practices and support all college functions. We have also added services to enhance the college’s cybersecurity, updated our website, and added essential support staff. We are committed to innovation in a complex and evolving medical regulation landscape, and are proud to continue to serve physicians and the public.”ONTARIO “We appreciate your interest in understanding the financial aspects of our work and welcome the opportunity to provide some clarity. There are important nuances specific to each medical regulator across the country, and we wanted to provide some context that reflects the unique considerations in Ontario. “Mandate and resource allocation: While we cannot speak to the unique circumstances of any other Canadian medical regulator, growth in CPSO’s expenditures over the period from 2011 to 2024 has been in line with inflation. . . . “In addition, from 2011 to 2024 the total number of registered physicians increased by 2.1% on average, from 37,684 physicians in 2011 to 49,435 in 2024. “All of this, while the college's membership renewal fee for independent practice certificates has remained unchanged since 2018—the lowest of all provincial medical regulators—with the average membership renewal fee increase also below the average inflation value in the years prior. “Commitment to financial responsibility: With that said, while inflation affects CPSO's expenditures it is just one of many factors. A comprehensive analysis considers factors like increased regulatory requirements; new priorities; rising physician registration numbers; increased pathways to licensure; modernization efforts; and initiatives addressing organizational risk, public safety, partnerships or government direction. “The college has always been—and continues to be—committed to responsibly managing our financial resources, and continues to seek efficiency in many ways, including embarking on a process to become a fully digital regulator, making continuous process changes and reducing resources to address non-urgent matters. “As part of several modernization initiatives at CPSO, the college has invested in technology to transition to electronic regulatory processes, including the introduction of a fully online, real-time application system for annual renewals and a self-service portal for membership requests. We have also moved our IT systems to the cloud, which has enabled us to integrate internal data systems, go paperless, and enhance the security of our information and processes, protecting against cybersecurity risks. All of this has allowed us to improve the overall efficiency of our regulatory processes, significantly reducing the time it takes to register physicians, resolve complaints, and more.”

College budgets continue to balloon

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