Sensationalism+

Montreal, April 27, 2016La Presse+ headlined its front page "$2.4 million for a single physician" (2,4 millions pour un seul médecin). And, in the article signed by Ariane Lacoursière, a breakdown was included entitled "The 25 best-paid physicians in 2015" (Les 25 médecins les mieux rémunérés en 2015). The information was, of course, taken up by several news channels and commented on the spot by the Minister of Health. "This is a perfect example of a sensational news item and its easy political recycling," declared the President of the Fédération des médecins spécialistes du Québec (FMSQ), Dr Diane Francœur.

"NO, the total remuneration [of these 25 medical specialists] does not reach close to $50 million," explained Dr Francœur. Why ? Because billings by physicians are not limited to their own remuneration, but also include the technical component associated with them, according to their medical specialty. "In the case of the so-called physician earning $2.4 million, the technical component represents close to 80% of this amount. In clear terms, this physician earned 20% of his total billing to the RAMQ."

"YES, this physician worked a lot, more than the average for his specialty as a matter of fact, because his practice was in his office where there were neither limits nor restrictions on his working hours... contrary to what happens in hospital centres. Are we now going to reproach him for seeing too many patients ?" worries Dr Francœur. In this specific case, the billing of one cycle of in vitro fertilization amounts to $4,850, out of which $3,700 apply to technical fees (embryologist, egg harvesting equipment, incubators, freezers, etc.), which represent 77%. This then means that $4,850 was billed to the RAMQ in the doctor's name, but that he will receive $1,150 in remuneration, which is an amount similar to what he would receive if his remuneration came from a hospital.

As for the Minister of Health's comments regarding this erroneous news item, after more than seven years at the head of the FMSQ, he knows only too well how the remuneration of medical specialists works. He knows the difference between billing and remuneration. As for his invitation for us to reflect on the fee schedules and their management, that is exactly what the FMSQ has been striving to do since he left the position. "We all remember that, because of his political ambitions, he left the organization with great precipitation. And yes, an extensive clean‑up was needed !"

"In cooperation with the Presidents of the medical associations affiliated with the Federation, we check into what is happening in the field. We evaluate the practice profiles of physicians," adds Dr Francœur. What does a substantial billing correspond to? Is the medical specialist in question the only one to practise in a given region? In what kind of environment does he practise? Is he the only subspecialist in his field? What kind of procedures does he perform? Are there any absurd differences between the number of procedures performed and those that are billed ? Are there medical specialists who see too many patients in a given period, going against good practices, because in medicine too speed has its limits.

"Since I took on this position, I have mobilized our people and launched numerous projects so that we can equip ourselves with the mechanisms and tools we need to evaluate and follow up internally. My objective has been to make sure that public funds are used for the right purposes and that a maximum of care is dispensed to patients. Disinformation will not win over my determination," concluded the President of the FMSQ.

The Fédération des médecins spécialistes du Québec represents more than 10,000 medical specialists certified in one of 59 recognized medical specialties.