For greater access to healthcare - Bill 20 needs to be completely rewritten

MONTREAL, March 24, 2015 /CNW Telbec/ - "Bill 20, as currently proposed, is doomed to failure," stated Dr Joseph Dahine, President of the Fédération des médecins résidents du Québec, "because it attributes the difficulties of access to healthcare solely to doctors, thus ignoring all the factors which affect health system performance." In its brief tabled today before the Health and Social Services Committee, the FMRQ maintains that the coercive measures the Ministry intends to apply, supposedly to increase family physicians' productivity, are missing the real problem.

Access to healthcare services can be realized only through a group effort, and through government investment in technical platforms of every kind, as well as the physical and human resources necessary to run those platforms and for services subsequent to a visit to the family doctor. "The government cannot state on the one hand that it wishes to enhance access to healthcare," Dr Dahine emphasized, "while on the other hand withdrawing some family medicine clinics and the nurses, nutritionists, psychologists and other health professionals necessary for an effective, quality service offering. But that is what is currently happening." Dr Dahine added that the derogatory language used over the past few months concerning the work of general practitioners is disingenuous, since clearly the reasons behind wait times and access problems are much more complex than that. "It's all very well to keep very close control over primary services, but this will lead nowhere if the efforts made upstream hit a wall downstream, and access to specialist physicians, technical platforms, operating rooms and so on is unduly delayed." And the targets will not remedy the situation at all. "Let's be clear about this, even if a surgeon wanted to operate 24 hours a day, seven days a week, he wouldn't be permitted to do so. We quite simply no longer have sufficient resources."

Denial of free collective bargaining
"Also, with Bill 20, the Minister is ignoring free collective bargaining with doctors, an established right," the FMRQ president complained, "and this is unacceptable." With the revised increases given to the medical federations this fall, and with the measures proposed in Bill 20, the Minister is giving himself the authority to make, unilaterally, "changes to the terms and conditions of compensation applicable to doctors," notwithstanding the agreements negotiated in good faith with respect to fee schedules and other forms of compensation for physicians.

In short, the Minister proposes, in a Bill, to "violate the principles of doctors' free collective bargaining" by legislating, rather than shouldering his responsibilities and trying to reach a negotiated agreement with the medical federations. "We are concerned not only for the medical profession, but also for all government employees, who could be made to swallow the same medicine in the course of the current public sector negotiations."

Raising interest in family medicine: forget that!
"Imposing quotas that are likely to alter substantially the time devoted to each patient makes no sense to us," Dr Dahine continued, "and represents a U-turn for a generation of doctors trained in a comprehensive approach to patient health, to conduct follow-up on healthcare episodes, and to carry out prevention work with the population."

Today, whereas for years the government has been emphasizing the need to raise interest in family medicine in order to attract more medical students to a career as family doctors, the government has now decided to ignore that goal and change the ground rules. While 914 residents, half of whom will be completing their training in June 2015, are currently training to become family physicians, the government wants to alter the very foundation of family medicine as taught and promoted in their training sites. This is cause for major concern among future family doctors. In fact, in a poll of our members conducted in the past few weeks, we can see that what attracted them to family medicine was the diversity of practice (94.3%) and the possibility of adjusting their practice in the course of their careers (88.4%). Bill 20 now proposes to leave very little room for that vision.

Women doctors: an asset within the system
"As to the feminization of the profession, "Dr Dahine went on, "it represents an asset within the healthcare system. It has been accompanied by a humanization of medicine, and should serve as a model of which we should be proud in Quebec, rather than unduly associating it with the ills currently assailing the health system. The reduced work hours which some of them opt to perform at the start of their careers last only for a few years, thereafter gradually rising to the same level of involvement with respect to their patients." This situation exists in all workplaces in our society. Why would women doctors be seen differently? And what a sad message the Minister is thus sending to young families by proposing a "double whammy" for female physicians who decide to have children!

But genuine solutions ARE possible
According to Dr Dahine, there are other solutions for improving access to care, and the upcoming generation of physicians has some to propose. "Our solutions are based on what we observe day by day in the field, in our work with patients," the FMRQ president stated, "and they suppose close co-operation between the Ministry and doctors, and with all other health system professionals."

The FMRQ is thus proposing greater interdisciplinarity, which will have to involve increasing human resources and greater availability of technical platforms; respect for what is medically required and medically acceptable timeframes in managing care episodes, upstream and downstream; even greater involvement of specialized nurse practitioners in primary care; recognition by all stakeholders that responsibility for enhanced access to care is a collective responsibility; review of the order of priority of special medical activities (AMPs) and their eventual abolition; establishment of protected time for doctors training the new generation of physicians in training settings; health system performance indicators and measurable goals, reflecting sectoral and local needs; introduction of an effective electronic patient file; comprehensive, total computerization of the healthcare system; and, of course, closer consultation with health system stakeholders.

In the FMRQ's view, if the solutions it proposes, in conjunction with the other medical federations and system stakeholders, are taken into consideration, the unproductive coercive measures contained in Bill 20 will no longer have any justification. So the entire draft legislation should be rewritten in a perspective of collaboration and engagement of the stakeholders, and not on the basis of confrontation. "The FMRQ offers its full co-operation in putting measures in place that are conducive to improved access to healthcare for patients, and access to quality care," Dr Dahine concluded, "because it is today's new generations of physicians who will gradually be taking on this responsibility, in the next 10, 20, 30 and 40 years."

Fédération des médecins résidents du Québec
The Fédération des médecins résidents du Québec is made up of the four medical residents' associations of the medical faculties of the University of Montreal, McGill University, the University of Sherbrooke and Laval University in Quebec City. It has more than 3,800 members, of whom one quarter are headed for a practice in family medicine. The others are pursuing training in one of the 53 other specialties recognized in Quebec. Of that number, 39% are men and 61% are women. The duration of postgraduate education in family medicine is two years, while for specialized physicians it varies from five to six years, depending on the specialty chosen.

To view the FMRQ's presentation on Tuesday, March 24, 5 pm :
http://www.assnat.qc.ca/fr/travaux-parlementaires/commissions/csss/mandats/Mandat-29201/index.html

To access our brief : http://www.fmrq.qc.ca/ Actualités

 

SOURCE Fédération des médecins résidents du Québec

For further information: Source: Dr Joseph Dahine, President, Fédération des médecins résidents du Québec; Information and interviews: Johanne Carrier, Communications Advisor, Fédération des médecins résidents du Québec, Cell: 514-591-0502 / Pager: 514-751-9983, Office: 514-282-0256 or 1-800-465-0215, Email: johanne.carrier@fmrq.qc.ca

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www.fmrq.qc.ca

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