Wednesday, January 12, 2011

Quebec Government's Medical Malpractice

When car manufacturers produce cars that nobody wants or needs, it's inevitable that they go out of business, just as the once mighty General Motors went broke ignoring market realities by refusing to adapt to changing demand.

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."  Link
It 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

Each doctor who leaves is a gift to another province or state.

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
Premier Charest
Hi Chris, How's it going? I hear things are tough down there.

Gov. Christie
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
Gov. Christie
Lucky Bastard! How do you do it?
Premier Charest:
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.
Gov. Christie
What? You're giving away Ferraris? FOR FREE??? 
Premier Charest:
Yup. For free. 
Gov. Christie
Premier Charest:
Because we've got a surplus of them!  
Gov. Christie
Wow I better jump on this fast, it can't last!

Premier Charest:
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.


  1. Mississauga Guy said...

    Gee...maybe I should be nicer to Premier John James "Goldilocks" Charest. The only way these days I can even THINK of driving a Ferrari is if someone gives it to me, and even then I think the insurance (in Ontario anyway) would financially break me!

    Editor, didn't you sometime ago mention there are doctors who left Quebec and would like to come back to semi-retire as family doctors, but can't for some foolish bureaucratic reason?

    In any case, the welcome mat is out here in Ontario. We need doctors, getting a GP is increasingly getting harder, so if they don't have problems with communicating in la langue anglaise, put 'em in Ferraris and send 'em on down the 401. I work with a plenitude of Francophones from all over the world whom I'm sure would like to communicate in French with their doctor. West on Highway 20, cross the big blue ONTARIO sign, you're on Highway 401, so keep on driving for a few minutes and up to 7-8 hours. Get off highway, find work location, post sign on shingle, and get to work! Higher fees, no OQLF exams to write and pass and make a living.

    OK, it's a little more complicated than that, but I'm not too far off.

  2. I am an overworked, underpayed (for my level of training my salary is the lowest in North America) resident who went to Med School in Quebec and who is currently training in Montreal. My specialty is in dire need of more physicians, but alas, there are no jobs.

    When I complete my training in June my options are the States or more West in Canada.

    It’s a shame, I am a solid Doctor with consistently excellent evaluations. I am fully bilingual and I have won awards for my compassion. I would love nothing more than to stay here but the prospects are not good. I say it’s a shame because I know many residents who are in the same situation as me.

    Essentially I have to hope someone retires or dies and then maybe I can get a job. That plan might not even work because the Gov. wants to decrease (Yes! Decrease!!!!) the number of specialists in Montreal by 10% by not filling spots left open by the recently retired (or deceased). The job prospects in the rest of Quebec is just as grim.

    One of the main reasons I didn't go into family medicine is the poor pay, lack of resources, poor job prospects in this area and horrible working conditions (although, this is not much better in my specialty).

    It's not a hard nut to crack. Like the editor says, we live in a free market system. If you want to get more family MDs just offer them more money. You will recoup the costs by decreasing ER visits and through preventative medicine. This has all been shown in study after study. Instead they decrease the pay to Docs in urban centres in the hope they will move to the periphery and limit new physician hirings centrally. The government depends on the pure laine to stay here because they can’t work elsewhere. But this plan is falling apart. Even the staunchest nationalist still needs to get paid and is willing to learn English to get a job elsewhere.

    People love to complain that docs get paid too much. I can assure you that if you walked a day in my shoes you would get it. I always wonder why real estate agents, lawyers and financial planners dwarf my compensation, but what do I know, I’m just a physician.

    And the real reason docs get paid a lot (everywhere but here) is because of the free market system. Outside of Quebec people are willing to pay to get good health care, here it’s the government calling the shots for you, and the government is inept.

    All my patient’s ask me where I plan to work and I always say the same thing. “I would love to work here, but the government doesn’t want me. I’ll likely get paid double to work somewhere else.”

  3. Just the usual, regardless of province. I always find it amazing that, outside of perhaps Alberta, Canadians generally seem to think that the government can run things effectively. I'm always thrilled when they don't make a complete f**k-up of anything and everything they touch.

  4. Dr Dave,

    Just go to the Ontario border, and setup shop just in a town in the border area. Ontario governments (ontario health insurance plan) accepts Quebec health insurance cards as well. If you lived on the edge of Montreal, like in Vaudreuil, you can live in the Montreal area and have your clinic about 30 minutes away. Make sure you make the ontario address your primary residence so you pay the cheaper Ontario taxes. While at the same time enjoy the Montreal area way of life.

  5. "Make sure you make the ontario address your primary residence so you pay the cheaper Ontario taxes. While at the same time enjoy the Montreal area way of life."

    Êtes-vous italien et/ou libéral?

  6. @anon 2:48 PM

    No just non pur laine. I prefer that the least amount of my tax money goes to Pur laine chauvanist parasites as possible

  7. "Just go to the Ontario border, and setup shop just in a town in the border area. Ontario governments (ontario health insurance plan) accepts Quebec health insurance cards as well."

    I live in Ontario, and I don't want people from Quebec coming to my province and placing an excessive burden on my health-care system. They are taking health care options away from native Ontarians.

    From what I have heard, some doctors in Ontario along the Quebec border will not treat people from Quebec. Good!

    The Quebecois have made their bed. Let them lie in it.

  8. Mississauga Guy to Dr. Dave...

    Stop bitching about Quebec and come to Ontario. I had a bit of a time finding an MD for my common law partner. She moved here from Quebec over a year ago. The Ontario government website listed a number of doctors in my area, but many have closed practices. It's better than Quebec, I know that, but it's still not easy.

    Our Premier, Dalton McGuinty, mentioned a few years ago the government would be looking to fast-track foreign doctors here because as the population ages (and it is in Quebec, too), the need for doctors is inevitably going to go up. You're Canadian trained, so you're ahead of the curve.

    Toronto is expensive, no doubt, but Kingston is the half-way point between T.O. and Montreal, and if you're an outdoor type, it's quite the recreational area, and it's growing! Ottawa is a possibility as well, just two hours from Montreal. Housing in Vancouver is prohibitive and Calgary housing prices will likely keep going up with oil demands ever increasing.

    All I know is Quebec pays the least; furthermore, if you earn your fee cap before the year is up, and you close your practice, Quebec will claw your fees back for being closed. I moved to the Toronto Area in 1984, and every job I have had since 1988 has involved using at least some French. In my current job, I'm using a lot of French, sometimes all my calls on the phone in a given day are in French. I'm not fluent, but proficient and I get my idea across.

    Check out this website: There are more Francophones in Toronto and area than ever before, so you can advertise your services on the site in French. There are Francophones here that are more comfortable working with a French-speaking MD if they could find one. A colleague of mine used it as she was more comfortable talking with her doctor in French than English.

  9. Well, some of you will have to take your own Hillbilly heroine.

    Yes, Toronto has its French newspapers, his French European communities, (the Quebeckers are a part, as they can't stand the Anglos as much, on account of the persecutions)[if you contest the persecutions you are wrong, you are not a francophone here -so you don't know].

    The free cap, ha! ha! you will pay for them one day. Why should we have English at all in Quebec? Quebeckers are the French from Europe who settled first. (Not the first nation idiots). Again a lot of you don't understand very very basic notions, Quebeckers are the first CIVILIZED European Nation to settle in America. They have the right to preserve their CAPS. (If this is all you can think of!!)
    As far as the English are concerned they are only the second european nation to "take over"... Quebec pour le moment.... and we will see about that, because we should forget about them, we have enough of them, it's been a long time, and Wolfe died shortly after Montcalm anyway... Time to reassesse all that bs.

    Toronto is a good place to be bilingual.

    A lot of associations should be more bilingual. People take a few courses in French and then claim they are bilingual ! They can't communicate well, they recite a monologue ! stupido !!
    Or the people from New Brunswick will have to take more French courses, in order to re-inforce their language in peril....
    Sounds better...... at last !

  10. To the troll of 11:12AM this morning...

    Why don't you worry about more important stuff like the fact the Habs traded away Maxime Lapierre for better talent from outside Quebec?

    How many «Québécois pur laine» now left on le Club du Hockey Canadien?

    Take Réjean Tremblay with you to your friendly neighbourhood brasserie and you can both cry, cry, cry in your Laurentide!

  11. Your tet makes me laugh, it is so anchored into the belief that government is still the answer and only a few tweaks will resolve the issue.
    Government create shortage and mismanagement period, they never do otherwise, from the soviet union experience to the western state intervention models of the western world, when something is run 100% by the state, shortage and mismanagement occurs. When the private sector mismanage it is bankrupted out of existence, when the government mismanage taxes are increase to cover the shortfall.
    Your solutions are but a band aid, the real solution is getting the government out of managing what it should never manage.

  12. Nice post!
    If your Medical malpractice attorney decides that you have a case and you can proceed to trial, he can determine what legal avenues to follow and what damages you can expect to receive.