TORONTO – More than 500 doctors billed Ontario’s health insurance plan over $1 million each last year, with one ophthalmologist charging what the province’s health minister called “a staggering” $6.6 million.
Of the top five billers, two are ophthalmologists, two are radiologists and one is an anaesthesiologist, but their names and where they work are not being released.
The million-dollar club included 154 diagnostic radiologists, 85 ophthalmologists and 57 cardiologists.
“It’s not our emergency room physicians who are earning this kind of money,” Health Minister Eric Hoskins told reporters Friday. “It’s not our neurosurgeons who are billing over a million. It’s a very narrow category of specialists.”
The top-billing doctors represent less than two per cent of physicians in the province but account for nearly 10 per cent of billings.
Hoskins said the current structure allows some physicians to generate income many times the average doctor’s salary, mainly because the fee structure has not kept pace with medical and technological advances.
“Now I’m not saying these doctors did anything wrong,” he said. “What I am saying is that there is an inequity in the fee code structure that has created this unfairness.”
There are “a great number” of doctors who prescribe methadone for people with opiate addictions “clustered around the million-dollar mark” in part because they are paid $35 for a urine dipstick test that cost $2 to $3, said Hoskins.
“We found that in many cases physicians were earning more than half of their total billings from that one procedure,” he said. “We pay our community labs $10.”
The province spends $11 billion annually on physician compensation, but has to find hundreds of millions of dollars more at the end of year because there are no caps on billings by doctors, who earn an average of $368,000, added Hoskins.
“Unpredictable and frankly uncontrolled billing by some doctors is a problem that leaves less for family doctors and others, squeezes our ability to invest more in home care and community care, and robs us of our capacity to responsibly plan our health care spending each year,” he said.
The Liberal government has been locked in a fight with the Ontario Medical Association, which represents 34,000 doctors and medical students, after it imposed a series of fee cuts last year.
The OMA has said the best way to get a new fee agreement is for the government to agree to binding arbitration, something Hoskins said he was willing to consider if the doctors return to negotiations, which broke off in January, 2015.
“We created a sub-committee at their request to look specifically at the issue of arbitration…and they decided abruptly one afternoon to end those negotiations and walked away,” he said. “We’ve never said no to arbitration.”
The OMA asked Hoskins on Friday to clarify his position on arbitration directly with them, not through the media.
“Ontario’s doctors have long said that strengthening patient-focused care requires a fair and predictable agreement that includes binding arbitration,” said OMA president Mike Toth. “In order to move forward with the process of meaningful negotiations, rather than negotiate in public and mischaracterize the facts, Ontario’s doctors ask that Hoskins clarify his position directly with the OMA.”