Sunshine list: My thoughts, member comments

December 2, 2015

Dear Member:

I am writing to share what I have heard from you about Bill 5, The Public Sector Compensation Transparency Act, and to offer my perspective.

In several hundred emails, comments have been made by members about transparency, fairness, privacy, risk and relationships. If you are interested in reading a sample, click here to read a small selection under the various themes that I have observed in your responses.

Here is my perspective.

With the legislation before us, there are issues of transparency and the public’s right to know, fairness in treatment of payment information, and effect on relationships between physicians and peers, and physicians and patients. There is also an additional and all-important consideration. That is, there must be a balance between the need for transparency and the privacy of personal data. If government is going to overrule the privacy of physicians and all individuals touched by the legislation, then a clear benefit – and a distinguishable public good – must be apparent that is commensurate with the invasion of privacy involved.

I believe it is the public’s right to know what a physician is paid to provide a medical service. This information is, however, already available to the public.

• The Schedule of Medical Benefits (fee schedule) is a public document
  www.health.alberta.ca/professionals/SOMB.html.
• Every year Alberta Health publishes the annual and range of gross payments for every specialty of medicine
  www.health.alberta.ca/documents/AHCIP-Stats-Supplement-14.pdf.

In the responses I have received to my last letter about the proposed sunshine list, many members oppose any additional form of publication of total payment revenue. However, the government has clearly indicated their commitment to public disclosure, and the bill under debate is explicit that this will include revenue paid to physicians whose billings exceed the threshold.

Government has acknowledged that physician payment data are different and thus has offered to consult with the Alberta Medical Association (AMA) on regulations and about how to present the data. This is a good starting point and we appreciate the consideration. It is critical, because apart from the negotiated fee for a medical service, there are two variables that determine individual physician’s income; how much they work and how much overhead they pay.

Workload for physicians usually exceeds normal workdays. The hours worked by doctors give Albertans better access to health care. Reductions in workload would produce lower fee revenues, but would also limit access to care.

In terms of overhead, it is clear is that a large portion of the gross revenue paid to physicians flows into the pockets of other Albertans, including medical office workers, building owners, contractors, suppliers and others. Publication of gross payment information would not reflect these immediate deductions and provide a misleading picture of what physicians actually earn.

As I mentioned, the most important consideration in my view is the balance between public good and personal privacy. Members have indicated very strong privacy concerns regarding the publication of amounts paid to a named physician’s practice. Potential unintended consequences include criminal targeting of physicians homes and families, unfair business practices, identity theft and sophisticated targeting of individuals by cyber criminals. When considering risk, even a low incidence risk becomes important if the magnitude (of even one incident) is substantial.

Finally, a comment on the relationship between the medical profession and government. We are partners, sharing the same goal of providing accessible, quality sustainable health care to Albertans. Our success in jointly achieving this goal will depend on a respectful and collaborative relationship.

I believe there are respectful approaches to Bill 5 that can provide balance between public access rights and privacy of personal data.

The Board of Directors is reviewing all possible options in connection with this matter. As always, I appreciate your thoughtful comments and suggestions. Please email me at president@albertadoctors.org.

Kind regards,

Carl W. Nohr, MDCM, PhD, FRCSC, FACS
President