The private market works efficiently at rewarding those companies that provide products and services that customers want and need and punishes mercilessly, those who ignore market reality.
The danger when governments get into business is that these rules don't seem to apply, as they are insulated from the consequences of bad decisions by taxpayers who are forced to underwrite poor business practices and outright incompetence.
And so the Quebec government continues to produce doctors which they themselves have determined that they don't need and cannot use, at an astronomical cost, with no plans in sight to end this overproduction.
The Quebec health care crisis is much more than a lack of resources. The sad state of affairs can be traced to an egregious lack of planning and sound business practices as well as a bureaucratic nightmare that has by some estimates put the number of pencil-pushers in the system equalling the number of those involved in direct medical care, be they doctors, nurses, medical technicians, and ancillary support staff.
Nothing but nothing can better highlight the utter incompetence of those running the system than the debacle that is the production of the most basic and elemental part of the health system, the doctor.
In a closed system as we have here in Quebec (and all the other provinces), the government underwrites the universities which produces the doctors that flow into the health-care system.
It isn't that complicated an affair, the government is free to determine how many doctors are produced and what type of specialties they take up.
Like car company executives, who determine how many cars and what type of vehicles are produced in consideration of market conditions, so too government planners are supposed to produce doctors in direct relation to need.
But somewhere along the line the government of Quebec got things wildly out of whack and continues to produce doctors that it does not want. Incredibly, there is also no plan to fix this problem and like a tap that is left running for no reason, these surplus doctors are being flushed down the drain, at great expense to taxpayers.
"Since 2003, (the government) has doubled the enrolment in medical schools, but it continues to limit the opportunities for employment at the end of the residency training for doctors. ...
"...According to figures provided by the FMRQ, 22 radiation oncologists are projected to complete their residency training by July 2011. But the government only has seven positions available. A total of 44 doctors are expected to complete their cardiology residency training, but there are 21 positions available." LinkIt has been reported in the Press that it costs upwards of $250,000 to produce a doctor, but when all things are considered, the cost of a Quebec-born doctor who leaves the province after his or her medical training is completed, is infinitely higher.
Add to the cost of the actual medical degree, the cost of a lifetime of education, from kindergarten to high school, to cegep and then undergraduate studies in university. Add twenty to twenty five years of free health-care, baby bonus payments and subsidized daycare and the price easily adds up to another $250,000.
A doctor who remains in Quebec can be expected to pay over his or her lifetime, over two million dollars in taxes, aside from the incalculable benefit he or she provides the community in general and patients in particular!
It is an unconscionable loss.
For the past couple of years, certain medical specialists have been subject to a hiring freeze in Quebec.
While medical schools continue to produce these highly trained professionals, they cannot be hired in Quebec because the government has deemed those specialties redundant.
Each year at least one hundred specialists, even francophones, are given no option but to leave.
Read this story: Even francophone medical grads are leaving Quebec
Read this story: Have medical degree, must travel
The cost related to this loss, each year, can be compared to the price of two Ferrari automobiles, each with a price tag of $250,000, for each doctor lost.
That is the economic cost of incompetence and it doesn't even start to measure the human price that is a by-product of giving up so many doctors.
Imagine Premier Charest in a telephone conversation with New Jersey Governor Chris Christi
Hi Chris, How's it going? I hear things are tough down there.
Tough isn't the word. I don't know about you guys up there, but we're swimming in a sea of debt. I've just cancelled a big roads projects and I'm going to cut back expenses like crazy. Civil servants, teachers, government employees, entitlements, everything is going to take a hit. The voters are screaming, but what can I do, we are broke. How's it going up there?
Premier Charest:Can't complain. We've got labour peace and we haven't really made any cutbacks. For us, it's business as usual
Lucky Bastard! How do you do it?
Oh just sound management, I guess. Listen Chris, the reason I phoned is to ask you if you'd like a Ferrari. We're giving them away.
What? You're giving away Ferraris? FOR FREE???
Yup. For free.
Because we've got a surplus of them!
Wow I better jump on this fast, it can't last!
Nope we do it every year. Maybe you'd like a Bentley next year!! Listen Chris, not to be rude, but I've got to go. I've got another hundred and ninety-nine calls just like this to make!!
Ridiculous? You bet.....
By the way Governor Chris Christie is the most fiscally responsible Governor that I know of, one of the few to face the debt crisis that plagues his state, head on.
If you want to hear a politician dish out a dose of reality, I beg you to watch this inspiring video..... Governor Christie: Day of Reckoning
In Quebec, the ratio between family doctors and specialists is decidedly out of proportion. That isn't to say that we don't need more specialists, it's just that we need family doctors much more.
Over two million Quebeckers don't have and can't get a family doctor.
It isn't rare to find GP's whose practice services over 6,000 patients and this even on the island of Montreal where the government is refusing to hire more doctors on the basis that the shortage is more acute in the boonies.
It's hard to get a handle on a number like 6,000 patients, but consider that in order to do an annual checkup for each patient, the doctor must see 20 patients each day. Even at fifteen minutes (an average patient visit,) it represents over four hours per day before the doctor can attend to the sick!
The average patient visits his family doctor three times a year, so that means that some doctors are seeing up to 50 or 60 patients a day! Ideally doctors should see no more than 25 patients per day and should work about 210 days a year. LINK
Seeing 6,000 patients a years is unsustainable and leads to burnout as well as inferior treatment.
The reality is that the problem of matching doctors to patient needs is a question of sound management and a commitment to fix what is broken.
A good start would be to tell medical schools to produce doctors that we need, not ones that we don't want.
It's no different from adjusting an ice cream factory production line to produce the right ratio between strawberry and chocolate.
It isn't (pardon the expression) brain surgery.