Latest news with #AssociationdesjeunesmédecinsduQuébec
Montreal Gazette
28-05-2025
- Health
- Montreal Gazette
Young doctors worry Bill 106 will make more early-career physicians leave
News The Quebec government's bill to change how doctors are compensated fails to address serious flaws in the health system and could make it even harder to retain young professionals, according to early-career physicians and medical students. The president of the Association des jeunes médecins du Québec, which represents young doctors, characterized the Health Ministry's goal to strengthen access to health care as 'noble.' 'The problem that we're noting is that this isn't the best approach from our perspective as practitioners,' Dr. Chakib Setti said Tuesday night during committee hearings into Bill 106. Health Minister Christian Dubé's bill proposes tying up to 25 per cent of a doctor's salary to various performance objectives in an effort to see them take on more patients. About 1.5 million Quebecers do not have a family doctor or regular health-care professional. While Dubé and Premier François Legault have staunchly defended the plan, several medical federations and doctors argue the bill could push physicians out and leave patients behind. Quebec was already facing a problem before the latest legislation, according to Setti. He said up to 50 per cent of young doctors are currently considering settling elsewhere. 'We think there are a lot of young doctors at risk of leaving, unfortunately. Not leaving the public system, but the province,' he said. In the hours after Bill 106 was tabled, four colleagues said they had had enough and will be leaving the province, Setti said in an interview with The Gazette earlier this month. That came after 28 physicians told him they planned to leave due to Bill 83 requiring new doctors trained in Quebec to practice for five years in the public system or face fines. The AJMQ and the Fédération médicale étudiante du Québec, which represents medical students, both worry Bill 106 won't fix some of the long-standing issues in the health system. They pointed to a shortage of other health professionals — a problem one family doctor previously testified falls on his shoulders. In one example, Setti said some patients have no choice but to turn to doctors instead of psychologists because they can't afford the fees. Maxence Pelletier-Lebrun, president of the FMEQ, said if the bill goes ahead as is, more Quebecers may have access to a family doctor 'but only on paper.' 'They won't be able to see a doctor when they need it because their doctor will be crushed under the number of patients that largely exceeds their environment's capacity,' he said. Fewer clinical services even as docs 'work a lot' Economist and HEC Montréal professor Pierre-Carl Michaud and his team were asked by the Health Ministry to look at doctors' compensation and medical services. The report, tabled this month, concluded a 'sustained growth in compensation, accompanied by stagnation or even a decline in the availability of medical services' after analyzing figures from 2010 to 2023. 'We can find that, at once, doctors work a lot, which was found in the report. But at the same time, they are doing fewer medical services than before,' Michaud said during the hearings Wednesday. The brief submitted was also titled what roughly translates to: 'Physician compensation in Quebec: The status quo is no longer an option.' The report highlighted how both family doctors and specialists reported working an average of 46 weeks in 2021. But RAMQ data from the same period showed family doctors reached a 'minimum billing threshold' during 37 weeks on average and 32 weeks for specialists. 'This implies that about one in four weeks worked was not dedicated to fee-for-service medical care,' the report said. 'Physicians likely engage in significant non-clinical activities, as the number of weeks reported in the censuses far exceeds the number of weeks with clinical (fee-for-service) activity recorded in RAMQ data.' Michaud and his team found the trend in the supply of medical services 'is likely insufficient to meet the growing needs of the population.' Calls for calm amid letters to patients Earlier Wednesday, opposition politicians addressed reports that some doctors and clinics reached out to patients directly. Some patients were reportedly told access to their family physician could be 'compromised' if Bill 106 becomes law. 'Honestly, sending letters to your patients, I find it skirts the ethical border,' Liberal health critic André Fortin told reporters, but he said concerned doctors have 'worthwhile arguments' that deserve to be heard. Dubé, for his part, said he didn't like threats. He has asked the Collège des médecins to investigate if clinics were co-ordinating efforts. The timing of the bill has also come under scrutiny as it was tabled during ongoing contract negotiations with two of Quebec's federations representing doctors. Dubé recently hadn't ruled out invoking closure, but he said during a scrum Tuesday afternoon that Bill 106 won't be adopted this session and he would like for discussions to continue. Parti Québécois MNA Pascal Paradis said Wednesday that the tone 'needs to be lowered' and there should be a 'frank discussion' about the bill. 'It's time to listen and engage in dialogue to find the best solutions for Quebecers.' This story was originally published May 28, 2025 at 4:11 PM.
Montreal Gazette
12-05-2025
- Health
- Montreal Gazette
Hanes: Legault government is playing hardball with doctors. Again.
In the first few hours after Premier François Legault dropped the bombshell that his government would present surprise legislation Thursday to impose a new remuneration model on Quebec doctors, Dr. Chakib Setti got emails from four colleagues saying they've had enough and they'll be leaving the province to practise. That's on top of the 28 physicians who have already told the president of the Association des jeunes médecins du Québec in recent weeks that they're moving away because of Bill 83. Adopted late last month, that law contains clauses to force Quebec-trained doctors to practise in the public system and remain in the province — or face hefty fines. 'Instead of solving the problems in the system, with this law we're trying to lock young doctors in a prison,' said Setti, a family physician in east-end Montreal. 'If you're trying to stop someone from leaving, it's because you know if they were free they'd be gone.' But Legault's plan to 'stir things up' by foisting a new pay scheme on doctors just days after Quebec family practitioners unanimously rejected a contract proposal that contained many of these controversial measures is a whole new game of hardball, even for a government that has long resorted to sticks rather than carrots in its dealings with doctors. Bill 106, which was tabled Thursday, proposes to divvy up compensation for doctors into different categories. Part will be based on their patient loads, part will be an hourly rate, and part will depend on meeting certain performance indicators. The list of medical services that presently determine physicians' pay will be whittled down from more than 6,000 activities to fewer than 10. And patients will be colour-coded — green, yellow, orange and red — depending on their level of vulnerability. The federations representing general practitioners and specialists denounced the government for short-circuiting negotiations, which have dragged on since their last contract expired in April 2023. Health Minister Christian Dubé said discussions will continue. The law, he said, will establish the grand principles for the new compensation scheme, but the details will be hammered out at the bargaining table. Dubé said he has to move ahead quickly to ensure all 8.5 million Quebecers are either assigned to a family doctor or affiliated with a medical clinic by the summer of 2026 (a few months before the next provincial election). Right now, only six million Quebecers are lucky enough to have a general practitioner and one million have been signed up to a clinic they can call if they have a health issue. But 1.5 million have neither of those because of a shortage of professionals. 'It's really the taking charge (of patients) that will facilitate access,' Dubé said. 'This is the last big block that we need to put in place to make sure that the health system functions properly.' Just prior to the last election, the Legault government abandoned its promise of ensuring all Quebecers have a physician. But a version of that pledge is back on the table with Bill 106 after some major reforms to the health-care system. These include creating Santé Québec to manage daily operations and introducing laws that assert increasing control over doctors. Dubé framed Bill 106 as completing the work started by Claude Castonguay, considered the father of Quebec's health-care system, half a century ago. Legault saluted his government for having the 'courage' to do something he has wanted to do for 23 years — a reference to his stint as health minister in a Parti Québécois government two decades ago. But some of the measures Legault instituted then are cited today as major grievances that have deterred young physicians from entering family medicine in the first place, driven increasing numbers of practitioners to private clinics or out of the province, and hastened the retirement of older colleagues. Quebec is the only province that requires family doctors to obtain permits that restrict where they practise, down to the postal code, known as Plans régionaux d'effectifs médicaux. Legault introduced PREMs when he was health minister to evenly distribute physicians among regions. But they have become an obstacle to recruiting doctors. Quebec is also unique in demanding family doctors fulfil extra duties, known as Activités médicales particulières, working in emergency rooms, long-term care homes and birthing centres. These AMPs mean family physicians in Quebec spend less time seeing patients in their clinics than their counterparts elsewhere in Canada. Dr. Michael Kalin, a family physician in Côte-St-Luc, said the latest heavy-handed moves by the government follow a pattern of unfairly shifting the blame for problems in the public system onto the shoulders of doctors. 'Quebec is 2,000 family doctors short as a result of failed policies over the last two decades,' he said. 'The government needs to learn that attacking family doctors will never improve patient care. It will accomplish the opposite.' Kalin described the mood among his colleagues as 'alarmed, upset, disappointed, fearful.' He compared the government telling doctors to take on more patients when there is a shortage of physicians to telling a hockey team to let in fewer goals when they don't even have a netminder. 'We are extremely frustrated that the government would consider penalizing doctors when it is the government policies themselves that are impeding these outcomes,' he said. 'So if the government is saying we must meet a certain number of appointments per year but we lack the number of physicians to meet this target, it seems unreasonable to be penalizing us for that.' Expecting doctors to meet new quotas is not going to result in greater access or better care, Setti said — especially for vulnerable patients who need more of a doctor's time. 'We don't want to do fast-food medicine,' Setti said. 'We don't want to tell the 87-year-old patient in the wheelchair, 'Sorry, buddy, you have to come back another time and take the adapted transport, because I only have a few minutes to spend with you and the minister says I have to see a certain number of patients today.' It's ridiculous.' Creating more bad blood with doctors, who are already as demoralized as they are stretched thin, could backfire for the government. At a time when many physicians south of the border are looking to come north because of the political climate there, Setti said he was struck to learn some Quebec physicians are looking at opportunities in the United States. 'Imagine: American doctors are ready to leave the U.S., but Quebec doctors are so frustrated they'd rather go to the U.S.,' he said. 'It's serious.' This story was originally published May 8, 2025 at 3:43 PM.
