Published doctor billings must be put in context
Every day, 300,000 patients are cared for by Ontario’s 31,500 doctors. That includes everything from newborn care to surgeries to palliative care to everything in between. Patient care is why we all chose medicine.
Last Thursday, the Supreme Court of Canada declined to hear the OMA’s appeal regarding the disclosure of the highest billing physicians by name. Contrary to what was alleged in a recent Star editorial, the OMA respects the decision of the court.
The OMA’s position from the outset was to strike the right balance between transparency, accountability, and a measure of privacy for individual doctors. Disclosure will have unintended consequences. This is especially true in the case of physicians in smaller and rural communities, who have much higher visibility.
Many of us are concerned that any context of how physician billings actually work would be lost against headlines that focus on only a handful of physicians at the top of the list. That context is important to understanding how physicians bill OHIP, and what those billings pay for.
Under our health care system, doctors are independent contractors who own their own practices and operate as small businesses. Physician services depend entirely on patient need, and that varies from community to community, specialty to specialty, and physician to physician. Doctors bill for patients they see, tests they interpret and procedures they perform. Each billing submitted means one more patient treated and one less patient waiting. Ontario’s doctors work hard to care for more patients, not less.
However, the amount a physician bills is not the same as a salary. Billings are gross revenue, out of which physicians must pay staff salaries, office space, electronic health records, and medical equipment and supplies — health care infrastructure that is necessary to do our jobs well. On average, these expenses account for 30 per cent of the amount billed, but can be as high as 50 per cent. Many high-demand physicians also hire physician assistants, nurses, nurse practitioners, technicians and medical assistants. This team approach allows physicians to see many times more patients in a day than they could on their own.
Now that disclosure is coming, the question remains: If physician billings are to be published, how should this best be done?
The OMA would suggest that simply adding physicians to the annual Sunshine List would miss the mark. The Sunshine List discloses salaries for government employees, and 1) physicians aren’t government employees with benefits and pensions, and 2) physician billings are not the same as physician salaries.
With the Supreme Court decision just announced, the OMA and the ministry are in early days of discussing how the government might disclose physician billings in a way that makes sense. From our perspective, this means adding billing context as part of the disclosure. The OMA has also suggested that disclosure be done through enabling legislation as seen in other provinces.
At the end of the day, our patients expect thoughtful, measured conversation from their physicians. So that’s what we’ll provide.
Dr. Nadia Alam is the president of the Ontario Medical Association.