The QMA Has Chosen to Be Part of the Solution
Last October, the QMA joined forces with three organizations representing patients, workers and managers. Seeing me at a press conference at the table with a CSN representative surprised a lot of people. For many, while I still practice in the public sector, I am firmly rooted in the private sector. Yet there is nothing surprising about that. If you want to make progress, at some point you have to decide that you are ready to take the discussion further.
For me, that point is now. The health care system is becoming increasingly more expensive, and what is given to one person is taken away from another. With more than 50% of program spending dedicated to health, it is time to reverse the trend. If we want to keep a publicly funded universal health care system, while recognizing that resources are limited, then we have to put aside our differences and work together to find solutions. To achieve this, the QMA therefore decided to sit down at the same table as the CSN.
The discussions were not easy. It is only now that I realize the extent of the work we had to do to succeed in agreeing on constructive options without being blocked by what separates us. This took us six months, but we all made progress.
At the QMA, our work had shown us for several years that salaries are not a solution. We explained to our counterparts, supported by scientific data, that like any compensation method, salaries have strengths and weaknesses. Today we all agree that it is time to readjust the compensation methods. We are aware that this has to be done in a constructive manner and in a setting where physicians can give their input. They must be involved in order for changes to financial incentives to be effective, and for patient management to be linked to population-based responsibility.
On the other hand, if we really want to improve the management of vulnerable patients and especially the elderly, all stakeholders in the system must accept some measure of coordination of care and services. The FMGs are not equipped to take on all home care to promote and prolong the independence of seniors. The same holds true for rehabilitation services, mental health services and midwifery as well. While continuing to support the FMGs, we also have to better support the CLSCs and those who practice there.
Other issues must be resolved. We all want to improve primary care. But to do this, we have to ensure that the organization of care and services encourages the full participation of patients and all stakeholders in the system. This means putting the priority on interdisciplinary practice by expanding and defining everyone’s areas of expertise in order to work in a complementary fashion. If we want effective prevention that can act on the social determinants of health, then we have to give ourselves the means to fund public health and increase efforts to promote healthy lifestyles. A broad discussion that includes managers, health care team representatives and patients is needed in order to set up independent, transparent, accountable governance. Finally, absenteeism at work, in particular for illness and burnout, is reaching alarming levels. We therefore have to ensure that we provide a healthy work environment and good working and practice conditions.
Together, the Alliance des patients pour la santé, the Association des cadres supérieurs de la santé et des services sociaux, the Québec Medical Association and the Confédération des syndicats nationaux, are proposing 15 solutions. We have to see beyond the image of an association of physicians or a union of workers. We have simply all realized that we are at a crossroads. Upon reading our proposals, many other organizations subsequently chose to support them too. The movement we have launched is appealing to others as well. It is also proof that we have to think collectively and not in a silo like before. There is no alternative.
The government wants to balance its books. It will look for the money where it can be seen, in our pockets. Even when this money, the fruit of our efforts, is legitimately earned.
Physicians can choose to be the target or the leaders of a renewal. But only a non-partisan approach will enable us to address matters as complex as health care issues. We have already proven in Québec that we can work together when we want to. You may remember that not too long ago, nobody could have imagined that patients at the end of life could ask their physicians to assist them in shortening their life. Yet medical assistance in dying is accessible in Québec today. To get to this point, the QMA and other organizations, MNAs and opposition members, physicians, citizens, legal experts and patients agreed to work together for the common good of all.
The QMA has not chosen to turn away from the issue. It has decided to be part of the solution. I thus invite you to make your choice too, and to work with the QMA and the other stakeholders in the health care system.
Dr. Hugo Viens, B.Sc., M.D., FRCSC