Montreal clinic wants Quebec to do more to keep doctors in public sector

A doctor at work at a hospital. Quebec will not follow other province's leads and attempt to recruit doctors from the U.S. (Jonathan Hayward/The Canadian Press) (JONATHAN HAYWARD/THE CANADIAN PRESS)

Quebec is poised to adopt a bill aimed to stem the exodus of doctors to the private sector, but a Montreal clinic says the approach is all wrong.

Health Minister Christian Dubé’s Bill 83 requires all new doctors to work in Quebec’s public network for at least five years before being allowed to practice in the private sector.

After some amendments, Bill 83 proposes that all doctors obtain authorization from Santé Québec to disaffiliate from the public system, rather than simply informing the Régie de l’assurance maladie du Québec (RAMQ).

The health authority will then assess each request according to:

• The number of non-participating doctors in the region where the doctor intends to practise and whether this number is too high for insured services to keep being provided under uniform conditions;
• The impact on the quality or accessibility of insured services in the region;
• The doctor’s ability to contribute to improving the quality and accessibility of insured services in the region;
• If the doctor intends to change region after obtaining authorisation, the assessment must also take account of his current region.

According to the health minister, of the 22,868 doctors in Quebec, 835 are currently working in the private network.

But the Clinique communautaire de Pointe-Saint-Charles says the proposed rules don’t go far enough and raise new questions. It says it’s unclear how many doctors are needed to maintain proper public services, and that the repercussions of leaving the public system must be clearly defined.

“The amendments put forward by Christian Dubé leave too much room for interpretation. They give Santé Québec undefined discretionary power and, above all, are not based on any conclusive data,” said William Archambault, member of the clinic’s health action committee.

“Bill 83 does absolutely nothing to encourage the 800 doctors who made the leap to the private sector to return to the public system, or to ensure that future doctors do not move to the private sector after their five statutory years.”

Instead, the clinic would rather see the government abolish the status of “non-participating” physician and follow other Canadian provinces, where only “disengaged” status is allowed for doctors who do not want to practice within the public system. These doctors would have to follow RAMQ’s fees for consultations and surgeries, effectively removing financial interest from the equation.

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The clinic also wants Dubé to increase the time limit for disaffiliating from the RAMQ from 30 days to eight months and have these changes only made twice in a five-year period to limit back-and-forth.

A spokesperson for Dubé’s cabinet said the minister is “concerned about the increase in the number of doctors practising in the private sector or moving back and forth between the public and private networks, and we have a responsibility to act to stem this exodus.”

“At all times, it is the patient’s interest that guides our decisions. We are acting to protect access to care for all Quebecers,” the statement said.