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A leading-edge association that moves things forward

I got involved with the QMA because it convinced me that the issues it was championing deserved to be heard. Today, more than ever, it’s clear that I made the right choice. The issues raised and supported by the QMA are making headway, prompting other medical organizations in Québec to also examine them.

Since 2013, the QMA has been sounding the alarm about overdiagnosis and the importance of reducing it, both for the good of our patients and to improve access to care. After years of research, initiatives and training in this area, the QMA has succeeded in raising awareness among physicians, patients and policymakers about the issues of overdiagnosis and over‑medicalization, while stressing the importance of focusing more on appropriateness within the healthcare network and on shared decision-making between doctors and patients. While provincial governments across Canada were investing in the Choosing Wisely Canada campaign, the QMA was the only organization to step up and manage its French-language counterpart, Choisir avec soin, but also to create the Québec chapter, Choisir avec soin Québec. The QMA also organized the first Québec Symposium on Overdiagnosis, and hosted the fifth edition of the international Preventing Overdiagnosis conference in Québec in 2017. So, we were very pleased when the FMOQ followed suit by organizing a major symposium for family physicians on the theme Le Surdiagnostic et vous ?.

Since 2014, the QMA has been examining and speaking to its members about the redefinition of the social contract between physicians and society—a social contract on the verge of crumbling and that risks leading to a breakdown in trust. This examination prompted us to undertake a major tour to discuss professionalism with physicians throughout Québec. Together, we reflected on medical professionalism and contributed to the dissemination of innovative professional and organizational practices. Now, the Collège des médecins du Québec wants to broaden the debate, choosing physician professionalism and the different ways it’s perceived as the theme of its next annual conference.

In recent years, the QMA has put forth several important projects on ways to improve the healthcare system and the organization of care. As part of this, they organized missions to different Canadian provinces and to the United States to study methods of managing chronic disease or the computerization of healthcare (British Columbia and Cleveland), as well as innovative clinical organization models (Ontario, Alberta, Kaiser Permanente, New Brunswick). It also created the Physician Executives Group, even organizing an annual conference on the subject for the past four years.

The key issues that the QMA has been working on for several years include the importance of determinants of health, the new management models, the doctor-patient relationship, medical practice based on the appropriateness of care and interdisciplinarity, the use of computer tools, etc. The importance of these issues was reiterated by the FMSQ this summer it in its action plan on the organization and delivery of care, published in tandem with its salary negotiations.

While the QMA is certainly pleased to see that its words aren’t falling on deaf ears and that other associations are jumping on the bandwagon, it is now waiting for the new government to agree to have all parties sit down at the table together. This is especially true since the QMA is once again a forerunner on the next topic appearing just over the horizon: pay equity.

In fact, the QMA is the only medical organization to complete the studies on medical compensation ordered by the Commissaire à la santé et au bien-être. Through the links it maintains across Canada, it also gained insight into the work done by several other provinces in this area.

Throughout Canada, questions are being raised about physician compensation—not so much the amount they’re paid, contrary to what some media outlets are reporting, but rather the lack of equity between the different specialities. And the profession is definitely feeling the effects of accelerated technological developments. Around the world, we’re witnessing a shortening in the time it takes to perform several medical acts, due to the more modern tools available to physicians. Nowadays, an orthopedic surgeon can perform an extra two, or even three, surgeries per day. And the same goes for an ophthalmologist, who can now do many treatments faster, or a radiologist, who can process more images in a day thanks to digitization. Conversely, a psychiatrist or a geriatrician still takes as long to examine a patient as they did 10 or 15 years ago.

A divide now exists between the specialities that have benefited from technological advances and the more cognitive, patient-focused ones that still require as much time as they did before.

In some provinces, physicians have chosen to re-examine the absolute value of medical procedures to reduce the gap between the different specialities to 25%, as recommended in the evidence-based data. Let’s be honest—the matter is a complicated one that won’t be solved at a five-minute meeting or in a hallway. We need to consider training, technological advances, the expertise required, practice time, possible delegation, etc.

Doctors in Alberta and New Brunswick didn’t really want to touch the issue, but admitted that the medical profession had to take action if it didn’t want others to do it for them. In Ontario and British Columbia, despite repeated requests from the governments, physicians haven’t budged in months. Recently, the governments in those two provinces decided to impose their will, and now the matter is headed for the courts!

Is that what we want for Québec? The QMA and the Commissaire à la santé et au bien-être have been working together to help researchers compile evidence-based data on the issue. It’s essential that doctors don’t waste any more time in openly and honestly discussing pay equity.

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

 

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