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The survival of the healthcare system depends on greater organizational flexibility

During the election campaign, François Legault promised to make education a priority in Québec. This is good news when it comes to my children’s future, but it also raises a slew of unanswered questions about the possible backlash on healthcare. Education is the second-largest budget item in this provice, a far distant second to healthcare.

The people of Québec care deeply about health—a fact that hasn’t prevented the cuts to the network we’ve seen in recent years. But, year after year, the healthcare system continues to monopolize almost half of the province’s budget. And we expect the government to do more with less, or at least with the same amount.

At the QMA, we have always maintained that there’s enough money in the system. We’ve also explained time and again that a paradigm shift is the only way to bring about change. Negotiations on the practice conditions of healthcare professionals and on the way the system is set up didn’t yield the desired results and don’t respect the government’s ability to pay.

After 30 years of negotiations, we need to resign ourselves to the fact that this approach has been lose-lose for the population and the physicians. Of course, we’re accused of being luckier than other healthcare professionals because of the raises we’ve been given, but we’ve paid dearly for them with our health and practice conditions.

Starting over on solid ground

Fortunately, since October 1, the tide seems to be slowly turning in favour of collaboration. As physicians, we want to start fresh. Even though we’re still on the defensive, more and more of us are now willing to be part of the solution. Take the recent example of the Québec Medical Appointment Scheduler (QMAS). The government is willing to listen and says it’s prepared to give physicians one last chance to deliver the goods.

However, we still need to agree what exactly that means and avoid repeating past mistakes. If we take one more stab at negotiating our practice conditions at the same time as our income, what are the chances we’ll succeed where we’ve been failing for 30 years?

This approach leads to inefficient organizational solutions being put in place by governments. The flu season is the perfect example of this. The most efficient thing to do would be to hire extra nurses and/or doctors to triage patients more strictly in Emergency departments and send everyone home who doesn’t need urgent treatment. But this would involve complicated negotiations with the unions, adjustments to the regional medical staffing plans (PREMs) or locum system, or even the introduction of a no-fault system for triage nurses.

The minister had no choice but to look outside the hospital for a solution. Her answer was to create winter clinics, and now she has to negotiate with the family physicians to staff these clinics during the extended opening hours. The FMOQ has already said publicly that it’s asked its members to cooperate, assuring them that amendments would be made to certain agreements with the government.

Negotiating is no way to achieve organizational flexibility! Agreements are highly complex contracts that take a long time to implement and that involve an arduous reporting process.

To break out of this spiral, physicians need to create structures in which they are jointly—instead of personally—responsible for managing patients, according to best practice guidelines that respect the government’s ability to pay. This is the only way to control the potential costs and to meet the needs of both patients and physicians.

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


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