Letter to the Editor from Dr. Laurent Marcoux,  
president, Québec Medical Association


Montréal, January 15, 2015, letter to the editor released to the media by the QMA – Nobody can deny that there is a problem accessing health care services in Québec, in particular family physicians. Despite major investments in recent years, we have to admit that many Quebec citizens have reason to be frustrated at not having access to a family physician and other specialists.

Everyone agrees that there is a need to address this problem. However, the bitter exchanges between the Québec government and physicians regarding Bill 20 are unproductive.

Measuring productivity

The government is singling out physicians by insisting that they do not work enough. This statement is based on a reductionist, incomplete, simplistic way of measuring productivity using the number of activities performed (transposed into working days) that are billed to the RAMQ.

Wanting to associate productivity with fee-for-service billing disregards a number of actions, procedures and investments in time and compassion that are part of the daily practice of our Québec physicians, in all specialties and all clinical settings.

This mathematical logic leads to a dead end and feeds a dynamic of unhealthy confrontation that must change.

Elsewhere in the country

In order to properly analyse the problem of health care productivity in Québec, it is essential to look at how things work in Canada’s other provinces.

The 2014 National Physician Survey, released in December, slipped under the radar of most of the Québec media. However, it contains some extremely useful information. The study uses longitudinal analysis to put the “productivity” of Québec physicians into perspective compared to that of their colleagues in the other provinces over a number of years.

In short, the study showed that the number of hours worked by physicians in Québec has been rising for several years, whereas on average this number has been dropping in the other provinces. Yet in most of these provinces, despite the decrease in the number of hours worked, there has been a clear improvement in accessibility. Why is this?

Three winning conditions

It is particularly useful to look at the achievements in British Columbia, Alberta and Ontario. The spectacular improvements observed in accessibility share three environmental conditions that are available to the Québec government.

The electronic medical record (EMR)

Access to the EMR, based on what has been observed elsewhere in the country, is the cornerstone of improved productivity.

But in this regard, Québec is dragging its feet. According to the 2014 National Physician Survey, physicians in the other provinces were far ahead of their Québec colleagues when it came to the use of information technologies. To illustrate, barely one quarter of physicians in Québec use electronic tools to order laboratory tests and procedures.

Recently, Minister Barrette was critical of his predecessors, describing the development of computerization in Québec as a “resounding failure”. It was now up to him to deliver. Québec physicians are watching his productivity.

The organization of work

Significant differences with the other provinces can also be seen with respect to the way work is organized. The other categories of professionals are involved much more than they are in Québec.

Work must be organized so that it entrusts the members of the health care team with the tasks for which they are trained and have the skills. And let the physicians practice medicine. This simple finding leads us to the third winning condition.

Compensation methods

In Canada, Québec is the province where physician compensation is the most linked to fee-for-service payment. In the other provinces, the use of a mix of compensation methods made it possible to introduce the concept of population-based responsibility, which greatly contributed to improving access to health care services, especially primary care.

The QMA sincerely believes that physicians in Québec are ready for an open discussion on compensation methods, for the greater good of Québec’s citizens. As long as they have a say in the issue and are not seen as the problem, but as part of the solution.

The fourth, most important, condition

Everyone in Québec seems to agree on at least one point: the status quo is not an option.

In its analysis of the improvements achieved in the other provinces, the QMA has found that there is a common denominator: they were developed and implemented in a course that sought consensus between members of the medical profession and the governments. Bill 20 is certainly not taking this approach.

We remain hopeful that the government will move away from its confrontational dynamic and agree to sit down with physicians to discuss the best way to improve health care services for the population.


Laurent Marcoux, M.D., M. Sc.
Québec Mediacal Association



Denise Pelletier

Communications Coordinator 

Telephone : 514 866-0660, ext. 230

Toll-free number: 1 800 363-3932