The battle between Ontario's doctors and the provincial government is escalating with the installation of a new Ontario Medical Association president and calls for the names of the province's doctors and their compensation to be made public.
British Columbia and Manitoba publish annually the names of all doctors and the amounts they receive from billing their insurance plans, in an effort to show transparency and accountability in the health system.
In Ontario, doctors' names and their compensation are not made public because of privacy concerns. However, there is a push for this to change.
Doris Grinspun, CEO of the Registered Nurses' Association of Ontario, says all doctors who bill the Ontario Health Insurance Plan (OHIP) should be named.
"The money does not come from a company," said Dr. Grinspun. "The money comes from taxpayers. This is OHIP billing. OHIP billing is through our taxes."
Dr. Grinspun said she will be making the case for transparency when she meets Thursday with Ontario Health Minister Eric Hoskins, who is attending the nurses association's annual general meeting in Toronto. She will also be advocating for doctors to be on salary, a move her organization has pushed as a way to make compensation in the health system fair and to ensure the system's sustainability. On average, Ontario doctors' gross compensation is $368,000 annually, making them the best paid in Canada, according to the Canadian Institute for Health Information.
The NDP's health critic, France Gélinas, has also called for public disclosure of names, and has a private members' bill on this issue.
The province has a budget of about $11.6-billion for physicians' compensation – and Ms. Gélinas said it's simply wrong to have that amount of taxpayers' money "completely opaque."
"We need to have transparency and accountability and it will change things for the better in the health system," she said.
Meanwhile, Ontario Information and Privacy Commissioner Brian Beamish said in a statement that his office has "traditionally treated doctor salaries as the personal information of physicians and exempt from disclosure."
That protocol was established by a former commissioner in 1997 – but there has been an appeal of that recently, and a decision by Mr. Beamish is expected soon.
Dr. Hoskins is waiting for of the commissioner's decision before commenting on the issue.
Tension between the doctors and the provincial government has been building over the last few weeks, provoked by a recent news conference in which Dr. Hoskins revealed that more than 500 doctors billed OHIP more than $1-million each last year, including one doctor who billed $6.6-million.
The Health Minister is trying to get the doctors back to the table to work on the fee codes to even out some of the disparities in billing; there are 7,300 procedures for which a doctor can bill.
So far, Dr. Hoskins's tactics have not been working.
The OMA's new president, Virginia Walley, who was just named to the post on the weekend, is resisting calls to go back to the table, and for the names of Ontario's physicians and their billings to be put on a public list.
"Ontario's doctors are committed to transparency and accountability, but publishing a list of individual physician OHIP billings is not about accountability," Dr. Walley said in a statement to The Globe and Mail. "It is also not about transparency. Publishing physician OHIP billings is not the same as publishing a list of salaries; it is not an apples to apples comparison."
The OMA represents 29,000 practising physicians, who have been without a contract for two years. Talks between the government and the OMA broke off a year ago and the new president said that her side will not be back at the table until the government agrees to binding arbitration.
In her statement to The Globe, Dr. Walley said, "disclosure of billings without context does not provide the public with an adequate picture, and may lead to a misunderstanding of billings versus income."
"Doctors are generally independent contractors who bill OHIP, and they support a large portion of the health-care infrastructure that is needed for patient care in this province," she said. "For instance, much of the out-of-hospital radiology equipment used in clinics has to be purchased by physicians, or they would have nothing with which to provide those diagnostic patient services."