Medical billings now public after 4-year battle by doctors association to keep them secret

For the first time ever, doctors' billing information is beingmade public, after the association representing doctors in Newfoundland and Labrador dropped a legal fight to try to keep the information secret.

In a letter to doctors, Dr. Charlene Fitzgerald, president of the Newfoundland and Labrador Medical Association, said given that such information is made publicly available in Ontario, British Columbia, Manitoba, New Brunswick and Prince Edward Island, the association's board of directors decided to withdraw its appeal.

In April 2016,CBC filed an access-to-information request for a copy of the billings for doctors. The province already discloses its highest-paid civil servants, which includes doctors on salary, but has never disclosed what it pays out to doctors who bill for each service they provide to patients.

The Department of Health and Community Servicesinitially refused to provide the information, but later agreed to release it after the information and privacy commissioner ruled that releasing the information would not be an unreasonable violation of doctors' privacy.

The NLMA went to court to try to block the information. That court case dragged on for years as it waited for a decision about a similar casein Ontario. A court of appeal decision there ruled the information can be released, and the Supreme Court refused to hear an appeal.

19 doctors billed more than $1 million

The most recent billing information provided by the province shows the billings for the fiscal year 2018-19.

Dr. Christopher Jackman, an ophthalmologist in St. John's, billed more than any other doctor: $2.8 million.

Jackman said he was not available to do an interview but in a statement he said while his billings are high, so are his costs. Hesaid more than 50 per cent of his billings go to overhead.

"To run such a medical facility he has an annual payroll of about $1 million, employing 20 staff made up of office staff, nurses, technicians, and an optometrist," his office said in a statement provided to CBC News.

Jackman said his billings are double the amount of many of his colleagues because he has a second ophthalmologist working at his clinic, but all the billings go through him.

"Dr. Jackman has chosen to invest in his province with a state-of-the-art facility that is able to provide care to patients in N.L. that is comparable to the best clinics anywhere in the country," his office wrote.

The amount of his billings do notinclude other sources of income, like non-insured procedures that patients pay for directly or compensation from Memorial University for teaching.

Like other fee-for-service doctors, Jackman is paid a fixed amount for each service he provides. From that payment he is expected to cover his own expenses.

The government data obtained by CBC shows Jackman has almost doubled his billings over the last six years. In the statement, he saidthat as the number of ophthalmologists has shrunk, he and other doctors have had tosee more patients.

Out of the top 10 billers, five of them are ophthalmologists.

Family doctors on top billing list

Two of the doctors billing more than $1 million a year are family doctors.

Dr. Anas Abdulkhaliq billed $1.6 million last year.

He works in a walk-in clinic in St. John's. He wouldn't do an interview, but told CBC News his high billings reflect the high number of patients he sees at his clinic.

He also operates a separate methadone clinic to help people with opioid addictions. That clinic employs five staff, an expense he pays for from his billings, and he also pays overhead to cover the rent and staff at the walk-in clinic.

The other family doctor who tops the list is also treating opioid patients.

Dr. Todd Young said most of his payments also went to overhead, not into his pocket.

From the $1.2 million he was paid by government, he said in a written statement,his accountant tells him $990,000 went to overhead expenses.

He said he has eightclinics around the province employing 12 people and operates a "very labour-intensive, very tech-based" provincial addictions service.

Context is important: NLMA

The NLMA said it now supports releasing the information but wants people to understand what it means.

"We think that this is important to make public, with context," said Fitzgerald.

"That's not exactly how much the take-home pay is for those physicians."

A survey of physicians done for the NLMA by the consulting firmDeloittefocused on doctors'overhead costs. It found:

• Family physicians pay on average $81,000 a year in overhead.
• Expenses for surgical specialities average $114,000.
• Medical specialists face an average overhead of $203,000.

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