Patient care requires privacy. Only patient safety can trump it.
What about doctors’ privacy?
Most voters do not care. They should, but not because doctors do. The public should worry because everything that impacts doctors impacts patient care.
Our society functions on freedom and private property, which includes privacy.
The UN Declaration of Human Rights enshrines the Right to Privacy in Article 12 and elsewhere. The right to privacy is the right of the individual to decide for himself how much he will share about his personal “thoughts, feelings and the facts about his personal life.” (Scruton p 441)
Western democracies revolve around privacy and civil liberties. See Canada’s Privacy Commissioner and the USA’s Privacy and Civil Liberties Board .
“Private life [comes] to an end” in Orwellian totalitarianism.
Even The Toronto Star writes, “Canada’s Privacy Commissioner says there’s an urgent need for stronger privacy laws to protect personal information.”
Privacy Versus Publication
Given the primacy of privacy, publication of doctors’ billings must rest on a truly profound argument to justify the attack. Is this an issue of
Patient safety?
National security?
Criminal activity?
The only reason offered by pro-publishers’ is transparency. Fraud has been ruled out. Security and patient safety do not apply.
The Harris government created the Freedom of Information and Protection of Privacy Act (FIPPA). It allows access to information held by government and government agencies through a freedom of information request (FOI).
Transparency makes government accountable. Otherwise profligate politicians would give secret deals to friends and patrons. Transparency curbs patronage. Sunshine lists supposedly cut wage growth and address productivity, except they do not.
If this is true, then Sunshine lists are an indictment of government. We would not need lists if voters could trust government.
If voters cannot trust government with salaries, then why trust it with healthcare?
If we must enforce transparency, publish doctors’ personal information, and risk decreased patient access because we cannot trust government, then why trust it with Medicare?
Patient Impact
Two courts have ruled on the Star’s FOI request for the top 100 doctors’ billings (See Fight). Another FOI is pending for all doctors’ billings. But judges do not care about harm to doctors or patients, nor are they qualified to assess it. They only interpret the law.
Given current legislation, does the law allow publication? Judges do not decide whether it is good to publish. Or whether patients will be harmed. Or whether access to care might suffer. Or whether doctors’ job satisfaction might decrease.
Those who support publication say, “It’s only news for a day.” No one cares. Then why publish it in the first place? No other independent contractors are published. We are not Norway, where all tax returns are published. Why isolate doctors, as the only independent contractors who need their billings published?
Doctors build careers around privacy. Privacy matters because patients matter. No one will open up to a doctor who cannot keep a secret. And privacy goes both ways.
If there is any good in publishing doctors’ billings, does it outweigh the bad? How will publishing impact patient care? Decisions require tradeoffs. What must we sacrifice to gain transparency for the Star?
Most docs prefer privacy. But they also do not care enough to fight. If the Toronto Star wins, most doctors will keep seeing patients like before. They will add this insult to a long list and carry on.
A small group of doctors will celebrate: Other sectors see salaries rise. Some docs will slow down or retire. Some will continue the trend towards non-Medicare work. A few may get disgruntled and distracted, which drives down productivity.
Patients already wait 4.5 years to see a neurologist and 6 years to get spine surgery in some areas. If even a few doctors slow down, shouldn’t we find out first?
Andre Picard wrote about issues that could cause doctors to slow down or leave in 2015 and 2016. He called them threats. Instead of helping find solutions, he repeated the same message to doctors both times, “There’s the door.”
Doctors are tired of being kicked and mocked by Liberal politicians, media, and the courts. If the Toronto Star publishes doctors’ billings, some docs will see fewer patients. And that won’t help patient care.
Photo credit: Stanford Prison Experiment
Three provinces and the US publish billing data.
Do you have any evidence of harms to patients as a result?
I do not. I heard that they did not do a before and after analysis of workload, access and wait times.
Here is the billing data that is, in my opinion, relevant. The billing data is taken from a recent Decision and Reasons of the Health Services Appeal and Review Board and from a tweet by an Ontario physician. An Ontario physician would appear to bill OHIP $30 for an office visit. A Florida physician would appear to bill a patient $208 US for an office visit.
Well said, Perry. Well said indeed.
That was a tiny part of Shawn’s argument. Even if doesn’t do harm to patients, there is no proof that publishing doctors’ billing does any good.
Physicians who work longer hours are paid more than those who do not. Because of the nature of the profession some make higher income than others. Some pay higher and some pay disproportionately for costs of running their practice.
I do not personally know who the top 100 billers are but we have established that this is not about possible wrongdoings.
We need to defend privacy . In the event this defence is not found to be established then all Net incomes after overhead expenses deducted should be released. There will be a large range in large part due to the number of hours worked.
Solid comments, Debbie and Gerry. Privacy seems worth defending regardless of what’s at stake.
Everything government has done towards doctors seems to encourage each doc to invidually work less. I think they were counting on the response being that we will simply work more to make up for it because we can’t curtail our spending. Some may.
When you pay 53-54% marginal tax, that is a strong deterrent. If you save too much in your corp, you can work less or pay more tax. If you work excessively, you would stick out like a tall blade of grass to be mowed if your billing is made public.
We all make trade offs on how to spend our time. The time spent working is time spent away from family, friends, and other pursuits. The financial return on time for working keeps shrinking. I need to work a certain amount for the intrinsic satisfaction of practicing medicine, but that is a lot less than I used to work. For me, the logical response to all of this is to work less and spend less. I know many who have the same approach. Really the government is just promoting physician work-life balance 😉
Great comment, Loonie Doctor!
I agree. I think we will see far more docs slowing down than people expect. The message is crystal clear: hard work is NOT attractive in Canada anymore. Might as well aim for mediocrity and enjoy more time off. This is not good for anyone.
Thanks so much for taking time to share a comment!
Perhaps EVERYONES net income should be posted at their places of business…privacy for no one…lawyers offices…politicians’ offices…teachers’ offices…taxi drivers’ windows…every farm house should have it posted in the window…every hairdresser’ workplace…every truck driver’s…every gas station…every government bureaucrats’ office should have it posted at their door…every store…restaurant…bar…should have the owner’s net income posted…every journalist….every newspaper editor…political activist…Reductio ad absurdum…why stop there…every citizen should carry a tag with their net income recoded on it to be checked by whomever…tattooed perhaps on their foreheads.
Why should anybody be allowed to walk the streets with incomes kept confidential according to the logic of those pushing the publication of doctors incomes? …gross incomes at that , pretending that they are net….the only people that matter….the government and the tax department, know the MDs exact income to the doctor’s last cent….and demand and take their cut….not to mention claw backs of earned incomes on top of that.
Why focus only on MDs who are forced by law to bill and receive their monies only from the government?
There is a huge mass of those whose incomes are hidden altogether from the public view…with no one agitating to have them uncovered…captive MDs are easy targets for the investigative media playing the game of identity politics , envy and hatred generation.
Let them start poking their noses into the incomes of those prospering in the dark and sordid underworld who won’t roll over passively and see how courageous they really are.
The confusion would come from the fact that e.g. teachers or politicians will never provide their full cost to the society (offices/staff, benefits, pensions, educational costs), while for Doctors is all will be lumped together (billing), but presented/perceived as “income”. Can be compared to an elementary school principle with ~15 mln/year “income” 🙂
And the general public will never remember/admit the fact that the doctors were FORCED (and actively resisted but failed) to become the taxpayer – funded “public servants”, though would prefer to remain the independent practitioners like dentists or vet’s, who do not “owe” anything to anyone, except for the mutual respect.
Great comments, Andris and Alexey!
Andris, you said, “…captive MDs are easy targets for the investigative media playing the game of identity politics , envy and hatred generation.” Exactly. I cannot see how one profession can survive after 50 years of continual slander and attack from Canada’s largest circulation newspaper. Lies are believed when they get repeated often enough.
Alexey, you make a good point about all the costs that go into hiring one FTE teacher or politician. No one ever sees those costs: office, staff, supplies, continuing education, travel, pension, benefits, holiday, etc, etc. We also have to remember that the replacement cost of 1 FTE salaried worker always includes the cost to pay for the same work when the worker is away. So our nurse practitioners may get a salary of $95k but the cost to have full time NP services available is closer to $150k. A big chunk never goes to the NP. People don’t realize that a similar big chunk comes out of doctors’ billing that goes far beyond line items listed in ‘overhead’ (e.g., management, staff training, supervision…all ‘expenses’ that do not show up on a balance sheet because most docs do it in their spare time).
Someone said it well on FaceBook: We need to aim to be unnoticed. That will mean shifting time away from work spent in OHIP. That won’t help patients.