Billing disparity

The MSP blue book gives some idea of how much our colleagues billed to MSP from March 2011 to March 2012. Copies can be ordered or viewed on the web at The numbers are fascinating and, at times, mind boggling. Disparity in physician income has been a problem in BC for as long as I have been practising (42 years) and the BC Medical Association has been incapable of solving the problem.

There is a small community of 8000 (with surrounding area the total population is 15000) 2 to 3 hours’ drive from Vancouver that has five GPs, according to the 2011–2012 medical directory. It seems some of them are very hard working—toiling 24 hours per day with no time for eating, sleeping, etc. According to the blue book, one GP in that community has billed the MSP $1 204 796, one GP over $700 000, and two GPs over $600 000—some 30% more than the previous year. 

The Section of General Practice should pay attention to these figures. The GP of the year has made one-sixth of these figures. I know many hardworking GPs in the Lower Mainland who work 50 to 60 hours per week who also bill the plan only one-fifth or one-sixth of these figures. Of course there are also GPs and specialists in the Lower Mainland who have billed the plan $600000 to $700000. Glancing through the pages of the book one can see that a lot of doctors have been billing the MSP over $1 or $2 million, and a few close to $3 million. The disparity in billing amounts among specialists is also shocking.

It is time for the BC Medical Association to take definitive action and address this disparity in both GP and specialist billings. Sooner or later the government will take action and it will be too late for whining and complaining. If the government decides to publish the blue book as they have done in the past the public would not have any sympathy for BC physicians. 
—Ebrahim Rafi-Zadeh, MD
North Vancouver

The Medical Services Commission financial statements (the blue book) are available online at

Ebrahim Rafi-Zadeh, MD,. Billing disparity. BCMJ, Vol. 55, No. 1, January, February, 2013, Page(s) 8-9 - Letters.

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Gerald Tevaarwerk says: reply

It would be interesting to see if high billers translate to superior healthcare outcomes. We badly need a system that rewards measurable health and disease management outcomes, not just rewarding process. Both the UK and US have initiated such systems. With it we might examine the high billers and possibly find that their effect on the overall health of their patients justifies their high rewards. Or not.

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