The president of the organization that represents Ontario’s doctors says the group supports transparency for all OHIP billings, following the launch of a Toronto Star series revealing the names and totals of the province’s top billers.
“We’re all taxpayers as well, and it’s important for us actually, frankly, to ensure that tax money is well spent,” Dr. Sohail Gandhi, the new president of the Ontario Medical Association (OMA), told the Star.
This is a departure for the organization, which, under previous leadership, tried to keep billings secret. The OMA fought a lengthy and ultimately unsuccessful legal battle to block the province from releasing data on top billers that the Star had asked for in a 2014 Freedom-of-Information request. The OMA had long argued that physician billings are private and personal information.
Seven years of ministry data obtained by the Star identifies 194 doctors out of the 31,500 across the province whose annual billings to the Ontario Health Insurance Plan — from a high of around $6.9 million to a low of $1.4 million — placed them in the Top 100 at least once between 2011 and 2018.
Gandhi says the OMA’s concern has always been that such a small percentage of top billers don’t tell the whole story.
“That list represents 0.3 per cent of physicians and doesn’t really contribute meaningfully to discussions around transparency of billing,” he says.
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He proposes this be accomplished through an act of legislature, which he said has worked well in some other provinces to provide context. This is not required for billings to be released in Ontario, according to a ministry spokesperson.
Following the Supreme Court’s April decision not to hear a final appeal from doctors trying to block the release of the top billing information to the Star, the Ministry of Health has been working with the OMA to determine how to make this information publicly available going forward, according to a spokesperson.
But no decisions have been made.
Most Ontario doctors — including the ones published in the Star’s list of top billers — get at least some of their compensation under a fee-for-service model, one of three ways they can be paid from OHIP.
Under this model, doctors bill OHIP for each service they provide using a unique fee code. This is on the honour system.
The billings are not the doctors’ take-home pay and do not take into account the often hefty overhead expenses they pay for equipment, staff salaries and rent.
Ontario Information and Privacy Commissioner Brian Beamish says making information on government spending available to the public is “a good thing” and will help the health-care system set priorities.
It was Beamish’s office, in 2016, that ordered the Ministry of Health to release the billing information, which the doctors later challenged in court.
“That kind of transparency can help lead to a debate about how government is spending money and help hold government accountable,” he told the Star Friday.
Physician compensation costs Ontario about $12 billion annually, and amounts to about 8 per cent of the entire provincial budget.
A 2018 article in Healthcare Papers found Canadian doctors are among the more highly compensated among comparable countries, including Belgium, Germany and France. As well, the growth in compensation, especially for specialists, is among the highest. But Gandhi notes in Canada there are more patients per doctor.
Dr. Javeed Sukhera, president of the Ontario Psychiatric Association, also “firmly” supports transparency around billings. “Where the challenge becomes is when we conflate this idea of high billing as somehow dubious or nefarious,” he says.
It’s important to “have a deeper conversation about the issue of equity,” in the health-care system, he says, both between physicians, and other groups of professionals, such as nurses.
Dr. Lesley Barron, a general surgeon based in Georgetown and the federal Liberal candidate for 2019 in Wellington-Halton Hills, supports the province making billings publicly available.
This could be a mechanism, she says, for addressing both the gender pay gap and the issue of relativity — big pay gaps in medicine between specialties such as ophthalmologists, cardiologists and radiologists, and lower paid ones such as psychiatrists and family doctors.
“I would think women would hopefully rise up and get a little bit angrier than we have,” Barron says.
Thirty-nine per cent of physicians in Ontario are women, according to the most recent figures from the Canadian Institute for Health Information (CIHI), an independent research organization. But only nine of the 194 overall top billers are women — less than 5 per cent. Nearly half of the 194 are ophthalmologists or radiologists.
The OMA sent out talking points to members around the release of the Star’s stories, asking members not to “amplify the stories on social media” by sharing them. “It’s also unhelpful to make targeted comments about various specialties and people — this is something the media will magnify and does not reflect well on us as professionals,” the email read.
Barron calls this a “stick in the eye to psychiatrists, neurologists, to family doctors that are out there working hard.” She’s also unhappy with the OMA for not taking a stronger stand on both the gender gap and pay disparities between groups of doctors.
“What we’ve done is create these male-dominated specialties like radiology and cardiology, that are extremely well paid,” she adds.
“They say, ‘well I’ve trained for 10 years’, well I trained for 10 years too.”
Gandhi responded that there is already a working group to address the issue of relativity, and one on the gender gap. But, he believes, the sample size of the ministry data the Star obtained is too small to draw useful conclusions.
One of an ongoing series of stories.
May Warren is a breaking news reporter based in Toronto. Follow her on Twitter: @maywarren11
Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle