Tuesday, August 18, 2009

Quebec's Sad Doctor Fiasco

The latest round in Quebec's ongoing doctor fiasco is the news that doctors from Ontario are still facing roadblocks despite the bilateral agreement signed between the two provinces that was supposed to allow each province to recognize the other's professional accreditation and thus pave the way for elimination of the inter-provincial barrier.

This week it was revealed that the five Ontario doctors that applied to work in Quebec still can't get the green light despite the four month old agreement which remains blocked by red tape.

In the meantime, since August 1, doctors from Quebec are free to cross the border into Ontario and start practising immediately. Already close to one hundred Quebec doctors have made the move towards Ontario.
This has infuriated some opposition politicians who have demanded that Quebec withdraw from the agreement rather than take remedial action.

This reaction would border on hilarious, were it not not so sad. Quebec could certainly withdraw from that agreement, but even if they did, that wouldn't preclude Ontario from continuing to honour Quebec credentials. It would then become the worst of both worlds, with Quebec doctors leaving for Ontario and no Ontario doctors allowed in. Our politcos aren't too bright.

Despite what we hear on the news, Quebec does not really have a doctor shortage. Really.

There are more physicians per capita in Quebec than any other province (except Nova Scotia): 215 per 100 000, compared with 179 in Ontario and 166 in Alberta.

Quebec's real problem is the type of doctors that we have.

Although there is an appalling shortage of family medicine doctors, the other specialties are so over-represented that the government is restricting licenses (PREMS) and has actually frozen the hiring of new specialists. For some reason the mainstream press refuses to report that aside from a few specific specialties and family medicine, the government isn't hiring doctors.

When it comes to finding a family doctor, twenty-five percent of Quebeckers are out of luck. Estimates vary as to how many family doctors are needed to fill the gap, but the figure of 700 does sound reasonable.

Why the extreme shortage in family doctors?

Mismanagement. For years the government imposed such harsh conditions, that it drove doctors towards other specialties or worse, out of the province.

First by imposing a salary cap. Doctors could earn so much and no more, regardless of how many patients they saw. It led to the ridiculous situation where GP's were working only three out of four weeks, having maxed out their renumeration, leaving patients in the waiting rooms and doctors twiddling their thumbs. This policy has since been rescinded.

Second was the policy that attempted to blackmail doctors into working in the backwoods of the province, where the doctor shortage was critical. Doctors who set up shop in urban areas were paid less than their counterparts in the sticks. This policy remains in force.

Third, the actual remuneration is inferior to that offered outside Quebec. Quebec has always counted on the language and cultural barriers to keep doctors at home.
The majority of graduating doctors in Quebec are unilingually French (except McGill grads) so few of them, upon graduation, have the option to take up residencies outside the province.
This is why that up to now, it's the Anglos who were leaving, but it is changing as Francophone doctors wise up and learn English.

What to do.....

The answer is much simpler than you could imagine.- Increase the amount of family doctors trained.

Require each of Quebec's medical schools to accept a proportion of their applicants based on a contract that streams them towards becoming a family doctors. Applications to medical schools are so overwhelming, that given a choice between being a family doctor or no doctor at all, applicants would jump at the opportunity.

Secondly, regularize pay and conditions. Quebec could still pay less, but it's got to be more reasonable.
Family doctors are the best investment that the government can make. Their offices are small and extremely efficient compared to the burdensome CLSCs, who's level of care leaves much to be desired, not to mention expensive emergency room visits that could be handled in the doctor's office. Experienced family doctors are a health system bargain, they see more patients a day than any other specialty, with some practices of more than 5,000 patients!

For towns and cities outside the urban hubs, it would be smart to make it worthwhile for doctors to come, instead of bitching and moaning. A free home and office facilities would be a start. The government should allow communities to directly subsize doctors if they want to do so.
It would cost a small town of 20,000 just $5 person to offer a $100,000 yearly bonus to a doctor to set up shop. Believe me, there would be a stampede to the hinterland.

Remember in the real world the carrot is always better than the stick.

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