Quebec Health Minister Needs a Second Opinion

Back in 1959, the Quebec government opened one of Quebec's first toll roads, the 'Autoroute de Laurentides,' which still today connects Montreal to the Laurentian communities north of the city.

The road, when ultimately completed, boasted five toll plaza's which charged 25¢ each per vehicle, a  princely sum at the time. The charge remained unchanged until the early 1980's.

At that point the government bean counters, mindful that the price hadn't been raised in over twenty years calculated that if the toll was raised to 50¢, the government would more than double their revenues.

Well, it didn't work out that way. Motorists were furious at the enormous increase and many refused to pay. They viewed the doubling of the tolls as a commuter cash grab and were furious.
The toll plazas were old and weren't equipped with mechanical arms that came down to act as a barrier until payment was effected. The system was a simple red light/green light affair with a bell and flashing red light triggered in the case where a motorist stiffed on the payment. Supposedly, a police car parked in reserve would pursue and ticket the offender.
But the volume of scofflaws became enormous and it was impossible for the police to cope. At a certain point, it became hugely embarrassing to the government and action had to be taken in order to maintain public order. The government, had no choice but to re-build the toll plazas to incorporate barrier arms, but balked at the cost and more importantly feared the backlash that such an action would engender.
So they did the only thing that they could. They got rid of the tolls completely and went from a 25¢ toll to 50¢ and then to nothing.

Another planning fiasco that failed to take into consideration that people act in their own self interest and that paper predictions are almost always flawed. Perhaps our bean counters should remember the old adage-
"Men Plan, God laughs."

Nothing seems to have changed over these last twenty-five years.

The government continues to make decisions based on statistics, figures and data that rarely takes into consideration the human element.
The recent expanded parental leave program is hundreds of millions of dollars over budget because the government failed to account that an increased number of citizens would take advantage of the program's very generous provisions. 

Now we hear that the health department is considering cutting the amount of specialist doctors in Montreal because the city has a higher per capita ratio of specialists as compared to the outlying regions. The rumour is that the government won't offer new positions in Montreal, and won't even replace doctors who retire, with the stated goal of reducing the specialist population of Montreal by ten percent. Link
The Montreal Gazette reacted harshly to this news. The newspaper rightly pointed out that the 400 odd doctors involved won't just shuffle off to the boonies to accept jobs, far from their families and friends.They have choices and between Boston, New York, Ottawa and Val D'Or, it isn't much of a decision. It isn't easy to predict how many will leave, but since the bulk of the affected doctors are anglos, it is safe to assume it will be a pretty strong majority. Link

Now many believe that the Health department is oblivious to the effect that this potential new policy will have on the Montreal health scene. They believe that the government is making another decision that is bound to backfire due to faulty planning once again.

But they who believe that,would be wrong.

The health department understands very well that their policy will trigger an anglo doctor exodus.

IT'S WHAT THEY WANT!

Really,....

Way back in April, I wrote a piece warning that government bean counters were getting ready to reduce the number of specialists, practising in the province.  Read the Story           

In the jaded and skewed view of the health department, they want Montrealers to have the same bad service that the rest of the province enjoys, believing that the Montreal specialists are a luxury. By reducing the specialists in Montreal, some will go transfer to the boonies and some some will leave. According to estimates, the freed up money could then be spent on family doctors, of which the province is in dire need.

The department may or may not have their math right, but I highly doubt it, their track record on estimates is not that good. Readjusting and redeploying forces should never be accomplished by reducing effectives, not in the health field.
It's as if a general finds out that he has too much cavalry and not enough foot soldiers, so he tells the horsemen to go home. Surely there's a better way. These soldiers cost a lot to train and once they are withdrawn, they are lost forever.
Getting rid of professionals that you have paid a fortune to train makes little sense and short term solutions, like axing trained professionals usually comes back to haunt governments.

In 1996, when the Bouchard government offered early retirement packages to public workers as part of its deficit-slashing efforts, 3,200 nurses took the buyout. Today Quebec finds itself in a desperate nursing shortage which developed very quickly after the buyouts.  Enough said? Source

The government may have decided that they have too many specialists and not enough family doctors, but they've done nothing on the supply side to fix the problem.

Quebec medical schools are still pumping out the same amount of specialists as before, in spite of the fact that there will be no where for them to practice except outside Quebec, if the government goes through with its plans. Does that make an ounce of sense?

This is where Quebec planners fail miserably, their knee jerk reactions to fluid situations and their  ill-conceived remedies, lead to disaster after disaster.

I have told politicians and anyone who would listen that if the province wants to re-balance the specialist/family doctor ratio it has to start in the medical schools.

A  good first step would be to convert one of Quebec's existing medical schools to become a specialized institution that offers a family doctor program only, where everyone who enters would be trained to be a family doctor and a family doctor alone. The focused training would likely speed up the process and perhaps knock a year off the standard four year program. In fact such a focused program could turn out the finest family doctors in the world.
Don't worry, there'd be plenty of applicants, between being a family doctor or being no doctor at all, the choice for students is obvious. The Quebec family doctor shortage would likely be halved within five years and eliminated in ten. SHAZZAM!!

The specialists would continue to graduate, but on a reduced basis and time will balance everything out. Nobody should be fired or deprived of a job.

But that makes too much sense. Its too simple.

This is Quebec, so we need another plan.