After years and lord-knows-how-much in legal fees fighting ridiculous lawsuits trying to keep secret the amount of public dollars paid to individual physicians, it looks like the Ontario Medical Association has finally come to its senses and acknowledged the obvious: Transparency is in the public interest.
“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 told the Toronto Star.
He even proposed that Ontario adopt a law that makes the billings of all 31,500 physicians in the province public, following the lead of British Columbia, Manitoba and New Brunswick.
The OMA’s road to Damascus moment seems to have come only after the Toronto Star published a series of articles on the province’s top-billing physicians. Through the Access to Information law, the paper obtained the billing information of 194 doctors who were among the top-100 billers from 2011 to 2018.
Despite dire predictions that making this kind of information public would be inherently biased and unfair, and lead to shaming of doctors, there was no outcry and, frankly, few surprises.
The OMA’s position that the public was too stupid to know the difference between billings (gross revenues) and income (net revenues) never held any water.
Still, the Star’s reporters, Theresa Boyle and May Warren, did a masterful job of presenting the data in a fair, nuanced manner.
What easily could have been “gotcha” journalism turned out to be a thoughtful exploration of why some physicians are paid so much money, and more of a reflection on the inherent flaws of the predominant fee-for-service payment model than the singling out of individuals.
We have known for years that there was a doctor who billed the province more than $6-million a year on average. Now we know his name, Narendra Armogan, and that he is an ophthalmologist who runs OCC Eyecare in Mississauga. Because the information is public, journalists were able to report that he employs 70 staff and rents more than 50,000 square feet of office space – in other words, the operation has massive overhead.
We still don’t know Dr. Armogan’s take-home pay, but that doesn’t matter. Transparency in billings is about knowing that public monies are being spent delivering care to the public. Nobody begrudges doctors making a good living.
Publicly released data, however, can expose those who deserve scrutiny. Stefan Konasiewicz, a neurosurgeon who is No. 2 on the list with billings of $4.6-million for the 2017-18 fiscal year, has been sued for malpractice at least a dozen times, and has faced disciplinary action in three U.S. states.
Similarly, Kulbir Singh Billing, an anesthesiologist who ranked eighth on the list with billings of $3.5-million for 2017-18, has resigned his licence after being investigated for overbilling for pain treatments known as nerve blocks, and has previously been charged with fraud.
Alexander Hartman, a diagnostic radiologist who is No. 5 on the list with $4-million in billings, saw an eye-popping average of 265 patients a day and billed for 364 days over the 2017-18 fiscal year.
High billings do not imply something nefarious is afoot. The data can remind us that doctors are hard-working, sometimes to a fault.
Rajeev Muni, an ophthalmologist at St. Michael’s Hospital and the Hospital for Sick Children, is one example. Dr. Muni, 10th on the list at $3-million in billings, is one of the only doctors who can treat retinal emergencies so he is essentially on-call 24/7, year-round, and worked 335 days over the 2017-18 fiscal year.
The billings data, obtained by the Star after a legal battle that went all the way to the Supreme Court of Canada, highlights, more than anything, that in the province’s $12.1-billion physician services budget, there is an inherent unfairness in how doctors are paid.
Those whose practices are procedure-based – meaning they do stuff such as eye tests, radiology scans, injections for pain – can see hundreds of patients a day and bill enormous amounts of money. Those who practices are more cognitive – meaning they spend a lot of time interacting with patients, such as pediatricians and geriatricians – have billings that are far, far lower.
That equally trained and hard-working specialists can make orders of magnitude more/less money makes no sense.
It is telling, too, that among the 194 physicians who were top billers, only nine were women.
Men and women use the same fee schedule, and charge the same rates, but they practise differently and gravitate to different specialties.
These issues, relativity and gender bias, are ones that the medical profession principally has to work out itself, but government, in contract negotiations, can help them along.
With the distracting canard that transparency is harmful out of the way, we can now focus on what really matters to physicians, fair payment for the valuable work they do, and what matters to the public, getting value for money for the payments physicians receive.
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André Picard