The Auditor General published her Annual Report today, which focused to a large extent on payments to physicians. We welcome public scrutiny of physician payments, particularly when they are provided in context.
The Auditor General's report discussed physician payments at length. As she notes, her numbers are total gross billings, which is a dramatically different figure than what doctors actually earn. Fee-for-service doctors pay their own staff, their own medical equipment, and the usual costs of running a professional office; they also don't get a pension, maternity leave, or health benefits like most New Brunswickers. This overhead is estimated at over 40% across Canada, but can be even higher for some high-billing specialties, who typically use million-dollar pieces of equipment - that they buy themselves.
While much was made about the less than 1% of doctors who bill more than a million dollars per year, it is important to see both sides of the issue. Keep in mind that most of these physicians lose almost half their income to practice-related expenses like full-time staff, their benefits, ongoing medical education, insurance, office expenses, information technology, etc. The average billing for GPs is less than average amounts from several other Canadian provinces who are currently slashing physician fees. Some specialties do make more than others, which often reflects the tools they use, the education they need, and the hours they work. Government has negotiated these contracts jointly with the NBMS, and we believe most New Brunswickers agree that it is important to pay highly-trained, highly-skilled professionals a fair wage.
Physicians did not create the government's billing system. We have to bill according to the requirements of the government using a system originally created in the 1980s that is antiquated, out of date, and badly needs to be updated.
The AG noted that our billing system relies upon the honour system, as does every other province in Canada, and that doctors sign legal agreements that they will abide by this principle. She notes that doctors understand and receive documents on how to bill properly before they can even begin their practice in New Brunswick. Therefore, we strongly object to her report of a Department of Health staff telling her that there is no incentive for doctors to bill properly. Every physician could be subject to audits, to sanction by our professional body, and held to our professional and ethical obligations. Any physician who may have misinterpreted the guidelines and rules associated with the Medicare fee schedule is subject to review by the government.
We note several examples from her report that show that doctors do want to bill properly. For example, salaried doctors are now required to shadow-bill, a process that informs the Department on their activities. After proper education and efforts have been made, the number of physicians who successfully comply with this requirement has gone from 35% to 96% in two years. She also notes that radiology billings are largely exempt from audit; we have been trying to fix this through a process that we have been driving with government for over a year.
For that reason, we appreciate the Auditor General's encouragement to the Department of Health to continue to improve their ability to properly assess physician claims. We believe this is in the best interests of physicians, the public, and the patients of New Brunswick. We have been active partners in trying to improve the billing system and will continue to take this approach in the days ahead.
Robert Desjardins, MD FRCPC
President, New Brunswick Medical Society