Quebec�s family physicians,
specialists, residents and medical students have until Sept. 30 to
convince provincial Health Minister Fran�ois Legault not to let
bureaucrats from regional health councils to decide how, where and when
they may practise.
On Aug. 22, Legault notified the 4 federations
representing the province�s medical professionals that he intended to
amend the Health and Social Services Act on Oct. 15. Under his proposals,
all Quebec physicians would have to sign a 2-year �commitment,� subject to
automatic renewal, that would turn them into employees of regional health
boards.
�These proposals are in no way acceptable,� says Dr. Jean
Rodrigue, director of communications with the F�d�ration des m�dicins
omnipraticiens du Qu�bec (FMOQ). �The minister�s intention is to draft
every physician in Quebec into the public service.�
The regional
boards would determine the type, location and hours of practice for each
physician within their jurisdiction. Physicians who fail to fall in line
would face stiff penalties, and physicians practising outside their
�assigned jurisdiction� would not be paid. Doctors operating an autonomous
business in unsanctioned areas would have to bill their patients directly
for services.
Dr. Stanley Vollant, president of the Quebec Medical
Association, says that based on its track record, he has no faith that
the government will be able to administer the plan effectively. And, he
adds, the government has put no counter offers on the bargaining table to
address poor working conditions, lack of access to facilities and other
problems.
�There is a complete and deliberate loss of choice,� adds
Rodrigue. Physicians would no longer be free to choose their place and
scope of practice. And, he warns, under the new plan, physicians would owe
their allegiance to the government, and this will undermine physician
advocacy on behalf of patients.
He says the new proposals are so
unreasonable that the 4 federations have flatly refused to discuss them.
Instead, they are sitting down with government officials to explore
alternatives.
�Doctors in Quebec will not accept that our status
will be different from the one doctors have across Canada and in the
United States,� emphasizes FMOQ President Renald Dutil.
The
federations �will take any action necessary to prevent those proposals
from becoming law,� says Rodrigue. �We hope to convince the minister that
this is the wrong way to ask for the collaboration of
physicians.�
These negotiations have ramifications for all Canadian
physicians, warns Rodrigue, because if the Health and Social Services Act
is modified in the way Legault proposes, �it will leave very little room
for negotiation.� And it could also have a domino effect across the
country.
Legault�s new proposals follow the passage of Bill 114,
Quebec�s hotly debated emergency-medicine legislation. The law was adopted
July 25 after a Shawinigan man died en route to hospital after being
turned away from a closed emergency room near his home.
As of Sept.
13, bailiffs � operating under the auspices of Bill 114 � had ordered
about a dozen physicians to report for 14 emergency-room shifts at
hospitals in Shawinigan, Dolbeau and Jonqui�re.
Meanwhile,
physicians complain that the province has made little effort to solve the
administrative and bureaucratic problems that led to the emergency-room
staffing problems, and has done nothing to cap the working hours of ER
physicians, putting public health at risk.
Dr. St�phane Ahern,
president of the F�d�ration des m�dicins r�sidents du Qu�bec, says the
legislation is dangerous because several US studies have shown that
working more than 30 hours per week in an ER increases the risk of medical
error.
At some hospitals, doctors who used to volunteer for ER duty
are now hanging back so that they won�t be overworked if drafted to serve
elsewhere by a health board. Not surprisingly, the health boards are
finding it difficult to attract new graduates in regions where the
bailiffs are active.
In one incident, the Saint Maurice health
board tried to force Dr. Pierre Bareil, who lives in Cap-de-la-Madeleine
but works in Quebec City, to cover 3 emergency-room shifts in that region
on days when he was already scheduled to work elsewhere. Only phone calls
from those institutions got him off the hook.
Faced with the
prospect of even more stringent legislation, Quebec physicians are on the
verge of losing hope. Vollant predicts an exodus. �After practising in
Quebec for 5 or 6 years, many of my colleagues in Baie Comeau are planning
on taking the Canadian and American exams.
�We already have
shortages of physicians and specialists in Quebec,� he says. �If more
doctors leave the province, the situation will be unliveable.�
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