Keep doctors off Ontario’s Sunshine List

Posted on April 7, 2016 in Governance Debates – Full Comment
April 7, 2016.   Francesca Grosso, National Post

Ontario doctors can’t cut a break right now. Their negotiations with government are not going well. And there is a renewed interest by media and others demanding that all doctors be included on the Sunshine List of Ontarians receiving salaries of more than $100,000 a year, paid by taxpayers.

Recently, Michael Decter, a former Ontario deputy minister of health, gave the CBC an interview in which he argued that every physician should be part of the already 115,431 names on that list, as doctor billings are paid for by the public. I have known Decter for ages. We wrote a book together. We both sit on the board of Patients Canada. When it comes to public policy, he’s usually right. On this occasion, I disagree. Here’s why.

The public has a right to know which doctors are billing obscene amounts. But the Sunshine List is not the place for disclosure of physician billings. Officially called the “Public Sector Salary Disclosure Act” it was intended to capture exactly that: salaries of more than $100,000. It was never intended to capture billings of those like doctors who hire staff, pay rent and maintain offices with that money. If that had been the intent, the threshold would be much higher.

Billings and earning are very different things. Consider a family doctor who bills $300,000 a year. With that $300,000, she pays for a secretary, a nurse who comes in once a week, a modest office, which she shares with another doctor, insurance and all business expenses. A public-sector employee earning $300,000, though, has his office, business expenses, pensions and benefit contributions paid for with taxpayers’ money.

The doctor and the public servant don’t earn the same thing. Reporting these both at $300,000 does not provide the public with an accurate picture or appropriate context. Nor is it fair to compare the earnings of salaried doctors with other doctors who pay for their own practices out of their billings.

We need to compare apples to apples. You cannot fairly lump in total revenues of a contractor or corporation before expenses alongside the pay of salaried individuals. Period.

I’m not against disclosure, but we need a real conversation about how we properly disclose corporate billings. Expanding the Sunshine List to cover all who receive public money won’t serve the public interest, because we risk giving Ontarians an extremely distorted view of how much people are actually making; demonizing certain professionals because the numbers do not provide proper context; and enabling lobby efforts to increase the pay of salaried workers who will, no doubt, look like poor cousins next to those whose billing are used also to support their operating costs. That is not transparency or good public policy.

The Sunshine List itself is in dire need of modernization. The threshold amount of $100,000 should have been indexed over the 20 years of its existence. For improved transparency it needs to be updated, badly. With more than 115,000 names on the list in pages upon pages of tiny print, it does not truly highlight the highest earners and outliers. Here is a good example: over the past years, salaries for community care access centre bosses climbed exponentially over the years without anyone really noticing. By the time these increases were finally publicly exposed, increases had already been awarded repeatedly over years.

The more names on the list, the easier it has become to hide out in the open. This clutter may serve vested interests, but not the public interest. We need a premier with the fortitude to move the threshold up to what it should be, about $150,000 in today’s dollars. That would require a courage that is uncharacteristic of government. But it would actually serve the public much better.

The Sunshine List needs to be more user friendly and focused, so it can give Ontarians a real picture of what is going on. Adding doctors to the list, especially as it currently stands, will make matters worse, not better. I am all for public disclosure, accountability and transparency. What we have now and what is being proposed is not that.

Francesca Grosso is a former director of policy to an Ontario health minister and a principal at Grosso McCarthy, a health policy firm.

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