The Reminder is making its archives back to 2003 available on our website. Please note that, due to technical limitations, archive articles are presented without the usual formatting.
Why would the Manitoba government launch a probe into an activity that is not only legal and commonplace, but also directly sanctioned by the province itself? It wouldn't, of course, but that's exactly what a linguistic snafu has CBC News viewers and readers believing. Last week, CBC Manitoba aired a three-part investigative piece detailing some of the public discontent with the Flin Flon General Hospital. Allegations of serious and fatal misdiagnoses, stories of scared residents driving to other communities for care, and questions about the safety of 24-hour ER shifts were all explored. These are all important, emotional topics worth delving into, as The Reminder has also done in recent years. But things got misleading when CBC examined how Flin Flon ER doctors are serving in multiple roles at once _ and, more crucially, how they are compensated for doing so. CBC rightly pointed out that in some if not many cases, a single doctor is looking after our ER while simultaneously acting as the hospital's on-call obstetrics doctor, on-call neonatal doctor and hospital physician of the day. They also noted that for each on-call duty an ER doctor assumes, the more he or she earns. Working as the on-call obstetrics physician, for instance, brings another $468 for a 24-hour shift. What CBC did not reveal, and probably did not know, is that the practice of one doctor serving in multiple roles at once is perfectly legal and, in small-town hospitals across Manitoba, quite customary. So is that doctor's being paid extra money to do so. But that wasn't CBC's biggest mistake; their choice of terminology was. CBC took to referring to this legal and common practice with terms like 'double billing' and 'quadruple dipping,' probably unaware that those terms carry very specific meanings. 'Double billing' and 'double dipping' do not mean 'getting paid for two different jobs performed at the same time,' as is the case with the ER doctor who is also on call for another department. No, those terms actually mean 'charging the government twice for the SAME job,' something that is quite different _ and highly illegal. The term CBC should have used is 'layered stipend.' This self-explanatory term means that for every 'layer' of a doctor's contract _ on-call duties, for instance _ he or she will be paid a new stipend. 'These stipends are provided whenever a service is being provided as per the Doctors Manitoba (union) agreement negotiated with (the provincial government),' Northern Health Region CEO Helga Bryant told me. Evidently unaware of any of this, CBC asked Health Minister Theresa Oswald what she thought of this 'double billing' _ while really meaning 'layered stipend payments' _ happening at the hospital. A spokesperson for Oswald, thinking that 'double billing' really meant double billing, naturally responded by saying that 'double-billing is never acceptable.' And so was born an eye-catching headline for CBC to close out its three-part series: 'Manitoba to probe Flin Flon MD double-billing allegations.' Only there were no 'double-billing allegations' made in any of CBC's extensive coverage. There were 'layered stipend allegations,' and they were not allegations but merely facts about how the provincial government pays doctors for services rendered. In essence, CBC asked Oswald about apples and her department answered by talking about oranges. All because of an undoubtedly innocent misuse of terminology on CBC's part. As a result, the province will apparently look to see whether Flin Flon doctors have been double-billing instead of layered stipending _ even though no one has claimed this is happening. Such a review is not necessarily a bad thing. It never hurts to be extra careful with taxpayer money. But the harm is that much of the public now erroneously believes that something illegal and sinister is happening with physician pay in Flin Flon. Important CBC left out another important piece of information in its report, which is this: ER doctors who are on call in other areas of the hospital must have a back-up physician ready to come in in case they are needed in two places at once. So, contrary to the impression viewers and readers walked away with, Flin Flon doctors are not expected to split themselves in two to deliver a baby on the maternity ward while suturing an accident victim in the ER. None of this is to say that having an ER doctor serving in up to three other on-call roles is ideal. Would it be better to have more doctors around the clock at the hospital? Of course. How could it not be? As chair of the local Concerned Citizens Health Care Committee, Thomas Heine has long advocated against doctors being given double duties. 'An ER doctor should never have another responsibility that he has to meet (while on shift at the ER),' Heine told me Monday. 'This is a real recipe for disaster.' Of course patient safety is not the only element at play in this debate. Many taxpayers, for instance, feel that if an ER doctor is already at the hospital and able to fulfill other on-call duties, then he or she should simply take on those added duties at no extra cost. Or why not, they ask, just pay the doctor for extra duties if and when they are required? Why pay someone to be on call to deliver a baby if no baby is born? Manitoba Liberal leader Jon Gerrard, himself a physician, certainly sees a problem with the status quo. He told CBC that he wants the province to change how doctors bill for their services so that they can no longer attach multiple stipends to their daily pay. But would Gerrard's proposal damage physician recruitment and retention efforts in small communities? Is 'we'll pay you less for the same work' a good recruiting slogan for doctor-starved hospitals? That said, Gerrard isn't alone in questioning physician pay, particularly now that CBC has revealed that total earnings for several Flin Flon doctors totalled between $700,000 and $900,000 in the 2011-12 fiscal year. That's substantially higher than ER doctors in Winnipeg who were required to disclose their pay. CBC noted that the highest-paid of these physicians made $578,000 in 2012. I have never known how to put a price tag on doctors, particularly the relative few who choose to work in small northern communities such as ours. What I do know is that following the CBC report, the debate over health care in Flin Flon _ whether it measures up, whether it is improving, whether its problems are unique or universal _ is not as over as I once thought it was.
