The Ontario Court of Appeal has ruled that the names of the province’s top-billing physicians can be made public.
In the latest installment of the long-running saga (which began four years ago when the Toronto Star challenged a routine rejection of an access-to-information request for the names), the court on Friday rejected arguments that billings data is personal information and that releasing it would be an invasion of doctors’ privacy.
The Ontario Medical Association (OMA), along with two other small groups (representing radiologists and ophthalmologists) who launched the legal challenge, must now decide if they will appeal to the Supreme Court of Canada.
Let’s hope they don’t waste more time and money doing so and delaying the inevitable.
It is a well-established principle that public spending should be subject to public scrutiny.
Ontario has a Sunshine List, which names every government employee who earns more than $100,000 – of which there were 131,742 last year.
Individuals and companies who do business with government – consultants, road builders, lawyers, etc. – are subject to public disclosure of their fees, and we are moving increasingly toward open contracting.
Together, Ontario’s doctors are paid about $12-billion a year from the public treasury. Yet, they tried to argue that transparency should not apply to them.
Their principal argument was inherently contradictory: The OMA said the billings were “personal information” but, at the same time, argued that billings are for business expenses (rent, equipment and supplies, in addition to salary) and the public will be misled into thinking billings are income.
The other arguments put forth were equally dubious: that doctors are “different” from other contractors because they have a single contract, not individual contracts, and because doctors provide services to citizens, not government.
The Court of Appeal rejected the lot of it.
Beyond the legal stuff, the larger problem with the OMA’s dogged opposition to public disclosure is that it is based on the premise that the public is stupid.
“Publishing physician billings without context does not paint an accurate picture of the physician pay structure,” Dr. Nadia Alam, president of the OMA, said in a statement issued after the ruling.
It was an oft-repeated reminder that physicians, for the most part, operate small businesses that must pay overhead in addition to salaries. This is not a difficult concept for the public to understand.
Aggregate data about physician billings is already published. We know, for example, that the average Ontario physician bills $348,000. Family doctors billings average $275,000, while those of ophthalmologists are $714,000. But averages tell only a partial story.
It is true that we don’t know how many hours a physician who bills $348,000 a year works. But nor do we know how many hours the police officer who earned a spot on the Sunshine List for earning $133,303 works.
If the OMA, or individual physicians, feel the gross billings lack context, they are free to release additional, clarifying data. The court has set a minimum standard for disclosure, not a maximum.
There are 28,100 practicing physicians in Ontario. Public disclosure of individual billings would not make a lick of difference to about 28,000 of them. We know this because British Columbia has been publishing individualized data since 1971, Manitoba since 1996 and New Brunswick since 2017. The only people indisposed by this information are those with questionable billing practices.
The Toronto Star has asked for the names and data on the top 100 billers. What little we know about this rarefied group – from audits – suggests that, as taxpayers, we should know more.
One ophthalmologist billed almost $7-million; the top 12 physicians averaged $4-million in billings; six doctors claim to have worked from 356 to 366 days a year; one radiologist billed for 100,000 patients, meaning s/he interpreted more than 300 scans per day.
The majority of doctors are paid well and fairly. The public would be as surprised by how little some doctors earn as by how much others do.
The eyebrow-raising excesses in the top 100 are by no means the norm. That is all the more reason they should be exposed.
But public disclosure is not just about blaming and shaming.
It should spark broader conversations not only about how much physicians are paid, but how they are paid and how we can ensure value for money for these large outlays of public money.
Transparency is in the public interest. Physicians, as with everyone else who get public monies, should take their medicine.