Release of Sunshine List regulations

September 11, 2020

Dr. Christine Molnar, AMA President

Dear Members:

On September 9, government released regulations on physician payment disclosure. The regulations are brief and lay out a 60-day disclosure date, meaning the information can be released as of Sunday, November 8, or anytime before.

The public, through their taxes, pays for our medical services. It is in society’s interest that our health care system is efficient, cost-effective and adds value. Transparency is important, as is accountability. Greater transparency for the public through the Sunshine List, in our view (August 10 President’s Letter), does not require the release of individual names. However, we understand from discussions with government that there is a decision to proceed with the release of our names with our gross billing data.

Two issues of prime importance remain: that the public is fully informed about the context of the information and that a fair and reasonable process for exemption is implemented.

For clarity, and since prior Sunshine Lists mostly reflect salaried positions, it is important that the public not confuse our billing data with our take-home pay. The AMA published a document called Context Matters: The Facts About Physician Compensation in Alberta to provide better understanding of gross billing data. Our annual billings support overhead costs in our practices, vary with hours and days worked, support disability insurance, parental and medical leave and retirement saving. They reflect the expenses from the long years of training required to achieve our degrees and certifications and the ongoing costs of required CME. In a recent September 3 letter from the Minister, he indicated, “Our intent is to provide useful information for Albertans. We are considering publishing non-payment data that will give Albertans important context for the payment information.” The AMA will work with Alberta Health to this end.

An exemption process that is fair, clearly communicated and allows time for submission and appeals is essential. The relationship of patients with their medical doctors is highly confidential and personal. The positive support patients experience in a doctor-patient relationship is important in the healing process. There are concerns that identifying physicians by name in the Sunshine List may, in some settings, negatively affect this powerful relationship. Members with family in politically unstable countries, or third-world environments have contacted me with concerns for the welfare of their loved ones for fear of kidnapping. A number of our members provide volunteer services in underprivileged countries and have expressed concern that they may become targets for ransom. The exemption process will need to be sensitive to these and other individual situations and circumstances.

On a last note, in light of the dramatic adverse changes wrought by the COVID-19 pandemic on our medical practices, the financial data to be published is historical and does not at all reflect our current reality. In this new environment of decreased revenues and increased overhead costs, the final equation is far from clear.

We met with government in August to provide feedback and explain our concerns. As noted above, the Minister’s September 3 letter stated his willingness to hear further from the AMA on issues related to the release of a physician Sunshine List. This further consultation is welcome.

I will share additional information on this issue as it becomes available.

In your service,

Christine P. Molnar, MD, FRCPC
President, Alberta Medical Association

3 comments

Commenting on this page is closed.

  • #1

    Anonymous

    Member of the public

    11:51 AM on September 11, 2020

    I read your above letter. I have some reservations. I feel like you are defending the doctors completely wrong. As a tax payer, I would like to know who is abusing the system. I also feel like the Government is hoping that by publishing the individual's names with their income will upset the taxpayers and thus they will support the changes the Government is bringing. In my opinion the Government should hold the AHS responsible. They have the power to audit the individuals who were misusing the system. I don't know why the Government is not taking any action against AHS and instead making sweeping reforms against all doctors. If the AHS audited the doctors or clinics that were abusing the system, the issue would have never occurred. It is likely that there are some doctors that grossly misuse the system, yet there are many doctors that do not and work honestly.

    I also want to bring up here that there are patients that are misusing the system by seeing different doctors frequently as a walk-in when they don't get what they want. There should be a check and balance. Every clinic is using a computer system, the EMR companies could setup something that would indicate that this patient is frequently visiting different doctors. Opening of clinics should also be observed diligently, there are places where you can see a cluster of clinics which needs to be curtailed. A good example is requirements needed for "registries".

  • #2

    John S Kennedy MD, FRCP(c)

    Physician

    5:08 PM on September 14, 2020

    It has been known for a very long time, years in fact, that Provincial Cabinets have been aware (based upon surveys and door to door campaign conversations), that the majority of Albertans consider physicians to be valuable only if and when the individual citizen has a personal need.

    Recall that during the past 30-40 years physicians have sat inside cabinet and learned this first hand. Outside of the immediate need state (and anxious dependence) physicians are despised. Physicians as a community, are a primary focus of a great amount of envy and jealously. Such socially focused Brain States do not tolerate reasoned accounts.

    We are not alone. It is also known to Government (based upon surveys), that all highly educated individuals belonging to any visible group who "seem to be doing well" in Alberta are despised. It is the Canadian way. It is also the human way - recall MARXism's fascist appeal to the worker class and what happened to the intellectuals etc.

    It would be of interest to know where else in the world such a breach of individual privacy rights as the sunshine list has occurred and, what the long term effects were on society as a whole.

  • #3

    Uzma Khan

    Physician

    2:55 PM on September 15, 2020

    Dear Sir,

    Releasing or displaying physician's sunshine list will be huge safety issues as economy going down, unemployment is increasing and crime rate increasing. Cases of robbing, break ins, kidnapping and ransoms will be increased, especially physicians like me who travel to south Ascian country or other countries where crime rates are more then here, these lists will place myself and my family at huge risk as this list will be available on internet and everyone will have access. Govt is placing my life and mine family lives and safety in huge danger just to making decisions one sided while Govt ministers living in bubble in Canada and no experience the lives and situation in other countries but currently in Alberta crime rates are increasing too and these kind of decisions will promote crime rates and placing Canadian physician's lives in danger.

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