Quebec medical specialists want a stronger say in health system reform

Health-care changes under microscope Patients’ rights groups are concerned about the proposed changes to Quebec’s health-care.

The Federation of Medical Specialists of Quebec (FMSQ) says it's unacceptable that it was not properly consulted before the tabling of Bill 15 - a plan to create a Santé Québec agency. The group is asking to have a stronger voice in the chain of command.

At a press conference on Tuesday morning, FMSQ President Dr. Vincent Oliva described physicians as advocates for patients. He says it is physicians who fight to ensure that patients are cared for and have access to the best treatments available.

"That's often what physicians are about, shaking things up, advocating for patients. Is that what having too much power is all about? Is that standing up to government officials? Absolutely, but this clinical counterbalance is necessary. We owe it to the patients," he said, calling for a greater role for doctors in the new structure proposed by Health Minister Christian Dubé.

Under the current provisions of Bill 15, each institution must have a medical director who is a doctor, and a council of physicians, dentists, pharmacists and midwives.

In addition, each region must have an "executive committee for territorial specialty medicine."

This committee consists of a medical director of specialty medicine, two physicians elected by their peers, and two to nine additional physicians chosen by the elected physicians from among their peers.

But Oliva laments that these committees have only an advisory role within the hierarchy.

"We want to be more than advisory. We want to be able to sit down and seriously discuss solutions. Yes, there are physicians present, except that at the end of the day, it's not necessarily (them) making the decisions and that worries us," he said.

Specifically, the FMSQ fears that the medical director, who is also a physician, will lose autonomy. Currently, regional directors are independent which may no longer be the case under Santé Québec.

"There will be a chain of command. I understand that supposedly the agency will be neutral or apolitical, but the CEO has a boss and we know who it is," he said, insisting on the crucial importance of preserving doctors' independence.

In the national assembly, Dubé welcomed the coming forward of the medical specialists, describing it as "positive." He said he wishes to maintain a channel of communication because "Quebecers want surgery and they want to stop waiting."

He was also pleased to hear there is "a sense of urgency" to continue working on the major projects underway in the health network.

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According to Oliva, the parliamentary committee consultations are insufficient. Faced with this massive reform, he believes that the transformations should have been worked on and negotiated upstream with the caregivers.

However, since Bill 15 has been tabled, the FMSQ said it intends to do its part.

"We will look at it with openness, we will take the time to analyze it carefully and rest assured that we will try to improve it, but let's not lose sight of the fact that it must be based on patients' needs," Oliva said.

On the other hand, medical specialists do not want to wait the three to five years it will take to roll out Santé Québec before taking action. He thinks the system is not working well and that action must be taken now to reduce waiting lists and relieve emergency room congestion.

At the same time that the FMSQ was holding its press conference, the health minister was adding data on wait times for specialized care to its dashboard.

According to the figures made available, the number of patients waiting for a consultation who have exceeded the recommended time limits (483,786 people) is higher than the number of patients still within the time limits (347,684 people).

There is however an upward trend in the number of consultations carried out as well as in the number of surgeries performed.

An initial solution submitted by the FMSQ is that doctors will commit to being available over extended hours to accelerate catch-up surgery.

"It is up to the network managers to open rooms and this cannot wait for the implementation of Santé Québec," said Oliva, who wants to tackle the network's problems "one by one."

"Waiting lists are very long for all specialty medicine. We can't wait for Santé Québec and we can't hide behind the reform to do nothing," he argued.

In his opinion, solutions exist and are already known, but the authorities are slow to make decisions. This is particularly the case when it comes to accessing consultations with specialists due to an inefficient appointment system. On the one hand, waiting lists are longer because of duplication while time slots go unused because of the system's lack of flexibility.

"We don't need to wait for the bill to start doing the work. The system is complicated, it doesn't work well. It needs to be improved quickly," he said.

When it comes to emergency departments, he deferred to those in charge, saying they will need to take action with their teams. However, he acknowledged that the lack of beds on the floors creates congestion on the front lines.

Oliva also appealed to the health minister to review the Optilab model "urgently," because the operation of laboratory analysis is far too slow.

"If we don't have access to test results, we can't treat or operate on patients," he explained.

For the FMSQ, there is a clear need to reform the Quebec health system, but the group thinks that it's a risk to remove doctors from the decision-making process. The medical specialists do not want to hand over decisions that could affect patients' health to bureaucrats, whether they are civil servants or employees of a government agency.

This report by The Canadian Press was first pulished in French on April 4, 2023.

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