opinion: sunshine list for alberta physicians is good governance

is health minister tyler shandro’s plan to make public all payments to alberta medical doctors part of his strategy to control physician pay? that’s obviously the case.shandro argues that alberta physicians are the highest paid in canada and that their pay just keeps rising, even as government revenues stagnated, then crashed. publicizing the payments — some of them in the millions of dollars annually — to individual doctors will highlight just how much money they get.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,” she told me in a recent interview.molnar worried that the information would mislead people because it reports just the gross payment, which isn’t close to a doctor’s take-home pay. it doesn’t account for buying equipment, paying for office space and paying staff.the information is also misleading because not all doctors have the same overhead costs, molnar noted, with some specialists having far greater costs than family doctors.molnar’s points are fair enough, but as shandro points out the alberta government rightly releases information on payment to all private contractors, from small roof repair outfits to massive information technology companies. at the same time, the government doesn’t release information on expenses from those same contractors, because that is their private business and up to them to publicize.in weighing the pros and cons to the public of this “sunshine” list for payments to doctors, the biggest issue at play — something more important than the current pay dispute — is that our health-care system lacks basic accountability and transparency.simply put, albertans deserve to know where their tax dollars are going and what are the outcomes.making public payments to physicians is part of this essential transparency. it helps taxpayers decide if their money is well spent. it also might help make the health-care system more efficient, maybe by highlighting outliers, both physicians not getting paid enough and physicians getting paid too much.if you think shandro and the ucp are out of line, are you aware that in 2015 rachel notley’s ndp government first brought in legislation to make payments to individual physicians public?in 2016, the ndp released a list of the top 10 billing doctors in the province along with their specialities, but it didn’t name them. the ndp never did finalize regulations in this regard, but five other provincial health-care systems — ontario, british columbia, newfoundland and labrador, manitoba and new brunswick — make public both the name of the doctor and their payments. b.c. has done so for about two decades.i recently took a deep dive into the doctor pay dispute, and asked health-care expert dr. tom noseworthy of the university of calgary, who has been a doctor, hospital ceo, professor and alberta health services executive in our system, for his take on publicizing payments to doctors.when he became a university professor, his salary was disclosed and he was fine with it, noseworthy said. “here’s why the doctors are upset about it, because they think the public is not able to discern gross from net revenues.”but noseworthy said some doctors are major outliers, with most family doctors making $225,000 but some taking in more than $1 million, which he finds hard to accept. “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.”ndp health critic david shepherd said shandro’s ucp brought forward the sunshine list suddenly and as a trap because listing the gross amount could indeed mislead the public.at the same time, shepherd notes the ndp also pushed for a sunshine list. “i certainly think that’s a reasonable provision.”noseworthy harshly criticizes shandro for breaking trust with alberta doctors by tearing up the old agreement with physicians last february. but with physicians’ pay high and alberta’s revenues low, noseworthy said it’s time for physicians to accept a cap on their pay.“it does need to be cost-controlled. but do it as if it were a surgical procedure, rather than with a machete.”this sunshine list is part of a reasonable approach to controlling costs and improving efficiencies. such transparency is standard with almost all alberta government payments to contractors and it’s done with doctors in other provinces.it’s no machete, it’s an everyday tool of sensible governments and useful for accountability in public systems.dstaples@postmedia.com