All stick, no carrots Liberals’ Bill 20 threatens rural medical care, say MDs

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Added: Fri, 12/19/2014 - 12:03am
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Laurent Robillard-Cardinal

Tabled by Dr. Gaétan Barrette, Quebec’s Health Minister, in late November, Bill 20 is sending shockwaves through the medical community and has raised the hackles of medical associations.
The Liberal government claims Bill 20 will optimize the medical and financial resources of the health system while improving access to family
doctors and specialized
medicinal services.  Doctors insist it will do the opposite.
Barrette is introducing very controversial measures, one obliging all doctors to provide medical care to a minimum number of patients. Another requires specialists to offer
medical consultations, other than in hospital emergency departments, to a minimum number of patients. The measure will penalize physicians who fail to fulfill these obligations: their salaries will be reduced by the Régie de l’assurance maladie du Québec (RAMQ).  Bill 20 would also give the Minister authority to change the doctors’ salaries for a limited   eriod.
Nothing good for rural care
Pontiac physician Dr. Tom O’Neill sees nothing good for rural family medicine here. “The government wants to move
family physicians out of the
hospitals – ER, anaesthetics, obstetrics – to seeing patients in their offices, but rural docs do much more than office visits. Fifty percent in the ER are
family physicians. Who will replace them?  Will obstetrics all be done in the city?”
According to Minister Barrette these measures, which have created an uproar in the medial profession, are supposed to increase the number of patients doctors see. “If you go elsewhere in Canada, the
average number of patients seen per day by family physicians is around 30. In Quebec, it's 14. We need measures that will reward those who work harder,” Barrette told the media.
Reactions were swift. The Fédération des médecins omnipraticiens du Québec (FMOQ) announced, these are “. . . very coercive measures, even shocking,” declared Dr Louis Godin, FMOQ President.
The FMOQ president said the “dictatorial” Health Minister is breaking the tradition of
collaboration between family physicians and the government. The FMOQ claims the quotas and financial penalties are attacks on the quality of family medicine, dehumanizing it. The minister argues that about 20% of Quebec’s population (1.6 million) is without a doctor, while Quebec has 20% more family physicians than Ontario.
The FMOQ also accused the government of subterfuge.
“On November 11 and 12, measures included in Bill 20 for family medicine were presented to us for the first and only time. Never was it mentioned that the government intended to introduce these very measures two weeks later. We understood these were starting points for discussions. Instead, Quebec will go ahead with a bill containing strictly numbers-based coercive measures. These have not worked in the past. Their only effect will be a greater destabilization of our fragile health system, the ostracism of family medicine in Quebec and a discouragement for general practitioners who are on the front lines everyday,” added Dr. Godin.
“Everything that you see here [in Bill 20] has been previously discussed with doctors,” stated Minister Barrette. ”If we don’t get an agreement on this, we might go in a
different direction.”
A question of jobs
Dr O’Neill pointed to a different problem, relative to all rural areas. “Health care is Pontiac’s biggest employer. If management positions are being
transferred to the city those are high quality jobs leaving our area, and there’s a domino effect. If a manger leaves, so will several office support positions – all well paying.  They say one city job is equivalent to 60 jobs here. Pontiac is responsible for 550 jobs, and has been pretty good with its
budget – why cut all this?  There’s nothing here that favours the rural areas.”
Several other local physicians have said these measures will prompt even more doctors to leave for other provinces or the USA, where salaries are higher and working conditions better. 
Federal NDP MP for
the Pontiac, Mathieu Ravignat, commented that although this is a provincial matter, he does live in Quebec and depends on Quebec for his services. “These changes (by Couillard) are troubling and I fear for services to my constituents and neighbours," he told the Journal. "There will be negative impacts on youth centres, youth job help, and more. The province’s priorities are misplaced. We now have two
right-wing governments, provincial and federal, who have retreated from the role of stimulating the economy and instead are putting more burden on the MRCs and municipalities. There seems to be no ‘rural lens” within either government, looking at what rural areas need and how those specific needs can be met. Government should be an enabler of socio-economic development especially for the hardest hit communities – like our own.”
Dr Barrette is a former member of the CAQ, a conservative party in Quebec.