They cost us over $5 billion a year collectively, over $400,000 each. They are among the highest paid in Canada. They generally chose their specialty, their place of work, their schedule. They make a lot of money, have a lot of latitude, are powerful and recognized. Yet for many patients, if not the majority, they are invisible.
If you have tried to make an appointment with one of them lately, you know that the wait can be long. It’s even worse in the ER where you may be rotting on a stretcher for long hours, sometimes days, because no specialist is available.
In the vast and ambitious reform of the health system in full decline that the government wants to undertake, one of the centerpieces will be to improve the management of specialized medicine. For example, to force our doctors to deploy to the regions and to be available evenings and weekends. These are requirements that seem minimal and reasonable in return for all the advantages granted to our specialists. There will, however, be no doubt, an outcry from them, or at least from the Federation of Medical Specialists of Quebec (FMSQ).
The constantly increasing operating costs of their practice, the excessive bureaucracy of our health care system, the consequences of the labor shortage on the practice of medical specialists and on access to operating rooms, will perhaps evoked by the FMSQ to justify immobility. Just like the agreement that was just signed by this same government just four years ago.
For example, the unavailability of medical specialists in the evenings and on weekends translates into unnecessary expenses. Think of the beds occupied in the emergency room by patients waiting for a specialist, mobilizing staff who could be assigned elsewhere, like those famous nurses who are essential to operating theatres. Another well-known phenomenon that puts sand in the gears: the laxity of many doctors to communicate effectively with their patients.
The specialists’ resistance to change, proven many times over the decades, will also be based on this atavistic corporatist reflex of never giving up anything, of preserving the gains at all costs and of placing the responsibility on the backs of everyone and their father. But the worst will be to hear some talk about the brain drain abroad. Because the threat is never far away and repeatedly formulated by the medical world to seek happiness elsewhere if Quebec is not a sufficiently welcoming land, this elsewhere (usually the United States) where, they will say, they can operate as they please and make mountains of money.
However, most of them would never have been able to afford such studies without the collective contribution of Quebecers to their training. This sum is for example 10 or 20 times higher and often even more in American universities.
Which leads me to make this suggestion to Minister Christian Dubé to ensure that his reform does not suffer the same fate as all those that have been attempted for 50 years, that is to say that it does not end up not in the graveyard of good intentions paralyzed by corporatist and union immobility, a natural wealth that we would like to see less abundant on Quebec soil. He could recycle this idea clumsily formulated last year to communicate to patients of the Régie de l’assurance maladie du Québec the cost of care received for an operation or for health care. But he should address this communication to the doctors themselves, to whom he will remind of the collective cost of their training. A checklist that may help them put pressure on their professional associations to collaborate on the success of a vital project for the future of Quebec.
And why stop in such a good way? The minister should go further. Ensure that this collective investment by Quebecers in the training of its doctors is accompanied by certain obligations. Like going to work where they are needed at least for a certain number of years. This almost free training, which is a guarantee of professional and financial success, should also be accompanied by a contract that would better define the public service objectives to which the doctor must adhere, as well as the accompanying financial framework.
So in the name of what principle can a young doctor still leave the territory of Quebec in 2023 as soon as his training is completed without having to contribute to the Quebec health system or, at the very least, reimburse the cost of this training? This is also a problem that François Legault raised in 2012, indignant that young medical graduates could leave Quebec with their diploma still hot in their pocket1.
A rebalancing of the duties and responsibilities of each is essential to restore the Quebec health network in poor condition. It is at this price that the reform of Minister Dubé will succeed. And one of the strong messages it should convey is that Quebecers invest a lot in health, starting with the education of the professionals who work there. It is high time that the latter, physicians in the first place, take note of it and above all, be accountable and dependent on this investment. In other words, dear doctors, remember that without your patients, without these taxpayers who paid for your university studies at great expense, you would not be where you are…