Over the years, I’ve developed a reputation for having a somewhat negative attitude towards bureaucracy. It will probably surprise many to know that I actually do try to keep an open mind and to understand the needs and the role of bureaucrats. Unfortunately, every time I think that I can reach some sort of detente, the healthcare bureaucrats in this province will do something so egregiously stupid that we’re back to square one.
Such it is with the latest move by the Provider Services Branch (PSB) of the Ministry of Health. They’ve aggressively sent a number of letters to family physicians in this province claiming that they work a “high number of days in a single year.” My thanks to Dr. Stewart for providing me with a copy of one such letter.
Look, I’m an Ontario taxpayer. I support a fair process to ensure that taxpayers’ dollars are well and appropriately spent. As loathed as I am to admit it, there are rare cases where physicians bill OHIP inappropriately. Those physicians are a disgrace to the profession as a whole, and will get no sympathy from me.
However, it’s one thing to try and root out fraud. It’s another thing to accuse a physician of fraud, and threaten “further review,” without clearly articulating which specific billing pattern is a concern. The PSB didn’t lay out how they chose doctors to attack. When the CBC tried to contact them, a spokesperson said it “could be” for working more than 15 hours or seeing a 100 patients in a day. The PSB ignored the CBC’s request to clarify how they identified physicians to harangue.
That’s not good enough if you are going to accuse someone (anyone) of potentially fraudulent behaviour.
Here’s the thing that the PSB clearly doesn’t recognize. Family physicians in Ontario work three hundred and sixty-five days a year. We don’t see patients 365 days a year of course. But Family Physicians like myself will log into our systems daily (about an hour each day in my case), everyday, simply to keep up with the sheer volume of reports, messages, requests for prescription renewals, and so on, that come into our inbox. (I have not gotten such a letter……yet).
This is why the Ministry of Health bureaucrats agreed to create a funding system for family physicians where they are actually paid to do administrative work. Additionally, the model is specifically designed to get family physicians to work in their offices, to see patients, so that patients don’t wind up in other settings (e.g. ERs). There are many issues and concerns with this model, but that’s a topic for another day.
Essentially, the bureaucrats have said “okay, do admin work when you can, and see patients more often.” Yet when physicians go ahead and do that, they are now accused of potential fraud. Frankly, physicians should be thanked for working so hard to keep up to health care demands.
I’m not surprised that the PSB is behind this. This is the same branch that has gone after Dr. Elaine Ma (as I’ve written about before) for allegedly inappropriately billing during her mass vaccination clinics for COVID at the height of the pandemic.
After protracted back and forths between the Ministry and Dr. Ma – the whole ridiculous mess went to Divisional Court. The main reason given by the PSB to the Divisional Court for why she shouldn’t have billed the codes she did was – there were “no extenuating circumstances” to justify it. Yup, you read that right. The whole country being in the midst of a (hopefully) once in a lifetime pandemic was not an extenuating circumstance according to the PSB. The District Court judge strongly begged to differ on that point. Frankly, anyone with an IQ over 80 would differ.
Fun fact, I knew there was no hope of me getting a freedom of information act request done, so I asked both ChatGPT and Claude to do an estimate of how much it has cost Ontario taxpayers to persecute Dr. Ma. Both guessed around $330,000 to date, and keep in mind the case is still ongoing. My full AI prompt will occur at the of the blog. I would simply point out that you could get up to four nurses for that amount of money.
What does this mean for Ontario?
The story has already spread across the country (much like Dr. Ma’s has). In particular, Dr. Adam Stewart has a wonderful video explaining this mess, that colleagues across the country have seen and told me is…..badass. I encourage you to watch his excellent explanation:
This once again creates an impression of Ontario as an unfriendly jurisdiction for Family Physicians to work in. Medical Students may also wonder about why they would go into a field where dedication to patients (which they have in spades) will only lead to moral injury.
What does this mean for the Ontario Medical Association (OMA)?
To its credit, the OMA has taken a strong stance against this. In particular, OMA President Dr. Rebecca Hicks has clearly, and very eloquently outlined just how harmful this letter is, not just to physicians, but to health care overall. The OMA is also demanding an apology, which is absolutely necessary. (Don’t forget to demand one for Dr. Ma as well).
However, one message I tried to convince the OMA of when I was in leadership roles, is message that needs to be highlighted again. The bureaucrats are not our friends. In response to some of my previous blogs, particularly that one, I got messages from OMA leaders that “relationship with government has never been better” and “we are working closely together”. Sorry, but this is, and always will be, nonsense.
The OMA has to work with health care bureaucrats. No questions there. They have to talk to them, come to agreements with them, try to implement policies and processes with them.
But never, ever, ever think that the bureaucrats are on your side, or actually like and respect doctors. They have their own agenda at all times and should always, always be viewed with just a little bit of suspicion.
Hopefully that message will get through to the current leadership.
Addendum:
This is the AI prompt I used to estimate the cost in taxpayers dollars to persecute Dr. Elaine Ma: “In Ontario, a physician, Dr. Elaine Ma has been accused of wrongful or erroneous billing by the Ministry of Health. Her case dates back to 2022 and has been widely reported in the media, particularly the media in Kingston, Ontario her home town. Review all the publicly available information about her case. Estimate how much money the government would have had to spend to carry on their dispute with Dr. Ma. Include time to review the case, time to appeal, the recent court decision that sent part of the case back. The cost should include the amount spent on employees/lawyers/court fees and all relevant costs for the government. An exact number will not be possible without a Freedom of Information Act request – but give a reasonable estimate.”
