photo credits: Francis Vachon
|
Last year Quebec's specialists
mutinied during contract negotiations, resulting in
you forcing a contract on them — the hated "Special
Bill." By contrast the new deal with Quebec's GPs seems
to have gone off without a hitch. What changed?
We went through a very difficult negotiation with the
specialists but fortunately we've been able to move
out of this phase and we have a very satisfying agreement
for both parties that's going to re-establish the true
partnership between the medical federation and the healthcare
system. Both parties came to the obvious conclusion
that they could not live without one another [laughs].
It's the same strategy with the GPs. We all agreed that
Quebec physicians needed a pay hike to make them more
competitive with their colleagues in the rest of the
country.
You've said that doctors in
Quebec work about five hours less than doctors in the
rest of Canada. Are Quebec's doctors lazy? Well,
I would not judge them but what I will say is that when
we attacked the 45% pay gap between family physicians
in Quebec and the rest of the country, we applied two
indicators — the purchasing power of people in
Quebec versus the rest of the country and also number
of hours worked — and the final gap was agreed
to be around 19%.
Which means Quebec doctors work
less, so they get paid less. Of course the individual
physician reading this who feels overworked will probably
feel bad about this, but we've agreed that there's a
difference in terms of productivity. But you know it's
always surprising to me to see that doctors say they
have no room to take more patients but surprisingly
enough when there are broker systems like the Chaoulli
Group offering money to see new patients they seem to
have enough room. I pointed this out to my partners
in the medical federations and they basically agreed
with me that it's a rather embarrassing situation.
|
 DOCTORS
ASK THE QUESTIONS
Montreal
pediatrician Emmett Francoeur
You've stated you want GPs to handle more and
more cases currently seen by specialists. But
GPs are not yet well trained for many kinds of
complex pediatric cases — what will you do
about that? Our philosophy is that you have
to use the specialists for the specialist tasks.
Seeing a well baby or a healthy kid is not necessarily
best handled by a specialist. Everybody likes
to see their cardiologist or gynecologist, but
for many problems at the primary care level it's
the right way to go.
Montreal
GP Mark Yaffe
I'm pleased you've added money for family doctors,
but part of the increase is linked to us taking
additional patients. Are you willing to jeopardize
doctors' health by making us extend our hours?
Of course not! The question is not only how many
hours you work and how many patients you see,
but how you work and what is the focus of your
practice. What has been noticed is that roughly
20% of the patients don't actually need to see
a physician. So that way you free up the doctor
to see more new patients and see patients already
in his roster.
A
new medical graduate from Quebec City
The Quebec College of Physicians recently attacked
the PREMs program (which requires new docs to
work in remote areas), calling it "medical purgatory."
This policy is very hard on new doctors and it's
not solving the shortages permanently. Do you
plan to keep it? People in the regions resent
a lot when they hear someone say that practising
at $200,000 a year in their region is purgatory.
The PREMs are needed because all citizens pay
taxes and and they must all have access to care.
I don't know how this doctor can say it's not
working - we have record numbers of new physicians
now in regions that were deserted a few years
ago. The PREMs will have to stay for a few years,
until we get a sufficient number of graduates.
Montreal
general surgeon Simon Turcotte
Do you view the day surgeries that Hôpital
Sacré-Coeur de Montréal has subcontracted
to the for-profit Rockland MD clinic as a temporary
or permanent solution to improve access to surgical
care in Montreal? We see it as a longterm
solution - it's one of the first experiments in
that regard. We're going to follow it very closely
for the first six months and be sure that our
objectives are met and that financially it remains
a sound investment for the taxpayer.
A
GP from Quebec City
Don't you think doctors should be allowed to
do work in both public and private, if they are
able and willing? Physicians can always opt
out, but they have to choose. They can't be in
and out. Right now I don't think it's advisable
to move in that direction because of the manpower
problem we have and the regional distribution
problem we have.
|
Speaking of Dr Chaoulli, ever
since the Chaoulli ruling to allows private insurance
for some services covered by medicare, the other provinces
have been watching Quebec to see how things play out.
I think it's going to be a landmark for the rest of
Canada and I'd be very surprised if other provinces
don't follow suit. I'm very proud that we were the first
government to legally define the legal status of clinics
offering specialized medical treatment — we introduced
the concept of private delivery under public funding.
Have any companies come forward
to express interest in offering expanded private health
insurance yet? We've opened the door very narrowly
to private insurance in Bill 33 [Quebec's legislative
response to the Chaoulli ruling]. It's a door that's
designed to open more, but it's going to be in a very
cautious way. But, you know, the private insurance companies
don't seem too eager to embark in this market.
Recent numbers out of the Fraser
Institute show wait times across 12 different specialities
have actually got worse in the last year in Quebec —
going from an average of 18.5 weeks in 2006 to 19.4
in 2007. Wasn't Bill 33 supposed to fix this? That's
going on all over the country. We are third in Canada
which is not all that bad [laughs]. We want to get even
better. You know we started with 44,000 people waiting
more than six months for surgery in 2003. We now have
less than 22,000. We've completely eliminated problems
in radiation oncology and cardiac care, and we're getting
really good results with targeted procedures like hip,
knee and cataract surgery.
Some people have called C
difficile Quebec's SARS. What would you do differently
if those outbreaks were to happen again? This has
been a tragedy, but the idea that this is just a Quebec
problem is ridiculous. What I would tell people in the
rest of the country is probably you don't know how many
cases you have. Once you measure it you're struck by
the magnitude of the problem. We have instituted a surveillance
program that monitors the rate of infection in Quebec
and publishes the results on the internet. The Quebec
situation shows that an orchestrated effort can significantly
decrease the number of cases.�
Quebec is seeing a rise in anti-immigrant
sentiment that you've referred to as "ignorant." Are
there unreasonable demands on the healthcare system
from religious minorities? Unreasonable? In their
eyes, no. A few healthcare institutions have come before
the Bouchard-Taylor Commission [on reasonable accommodation
of minorities] and shown what they were doing. They
have established policies and guidelines to address
these types of problems with significant success. It
shows that these situations are practical problems that
are not as common as the media likes to portray them
and they can be addressed quite effectively in each
institution.
You're the only health minister
who's also a physician. Do people trust you more because
you're an MD? It could bring some advantages, because
obviously I understand certain problems better than
the uninitiated person would. In other ways it doesn't
help, because people will say on the one hand I'm just
an ambassador of physicians, and physicians on the other
hand feel that I'm not treating them fairly, particularly
when we get to labour-type negotiations.
When you were still working
as a doctor, what drove you nuts about the way health
ministers, such as Pauline Marois, did things? I
would say there was a series of almost fatal mistakes,
starting with budget cuts in the 90s that had a terrible
and deep effect on the healthcare sector and that are
still felt. They didn't consider healthcare a priority
and they considered physicians as an expense instead
of part of the solution.
Would you encourage your fellow
MDs to go into politics? Well, if they can tolerate
the drop in income! The advice I would give is that
they should look at it very carefully with their accountant
- in my case I didn't do this. One of the factors that
made me go into politics is that I was tired of the
Monday morning quarterbacks who would stay on the sidelines
and say what should be done. Get involved and have it
done.
You're frequently tipped as
Jean Charest's successor as Premier. Is that in the
stars? No, no, no. I don't have career plans. I
just follow life and see where it goes.
Interview conducted
by Gillian Woodford
|
