The publishing of OHIP physician billing by Ontario doctors in @torontostar has been on my mind. I have a lot of thoughts to share about this topic and mixed feelings about how everything has unfolded. THREAD

The principle of transparency is a good thing. Democratic societies need to scrutinize the use of public funds as a mechanism to ensure accountability and to guide wise stewardship of public resources. /1

However, It is dangerous that the dominant discourse on this issue paints doctors with the same broad & negative stereotypes: greedy, overpaid, privileged, etc., It is also unfortunate that the billing database was published by a news corp under a paywall instead of govt. /2

What purpose does the narrative of demonizing doctors serve? Perpetuating mistrust harms health. It harms patients. It poisons society. No one wins when we fuel the fire and encourage the worst stereotypes we have about one another. /3

Data is useful yet gross billings is a very small piece of the puzzle. We need much more information to help us learn about billing variation and practice variation so that we can implement much needed payment reforms with the goal of system improvement. /4

Some doctors are billing because they work very, very hard. Some are likely conducting fraudulent practices, others work very hard yet the fee system is rigged against them. Broad generalizations are largely unhelpful unless we have more data and context. /5

I am a psychiatrist. We bill the lowest. Our system pays a lot less for psychiatric care than other type of care. I believe this is because of structural stigma and prejudice against mental illness/addiction…Yet even within psychiatry there are dramatic inequities. /6

From the limited data we can see that some psychiatrists are billing much more than others. For example, adult psychiatrists bill far more than child/geriatric psychiatrists. What does this mean for prevention & early intervention? What does this mean for patient outcomes? /7

Instead of pointing fingers at one another and sensationalizing the issue, I hope we can pause and re-orient ourselves towards a collaborative and respectful conversation about where we go from here. /8

I hope we can lean into this data and leverage it for meaningful change.

I hope that we can work TOGETHER to build a better system.

I hope that we avoid negative stereotypes and improve trust.

With trust comes compassion;

and compassion is what heals a broken system.

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