In early September 2020, the Government of Alberta released regulations on physician payment disclosure in what is promised to be “the most comprehensive disclosure of physician payments in Canada.”
These regulations are in line with the Alberta Health Care Insurance Act (AHCIA), which requires the Minister of Health to disclose all amounts paid to a physician for medical services on a “fee for service” basis annually, beginning with the fiscal year ending March 31, 2018. The Minister of Health is given discretion to disclose the following information:
- The name of the physician;
- The location in Alberta where the physician provided the majority of the insured medical services;
- The area (or areas) of medicine in which the physician has received a specialist training and in which the physician provided the insured medical services;
- The total number of individual patients, excluding repeat visits, to whom the physician provided the insured medical services;
- The total number of days during the fiscal year on which the physician provided the insured medical services; and
- The name of any organization to which an amount was paid and the total amount paid to each of those organizations during the fiscal year.
Unless a specific exemption is met, this information should be made public by November 9, 2020. Interestingly, one of the exemptions for physicians who wish to have their names excluded from the list is if the Health Minister believes that the disclosure of the information could “unduly threaten the safety of the physician” or if other criteria are met. However, no other criteria have been established, meaning the only way a physician can currently be excluded from publication is by establishing that the release of their payment information could unduly threaten their safety.
The onus is on the applicant to set out the facts that demonstrate the potential undue threat to his or her safety because of the payment disclosure. Such examples that may pass muster include: long-standing harassment, spousal abuse or stalking issues; and specific and credible threats against their safety where the disclosure could be linked to the threat. Exemptions are less likely to be granted if the threat appears purely speculative, if the applicant’s name is already on an employee list (especially if salary ranges are already public or readily accessible) or on a list by a health entity, or if the applicant is merely opposed to the concept of payment disclosure.
Dr. Christine Molnar of the Alberta Medical Association argues against making this information public. “From my point of view, it’s more about naming, shaming and blaming than it is about transparency,” Dr. Molnar stated, worried that the information may mislead patients as it just reports gross payment and doesn’t account for purchasing equipment, leasing office space, or paying staff. Additionally, she mentioned that overhead costs cannot be assumed to be the same across the board, as some specialists will have significantly higher overhead costs than family doctors.
Dr. Tom Noseworthy of the University of Calgary has a storied history in medicine: he has been a physician, a hospital CEO, a professor, and an Alberta Health Services executive. When he became a professor at a university, his salary was made public and he was okay with that. However, he acknowledges that doctors are upset about this particular disclosure “because they think the public is not able to discern gross from net revenues.” Even still, he seemed to cast some support the idea behind this transparency push, having a hard time with the income discrepancies even within a family practice (some doctors making $225,000 while others make over $1million), saying, “I know exactly what they’re doing to make a million bucks. I used to be a family doctor, too. Do I want that kind of medical practice? No. Do I want to be a patient in that kind of medical practice? No.”