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Seeing the right professional at the right time

When I accepted to become president of the QMA, it was to be part of the evolution in health care. The current stranglehold of organizational models and compensation methods is preventing us from having a health care system that belongs in the 21st century.

As an orthopedic surgeon, I practise in one of the largest orthopedic services in Québec, in terms of volume. We certainly have no shortage of patients! And even if my colleagues and I could work even more, which I am not sure we can given our schedules, this would not mean that our patients would benefit from better service.

For that to happen, they have to see the right health professional at the right time. It’s not a question of money, and it’s not a question of volume. But it is a question of teams and organization.

Currently, nowhere does anyone question whether I am still the best person to see the patients. Nor does anyone wonder whether my expertise as a physician is being put to its best use, and reflects the value of my skills and what I am paid.

Solutions in the field

My colleagues and I should not need to see all patients with a musculoskeletal problem in Saint-Jean-sur-Richelieu! A good number of them could be seen by a physiotherapist or multidisciplinary team, which would allow me to focus on those who need surgery. But the billing system does not allow me to do this and we have to get out of this stranglehold. Compensation should be separate from billing, which is possible only if the service is linked to billing, and not to the physician’s procedure. My practice would be more interactive, collaborative and interesting, and my patients would benefit from a service that is better adapted to their needs.

I know what the population in Saint-Jean-sur-Richelieu needs in terms of orthopedics, because I know the needs of the patients in my region. I know how to improve my community, because I have been dealing with its shortcomings for years. Every one of you knows your community, the needs of the patients in your clinic or the health institution where you practise. If we want to change things, all physicians – both general practitioners and specialists – must sit down together to discuss these important issues with the government and the other stakeholders in the health care system.

Working together

For the moment, everything is being done behind closed doors; physicians who are interested in professionalism therefore have only the public forum in which to express their views. But we should be having this discussion all together around the same table. In the last few months, I have started the conversation. Many of you have supported my approach, while others have felt that I am representing them poorly. But nobody has questioned the fact that we are on a path of no return. We just need to look at the latest surveys on physician health: as a profession, we are ailing.

The system is cracking at the seams because we are only tackling the symptoms instead of focusing on the root cause of the situation. We must continue the discussion and work to implement solutions. Once again, I invite you to contact me ( to tell me how you would change your environment, which organizational solutions you think would improve the quality of our practices.

Dr. Hugo Viens, B.Sc., M.D., FRCSC 
President of the Québec Medical Association