(Quebec) The vast reform of Christian Dubé does not go far enough to improve access to health care, according to the College of Physicians. Bill 15 is too focused on what happens in the hospital and not enough on local care, deplores the professional order.

“You have to take care of the patient before they have to go to the hospital and after an episode of care, the patient has to leave the hospital in good condition […] I am talking here about the first line and home care”, illustrates in an interview the president of the College, Dr. Mauril Gaudreault.

According to the professional order, Bill 15, which aims to make the health and social services network more efficient, is “exclusively focused on the organization of care within institutions” and does not focus sufficiently on this. happens outside, such as in family medicine groups (FMGs), health care clinics, home care and hospitalization.

“The College is of the opinion that it will therefore not be possible to significantly improve access to care throughout the territory without planning and management oriented towards local care”, it is stated in a brief that will be presented Tuesday to parliamentarians as part of consultations on the legislative text of Minister Christian Dubé.

“I think we shouldn’t limit ourselves to what happens inside institutions, access to care is across the entire territory,” notes Dr. Gaudreault. The College has also recently led a tour of a dozen health centers in Quebec.

“Everywhere, everywhere, I saw problems of access and quality of care with even certain regions where there were citizens who were deprived of care. It’s not true that we can go on like this, something has to be done to improve access,” he said.

The College of Physicians is in favor of Christian Dubé’s reform project, which aims to entrust all the operational aspects of the Ministry of Health and Social Services to Santé Québec, a new state-owned company. The Department will be able to focus on its planning role.

But Minister Christian Dubé must go further when the legislative text does not contain enough “concrete measures for better access” apart from a few possible solutions, notes the College.

The College recommends that Mr. Dubé amend his bill to add the notion of “proximity care” which must be provided by integrating all network resources, including community resources, into the management of Santé Québec.

Another source of concern, the College of Physicians believes that Quebec “seems to want to diminish the importance of medical leadership” in its reform by “diluting” the authority and responsibilities of the councils of physicians, dentists and pharmacists (CPDP) in the organization of care.

In the current form of the bill, the CPDPs will report to the medical director and the interdisciplinary council of the establishment. The College sees this as “a loss of independence of this body”.

“The diminishing scope of medical involvement comes with a significant risk of demobilization and disengagement of the medical profession,” warns the College. Physicians are also excluded from the governing boards, which will replace the boards of directors.

Further, the College believes that the Clinical Governance Bill “concentrates power in the hands of a select group of managers, resulting in a real risk of arbitrary decision-making” since “the same people will be responsible for both ‘grant privileges and determine sanctions’ of physicians.

The new structure provides for the addition per establishment of a medical director who replaces the current director of professional services and two other management positions, one for family medicine and the other for specialized medicine.

“We agree, but it can’t be those only people. We seem to forget that inside establishments, there have always been department heads, doctors who assume responsibilities. […] We have to put this back on the agenda, ”underlines Dr. Gaudreault.

Keeping the CPDPs according to their current structure is a solution recommended by the College.

After a two-week break, special consultations on the imposing Bill 15 resume on Tuesday. In addition to the College of Physicians, the unions of family doctors and medical specialists will be heard.