‘End health care privatization’ clinic and unions tell Quebec

Quebec plans to force doctors to work in the public system for the first five years of their practice. (Nathan Denette/The Canadian Press)

Clinics and unions warn that Quebec’s plans to keep physicians in the public health sector don’t go far enough.

Consultations around Bill 83, which would force doctors to work in the province’s public sector for the first five years of their practice, are set to begin Thursday but many are calling it a “cosmetic” measure.

The Point St. Charles Community Clinic, Conseil central du Montréal métropolitain (CCMM-CSN) and Fédération de la santé et des services sociaux (FSSS-CSN) will not be part of Bill 83 consultations, but have a message for the government: They want an end to the privatization of health care in the province.

They warn that with privatization comes unequal access to care and a profit-first mentality. It also costs the government to invest in both the public and private sectors.

Though they say asking new doctors to start out in the public network is a step in the right direction, it’s not preventing experienced staff from being sucked into the private sector — and not just doctors.

“These private providers come to pick the staff in the public system to work for the company and we have a lot of problems keeping the employees in the public system,” said Stéphane Defoy of the Point St. Charles Community Clinic.

The clinic identified six key areas and solutions to “halt the growing inequalities caused by the private sector’s infiltration of our health care system.”

They include preventing doctors from going back and forth between the private and public health sectors more than once a year; investing in public operating blocs rather than using public insurance to cover costs in private clinics; restricting private ownership of family medicine groups; only posting appointments in the public sector on Clic-Santé; and protecting the public long-term care network.

“A doctor leaving to work for the private clinic or the private system, okay, it’s a big concern. But it’s not the only concern,” said Defoy. “We need to fight against the constant expansion of the private investor in health care.”

FSSS-CSN President Réjean Leclerc said he isn’t even sure the provisions in Bill 83 will work.

“The message from Health Minister Christian Dubé is clear: ‘Doctors, after five years, you will all go into private practice if your heart calls you to it... or rather if profit calls you,’” he said in a news release.

On Thursday, the doctors' federations came down hard Dubé, saying that instead of “beating doctors over the head,” the government should try to understand why doctors are leaving the public system. They blamed a “lack of organization” and the “critical shortage of resources” in the network.

Getting doctors back in public system

CCMM-CSN President Dominique Daigneault said she is glad that with Bill 83, the government is recognizing the “mass exodus” of health care workers toward the private sector, which harms access to quality care.

Both Daigneault and Defoy said the main challenge is staff retention. While those working in the public network say they have to fight tooth and nail for good working conditions and competitive pay, private clinics make themselves much more attractive with more flexible schedules and salaries.

Daigneault stressed that there are about 775 doctors that are disaffiliated from the public health care system in Quebec.

“They’re the ones who need to be brought back in, 700 is more than all other provinces combined. It’s scandalous!” she said.

Much like the Point St. Charles Community Clinic, the CCMM-CSN wants an end to the back-and-forth of staff between networks, end the licensing of private for-profit clinics and a moratorium on all privatization activities.

A spokesperson for the Health Minister’s cabinet said that though “the private sector can complement the public sector to serve Quebecers more effectively,” there are still “issues that concern us” especially with the switch to Santé-Québec.

“That’s why we’re gradually phasing out private health agencies, for example,” Audrey Noiseux said in a statement. “That said, the bill is a first step, and we’re looking at various solutions, particularly with regard to the back and forth between the public and private sectors.”

Daigneault accused the government of “talking out of both sides of its mouth” and said its actions aren’t lining up with public statements.

Thousands of health-care workers are still waiting for bonuses meant to foster retention months after Santé Québec’s deadline. The union filed a complaint in court Wednesday. Santé-Québec also cut over 1,000 jobs.

“They’re saying there are problems with the private sector and in the same breath tell us the solution is the private sector. It makes no sense,” she said.

“When we say the private sector is the solution, it absolutely isn’t. If it was, since each government has chosen to keep opening the door to the private, our system would have improved. But it’s the opposite that’s happened.”

With files from The Canadian Press