45 thoughts on “Should We Fight for the Top 100 Billing Doctors?”

1. Its a basic tenet that involves us all. We are not civil servants, we are contractors to the system. No one has the right to our private billing data no matter how much you billed.

   BTW what is a section 75 investigation? Why is the college involved?

   1. While I completely agree with you in that very sane and logical argument, it appears several courts of law do not, and feel disclosing our gross billings is appropriate.

      I personally feel we should go all in and hop on the civil servant bandwagon: demand a salary, demand to be an employee, demand an office and infrastructure support, demand all the benefits that employees get, and let the government manage us as salaried employees. Enough of this indentured servitude as unappreciated subcontractors.

      1. Your colleagues at OHIP in Kingston are laughing all the way to the bank!

      2. Several courts of law may have ruled but that doesn’t mean that a higher court will rule against our privacy rights. If our lawyers say that there is a 30-40% chance of winning then I think we should go on. I might even go as low as 20%. We are fighting for privacy and also to show that physicians will not just lie down and play dead when we think we are being treated improperly.

         1. Can someone elaborate on the cost of all these Court actions. I believe we were also charged costs when we lost and had to pay the Stars court costs as well. What is the dollar value of all these activities ? What percentage of our fees does this represent?

            1. We don’t know the final cost, but so far, the cost has been far less than 1/2 of 1% of the budget. We are no where near the cost of one council meeting.

         2. I haven’t heard any lawyers offer percentages. This decision was made on principle: Do we fight a bully or not?

      3. Excellent point, Rob. Many other docs say the same. We’d give up much in that scenario, but I don’t think what we have to give up would be missed by many.

      4. Agreed, Rob. The current situation is ridiculous.

   2. Good point, Ernest. I don’t the details of a section 75. Sorry

2. Just like the Ontario civil servant Sunshine List, the names of the top 100 billing physicians in Ontario will be in the news for 1 day only and then forgotten by the media and the 15 million residents of Ontario.

   1. I believe that the Sunshine List is an invasion of privacy too.

      1. And I believe that all of your colleagues at OHIP in Kingston should all be dismissed. We are both dreaming in technicolor.

         1. I see your point, Perry

   2. I take your point, Perry. It’s a good one. But isn’t the 100 different than publishing all?

3. I wonder if there is a way for us to figure out who the top 100 billers are and ask them their opinion as to whether they are they care if their billings are published. I think we have a sense of which professions and Specialties are involved. Maybe a survey amongst them as to whether they care might help direct the OMA as to whether this fight is a reasonable one.

   Personally, I see this as a losing battle. It seems highly unlikely we will stop the inevitability of the disclosures as other provinces are openly publishing the billing data for their members. Regardless of what the numbers eventually show, I’m sure the Star will line up the docs like Lambs for the slaughter.

   I personally feel the OMA’s efforts and our money could be better spent on different endeavors such as moving along the contract talks and speeding up the timeline for decisions and arbitration. It is shocking when we hear on the news that after a month of failed negotiations for other unions, they are settling with fairly rapid arbitration and decisions for them while we’re still plodding along waiting for a meeting date.

   Regardless, I think the Star simply wants to incite a flame war between doctors and the public. The best way to deal with that situation is simply ignore it. It will make for interesting rhetoric for a period of time. It is a tale told by an idiot, full of sound and fury, signifying nothing.

   1. All fair comments, Rob. I guess I’d want to have an association that fought for me to the end, if I was the one being singled out. The cost is less than 1/2 of 1% of the budget, even if we are granted leave to appeal. While the final tally is unknown, it is not the ‘millions’ people have been throwing around.

      Should we fight a bully even when the likelihood of winning is small? I guess you say, Give in?

      1. Einstein defined Insanity: doing the same thing over and over again and expecting different results. We’ve lost this fight twice already. Other docs elsewhere have had their Billings published. The writing is on the wall. If you want to continue banging your head against that wall on the slim chance that the wall may crack, then be my guest.

         If we can’t fight the bully by preventing publication, then we may have to fight the bully with facts and debate once the Star’s Spin Doctors come out with their articles. With our track record though, we’ll probably just come out looking like whiners. Likewise the government is a bully that we obviously have seen we can’t effectively fight and win. Sometimes you just have to cut your losses.

         1. I hear you. All good points. I guess I still see the principle of defending members for attack as key.

            I know that it will be much harder to get a consultant out of bed at 0300 to race into the hospital to see an acutely ill patient. The billing issue essentially punishes docs for working hard. That means more patients will be medivac’d out. For some, that will directly impact their chance of survival (e.g. AAA). At least we can say we tried to prevent it.

            Thanks again for reading and commenting!

4. I believe that the Sunshine List is an invasion of privacy too.

   1. Agree

5. “A whole generation of doctors carries personal shame about the failed 1986 doctors’ strike.”

   Shawn, I have learned lessons from that time, but I have never felt shame. I said back then that I wanted to be able to answer future generations of doctors when they asked some day in the future, how I could have allowed our health care system to deteriorate so badly.”

   Those us who went on strike predicted the current mess in Ontario healthcare. It has taken decades to get us to the current level of deterioration in the treatment of patients AND physicians.

   I am not ashamed at all of the 1986 Strike because I can proudly tell the doctors of today that I tried to prevent the current mess.

   1. Sorry Gerry!

      Of course, you are correct. I adjusted the post to include your thought. I was thinking about so many (all?) of the physician leaders I’ve worked with who talked about ’86. They all talked with shame. They patted my on the head and said they used to want to fight on principle too. But now they know better.

      Thank you for standing up for us, Gerry. I think this system has a decade or perhaps two left in it before it collapses or goes through massive change. We will remember that you called for change decades before!

   2. Hi Gerald,
      I’ve been thinking that there may be a need for another strike. I am hopefully wrong, but I have a feeling we will have to fight for scraps (if that) with the current government or any other one in the near future. And as members of a caring profession, we are a very easy target, precisely because of the notion that doctors won’t abandon their patients. However, currently one could argue there is a slow abandonment occurring: doctors cutting back hours, taking more lucrative non-clinical work, retiring or semi-retiring early. I’m beginning to wonder if a strike would be a better way of ensuring physician’s healt and availability immediately and into the future.
      I was way too young in 1986,
      but seeing the situation now I am appreciative of both the dilemma and the decision made to strike, back in ‘86.

      1. Great comments, Jennifer.

         We have to keep telling people that the “slow abandonment” is a reality, not a threat. Every extra hurdle, sling, and attack puts docs closer to finding a way out.

         As for a strike…I can’t even hazard a guess. I’d bet on none, but I’ve been surprised before!

         Thanks for sharing your thoughts!

      2. Jennifer, in 1985 and 1986, I had doctor friends, who later did not go on strike, ask me why they should go on strike when they didn’t even bill patients directly. Many years later after the strike failed and health care deteriorated, I confronted them and they denied ever saying that. I never pressed the point but I have a witness who heard both discussions who corroborates my story.

         We hang together or we hang separately.

6. Think of the humiliation of the low billers…we have feelings too.

   How about the multi billers?…those that double, triple dip…earning an income via their medical practices…then side incomes from academic settings, government agencies …LHINs etc., …perhaps combining medical incomes and sunshine incomes would be revealing.

   1. Great points, Andris! I hope they leave us low billers off the list. After overhead, I’m down near the cut off to even make it on the tally. Makes me wonder…

      1. Oh, I think if they’re listing the top 100, why not list the lowest as well? I’m working like a dog and would love to have my pathetic billings published, along with my name. When I cut my hours, I can then just point to the published list as to why.

         1. Ha! Great point, Jennifer.

7. No shame in 1986.
   The only mistake was not going ‘all in’ ,and withdrawing ALL services like several other countries …. strike would have lasted less than 24hrs.Moral superiority prevented that.
   The real mistake was made in 1970,by docs who took ‘guaranteed’ payment and didn’t insist on a private option (like the UK/NHS) ….. now we are stuck trapped like rats running the spinning wheel for less and less while maintaining services(a perfect business model for gov’t),giving the star fabulous material for their doctor bashing.
   Good luck young docs ….. your 1986 may yet come.

   1. “…now we are stuck trapped like rats running the spinning wheel for less and less while maintaining services…”

      Brilliant comment, Ramunas. I agree: the real mistake was in the 1970s. The government did what Aneurin Bevan did to get the UK docs to buy in. He said, “I stuffed their mouths with gold.” Once the docs sign on, the gold runs out.

8. I think we need to choose our battles not just because of costs but because of how it looks to the public. If the OMA had just let the Star publish their “expose” in the first place this would have blown over so much faster.

   It may just be my perception but it feels like the OMA is putting way more effort (at least publicly) into this than they are into the related issue of relativity. It’s difficult to work up a ton of concern about the best paid people when we know that large numbers of MDs are underpaid for their work. Maybe the OMA is really working hard on the relativity issue (I know there’s a committee) but I’m relatively engaged and I still haven’t really been able to see any progress towards change on that front from what’s been released.

   1. Good thoughts, Jack!

      For what it’s worth, this issue uses up very little time, effort, and money compared to all that goes into negotiations and work on relativity. There isn’t even a close comparison. The Toronto Star issue is one of principle. The big discussion on relativity happens on Oct 21st at the special meeting of council.

      See you there!

      1. So I guess it’s an issue with the optics. From an “interested outsider” point of view, it looks like this is really a major issue on the OMA docket. Probably the Star’s reporting and the subsequent propagation has a lot to do with that but it’s still not a fantastic look on us. I think we agree to some extent – especially on the fact that releasing names of only 100 people feels like an invasion of privacy. But I don’t think these good points have really carried through in the media and it plays like we’re hiding some sort of secret.

         I thought that we could really achieve success here if we got out ahead and actively lobbied for the release of all physician billings with clear descriptions of the difference between gross and net as well as group billings and other nuances. I think the public would be surprised at how low the take-home pay is for some docs. I may be wrong but it doesn’t seem like the OMA is actively taking that position? Are we being overly reactive here where being proactive would defuse the Star and potentially get the public on our side and maybe even be a good step in discussing relativity?

   2. Is Relativity important to all OMA members, to most OMA members? Is it even a goal that will help all or most physicians in the long term? Frankly, it is my opinion that the PURSUIT of relativity has been detrimental to the financial well-being of ALL Ontario physicians. So if I suggest that the OMA not pursue Relativity so that we can pursue other things that are more likely to help Ontario doctors, will you support me?

      1. I’m curious why you feel that way. The way I see it, if something were to help all Ontario doctors it could still also address relativity. Say, for example, we somehow negotiated a 10% overall increase to billing codes that could be distributed amongst all billing codes as we see fit. For example, if there were only 2 codes and one was increased 15% then the other would have to be increased 5%. In that situation I would argue that the bigger increases should go to the codes used most by the traditional “have not” groups. The “have” groups would still get increases, but not as large. Everyone wins.

         But actively ignoring this issue means ignoring the fact that a few quirks of history (and the overvaluing of procedures to the detriment of other physician activities) have undervalued a large group of physicians.

         1. Jack, what you say is reasonable and I believe the right way to improve the lot of the lower billing sections BUT that is not how Relativity has been pursued. For many years now the process of Relativity has centred on fighting over a limited pie by funding increases to the lower billing sections by lower fees of the higher billing sections.

            I saw an OMA report celebrating that, even though fee increases had been poor, at least Relativity was improving. It did not seem to be celebrating that the lower sections had a significant increase in income but that the billings of top and lowest sections were getting closer together. The

            The government has squeezed the physician budget in the face of an aging population . Even in the face of an aging population and the need for more physician services, in the 2015 the Old OMA negotiated a Physician Services Agreement with a Fixed Global Budget. This would have meant that Ontario physicians would be fighting even more frantically over a fixed funding pie. The Old OMA actually pushed this Fixed Pie Agreement so aggressively to the membership that they were taken to court twice by an ad hoc physician coalition. The judge castigated the OMA and said that the executive committee of the OMA “abused the authority” provided to it under the Corporations Act.

            https://business.financialpost.com/opinion/terence-corcoran-judge-rules-oma-sneaky-in-bid-to-have-doctors-ratify-deal-with-province

            Because of the way Relativity has been pursued, I suggest changing the name or at least re-defining it. Pursuit of EQUALITY as opposed to EQUITY has hurt ALL physicians in Ontario.

            Jack, in the distant past agreements with the government, did precisely what you have suggested: no section’s fees were cut but larger increases were given to those sections that were vastly underpaid. I am all for your suggestion.

            1. Events seem to have overtaken our discussion.

               Here is the link to the Medical Post article about this. http://www.canadianhealthcarenetwork.ca/physicians/news/several-specialist-groups-consider-breaking-away-from-the-ontario-medical-association-54134?utm_source=EmailMarketing&utm_medium=email&utm_campaign=Physician_Newsflash

               I am not surprised that this has happened. I wrote about it in 2013 after the OMA had negotiated a deal that hurt many sections. I think it is worth reading my article again as the situation seems to be the same. The comments are very interesting and informative especially in view of what has transpired in Ontario medical politics since then.
               http://healthydebate.ca/opinions/is-the-oma-an-appropriate-vehicle-for-negotiating-doctors-fees

            2. Jack, events have overtaken our discussion. Today it was announced that a group of specialty sections will be breaking away from the OMA. I am not surprised that this is happening. I wrote about it in 2013 after the OMA had negotiated a deal that hurt many sections. I think it is worth reading my article again as the situation seems to be the same. The comments are very interesting and informative especially in view of what has transpired in Ontario medical politics since then.

               http://healthydebate.ca/opinions/is-the-oma-an-appropriate-vehicle-for-negotiating-doctors-fees

               1. Take a look at section 12 of the Commitment to the Future of Medicare Act, 2004 with regard to agreements with the Ministry of Health and Long-Term Care.

                  1. This is what you are referring to,right Perry?

                     12 (1) The Minister of Health and Long-Term Care may enter into agreements with the associations mentioned in subsection (2), as representatives of physicians, dentists and optometrists, to provide for methods of negotiating and determining the amounts payable under the Plan in respect of the rendering of insured services to insured persons. 2004, c. 5, s. 12 (1).

                     THE ASSOCIATION REPRESENTING PHYSICIANS is the ONTARIO MEDICAL ASSOCIATION

                     That is just a detail that has to be fudged a bit. I leave it to the lawyers but I suspect that the sections could negotiate with government directly and the OMA could be used as a conduit only but not do any negotiations.

9. I get your point Gerry and I think we all agree that billings don’t equal income. Even income doesn’t take everything into account (such as years of training and liability). However, there are systems that are trying to work on that, like CANDI (although far from perfect).

   It’s still clear that there are “haves” and “have-nots” within the OMA and that the division is not the result of fair or clear-headed decision-making. I believe that part of the OMA’s role is to address the discrepancy while at the same time negotiating in a way that benefits all MDs. As far as I can tell, that’s what most of the board believes as well. That one small group thinks (possibly erroneously) that they can get a better deal on their own doesn’t erase the issue.

   1. Relativity studies, survey after survey, looking at accountant statements and getting outside consultants have been done over and over again. Every generation of doctors in Ontario brings with it a new cry that previous attempts at Relativity failed because we just didn’t do it right all those other times. It looks good on paper and it reminds me of how when some say that Socialism has always failed, the reply is that they didn’t do it right all those other times.

      Relativity as it is currently defined will NEVER happen. It is a waste of time and effort. It has served governments well as it has kept the earnings of ALL doctors down.

      Fairness is a nebulous term defined differently depending on the beholder. We will never agree on its meaning and striving for something is not clearly defined is basically impossible.

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