Sunshine list: My thoughts, member comments

December 2, 2015

Dr. Carl W. Nohr, AMA President

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.

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

4 comments

Commenting on this page is closed.

  • #1

    Amin Bardai

    Member of the public

    2:07 PM on December 03, 2015

    I don't believe that we, the public. want to know that a physician gets x-dollars for performing a procedure. Rather.we are interested to know that a physician received $500,000 in 2015 to provide patient care.

    This is only fair. We publish how much a civil servant makes. There are too many excluded from THAT list. Beside, in BC, they publish a list of how a physician received from the public purse. SO WHY ARE OUR DOCTORS resisting a similar publishing os their earning? If they think that they earn x-dollars because they work 100,000 in the year, then include that information also in the list.

    Is it that physicians in Alberta don't want to tell us that they make a LOT OF money here? Why do they want to keep asking formore money from the public purse? Are they poor?

  • #2

    This comment has been deleted.

  • #3

    Ian Wishart

    Physician

    6:41 PM on December 03, 2015

    I fully support publishing physicians incomes but there are couple of comments and caveats. There is a huge disparity in physician incomes between specialties with equivalent training and skills and there is also significant disparity within professions due to creative billing practices . These issues have not been resolved through our governing body and perhaps this additional exposure will facilitate resolution.
    To make this income publication relevant and transparent we should provide either net salary after business expenses which would be ideal but too sensitive for most, or some reasonable reflection of overhead to allow comparison and justification. For true transparency all private billings should be made available as the public billing information that will be disclosed by many services does not in any way reflect take- home income and continues to add to the secrecy within our profession .
    If a physician feels their earnings are justified for their skills and time then we should be comfortable with the public been informed about their money being spent on us.

  • #4

    Frances Vettergreen

    Physician

    1:30 PM on December 29, 2015

    I think that if we are going to publish individual incomes with information that identifies where that individual works (which, for doctors, is a matter of public record, and it's not so hard to find home addresses either; but my concern extends beyond physicians to other government employees) then we are opening up all sorts of security risks, not to mention a real breach of privacy. On the other hand, it is absolutely fair for taxpayers to know where our money goes. But what is actually served by attaching a specific name to a specific income...unless this "sunshine list" is really meant to expose those who might be abusing the system? In which case shouldn't investigation happen outside of the public eye so as to avoid the "guilty by social media" phenomenon?

    So, for physicians, why can't we publish the billing schedule (as we already do), a range of billings per speciality with the range of overhead costs RIGHT BESIDE THEM and maybe also corresponding numbers of hours worked/patients seen? For other public servants couldn't we publish the salary ranges for union positions, specific salaries where they are individually negotiated, along with the qualifications it takes to earn a given income? Then implement some system for investigating situations that seem to require it, and leave individuals to their privacy?

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