President's Letter
Dear Members:
About 1,300 physicians registered for an AMA webinar last Friday entitled: Living with the Sunshine List. Government has said it will release the list on or before November 9. A recording of the webinar is available on the AMA website (member login required). Below is some key content for those who may not find time to watch in the next few days.
AMA’s messages
Alberta physicians provide excellent value. Taxpayers have a right to know where their dollars go. We don’t mind people knowing how much we bill the health care system, but we don’t want Albertans to think we earn more than we do.
As you are well aware, gross payment data is grossly misleading. We have already released the document Context Matters that explains the factors that go into the numbers that the public will see (e.g., overhead, hours of work, extra training/shorter career length, economic contributions as employers, etc.).
The AMA sought legal counsel when the payment disclosure legislation relating to physician payments was passed in 2015. The advice we received is that it is in government’s purview to release this information and that there is precedent in a number of other provinces.
If the objective is transparency, then information on the range of payments by specialty (from the lowest to the highest) is already publicly available in the Alberta Health Care Insurance Plan statistical supplement. We feel that publishing the names of individual physicians is unnecessary for transparency and merely crosses the line into curiosity.
About the exemption process
There are physicians who will be facing significant security concerns when the gross payment information is made public.
There is an exemption process and physicians were given three weeks to apply for an exemption for November’s release. The “bar” is set very high for approval. Physicians must make a compelling case that the disclosure will unduly threaten their safety, or perhaps the safety of their families. The AMA has helped some of these individuals with their applications. The deadline to submit an exemption application closed on October 7.
We understand that very few physicians who have applied have heard about the status of their exemption requests. We have been told that all physicians who applied will receive a response to their applications and will not have their information disclosed until a response has been provided. Any exemptions granted are good for five years. There is currently no appeal process. Physicians may reapply for exemption each year by January 1.
The Sunshine List for government employees and contractors is released in the spring and government has indicated that physician billing information will be re-released at that time, possibly along with payments from other programs. If you missed the deadline to apply for an exemption there will be another opportunity to apply to be exempted from the spring release; this deadline is January 1, 2021.
Planning for conversations
Curiosity is to be expected. To help you get ready for questions from patients or people in your community, we suggest preparing some figures about how much you spend each year for staff, rent, utilities, PPE, infection prevention and control, professional licenses, etc. You can use a rough percentage or some actual dollar figures. Consider relaying your real-life experience, for example, “I don’t take home anywhere near that amount. That number is the total amount that I bill for all the patients I see. You need to subtract about half/40% or more off the top.”
The experience elsewhere
Sunshine Lists for physician payments have been a reality in some other provinces for years. The experience there is that most of the attention is concentrated around the time the updated list is released annually – and little more than that. I am not trying to dismiss the concern you may be feeling now, but I want you to know that our colleagues in other provinces have also had to accept this.
We hope that this information will help you to prepare at a personal level, particularly in this first year of the experience. This first time may be a challenge, but we will get through it together.
The release of the Sunshine List is one more stress in an already chaotic year. Please ensure that you take care of yourself as you look after others. Reach out to the Physician and Family Support Program 24/7 at 1.877.SOS.4MDS (767.4637).
Your comments are welcome in the following ways:
- Communicate with me privately and directly by email if you would like a reply: [email protected]
- Comment publicly on this President’s Letter on the AMA website (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member).
Sincerely,
Paul E. Boucher, MD, FRCPC
President, Alberta Medical Association