Medical Specialists / Useful Tools
Replacement Bank
Background
As far back as 1976, the FMSQ recognized the importance of providing support to hospitals faced with problems in recruiting medical specialists, and developed ways to facilitate the organization of psychiatric services. The objective was to make up medical teams so that the accessibility or continuity of services in certain regional hospitals was ensured, particularly in those considered to have the greatest need. This initiative rapidly showed that the FMSQ should go even further in seeking to solve problems caused by the severe shortage of medical staff experienced by various specialties at that time. Over the years and faced with hospitals’ ever-growing needs, the FMSQ took even more definite, concrete action to prevent a shutdown in services, even though this was not part of its initial mission.
Creation of a replacement procedure
The FMSQ developed various ways to foster support for the regions and medical staff replacement. These included a bank of physicians, a communications network and a series of monetary and travel incentives. Initially, the main areas of concern were anesthesiology, surgery, psychiatry and diagnostic radiology. They subsequently covered all basic specialties. The affiliated associations are closely involved with the organization and management of replacement periods.
Federation objectives
The FMSQ’s actions are intended to support hospital recruitment, prevent breaks in services and alleviate the burden on centres faced with replacement problems. Although the FMSQ has assumed a major role in this process, it has no intention of becoming involved in hospitals’ responsibilities as regards planning, the management of medical teams and access to care and specialized services.
Definition
The procedure is designed to support small medical teams and compensate for the absence of medical specialists in hospitals that do not have the specialized medical staff available to maintain continuous access to medical services. Practicing physicians who wish to offer their services record their names in the voluntary replacement bank managed by the FMSQ.
Service network
In addition to dealing with emergency situations, the replacement procedure encourages the organization of service networks. The FMSQ develops, adapts, assesses and reviews the various measures negotiated with the MSSS by means of letters of agreement. These standardize the conditions governing replacements, encourage medical specialists to move to other areas to replace absent colleagues, and meet priority needs. The FMSQ ensures that these measures are fully effective at all times..
Regions targeted
When the replacement procedure was created, it applied to outlying regions:
- Bas Saint-Laurent
- Gaspésie-Îles-de-la-Madeleine
- Saguenay-Lac-Saint-Jean
- Mauricie-Centre
- Outaouais
- Abitibi-Témiscamingue
- Côte-Nord
Faced with the increasing demand, it was agreed that replacement services would be offered for other specialties and other regions in Quebec facing similar problems, particularly if access to specialized services might be compromised.
Statistics
The replacement bank now contains the names of 675 medical specialists in active practice in eight specialties.
In 2006, anesthesiologists and active surgeons accounted for 5,930 days’ replacement in outlying region hospitals, under article 2 of Schedule 32 to the Master Agreement.
The FMSQ only has partial data available for other specialties, regardless of region. However, the data available with respect to letters of agreement 102 and 112 show that medical specialists provided more than 10,870 days’ replacement from April 1, 2005 to March 31, 2006.
Retired physicians’ contribution
Physicians enrolled in the end-of-career program (Schedule 36) have also been invited to return to practice so that the most pressing needs could be met. In 2006, 61 of these physicians representing 12 different specialties provided 5,930 days’ replacement in 58 hospitals.
Future developments
The replacement procedure has been in operation for many years now, and the time has come for it to be reviewed. Changes will be incorporated into the Federation’s Internet portal, which will mean that the existing communication network between hospitals, physicians, the Federation and affiliated associations (including the MSSS and RAMQ) can be refined and the administrative process simplified.
Replacement procedure
The medical specialist replacement procedure, which was introduced under article 2, Schedule 32 of the Master Agreement, permits the payment of anesthesiologists and surgeons who agree to replace colleagues in the hospitals mentioned in this Schedule.
To take advantage of this, medical specialists must register their names, on a voluntary basis, in the replacement bank managed by the FMSQ in close cooperation with the Associations.
Objectives:
- To facilitate and enhance access to specialized medical services;
- To provide support to medical specialists in the establishments mentioned.
Expansion of the procedure:
- Over the years and given the increased demand for replacements, it was agreed that replacement services would be offered for other specialties and in other regions, with different methods of remuneration and conditions of practice.
- The procedure is now available for other specialties, including radiology, psychiatry, pediatrics, internal medicine, obstetrics/gynecology and orthopedics;
- All hospitals facing a shutdown in services can call upon the replacement procedure.
Support may take various forms, including:
- Joint action by the FMSQ and the associations concerned with regard to managing and promoting the procedure to specialists, as well as a constant stream of notices on establishments’ needs;
- Negotiation with the MSSS of letters of agreement, which are based on a rigorous assessment of needs and an equally stringent follow-up of problem situations;
- Formal application of the replacement procedure to other specialties, in particular those found in most regional establishments. The Board of Directors has just authorized and implemented a project in this area.
Operation:
- Drawing up a list of replacement physicians, using a form providing information on what is available, as well as the physicians’ fields of competence and interests;
- Regular updating of such lists;
- Invitation to newly-certified specialists;
- Information guide for establishments;
- Receipt and processing of replacement requests;
- Information forwarded to hospitals concerning the provisions of the various schedules and letters of agreement dealing with replacement remuneration;
- Information sheets sent to physicians every two weeks regarding priority needs;
- Support for establishments experiencing difficulty in paying their replacement physicians.
Replacement review:
The FMSQ replacement bank numbers 675 medical specialists in active practice, representing eight specialties. To prevent a break in services in certain Quebec hospitals, anesthesiologists and surgeons in active practice carried out 5,930 days’ replacement in outlying regions in 2006.
Although the FMSQ has assumed a major role in preventing the shutdown of services by setting up the replacement procedure, it has no intention whatsoever of taking over the responsibilities incumbent upon establishments with regard to the management of medical teams and the availability of care and specialized services.
Retired physicians (Schedule 36)
Retired physicians – i.e. those who have taken advantage of the end-of-career program – have contributed towards maintaining access to services or preventing shutdowns, mainly with respect to “basic” specialties.
These physicians have been authorized and invited to return to practice in order to meet the most urgent needs, under letters of agreement between the FMSQ and MSSS.
Operation:
The FMSQ’s role changes when a retired physician is designated to act as a replacement.
When the replacement request is received:
- The FMSQ and the relevant association weigh the reasons for the request and ensure that no active physician is available;
- The retired physician is identified and assigned;
- A pre-authorization notice is sent to the establishment, by completing the Authorization Replacement section of the form entitled “Remplacement – Médecins en allocation de fin de carrière”, specifying the guidelines for the replacement period.
Replacement follow-up:
At the end of the replacement period, a person duly authorized by the establishment must complete the form’s “Confirmation de remplacement” section, which certifies the exact dates the retired physician was present. This is faxed to Ms. Johanne Duquette at the FMSQ and to Mr. Serge Giguère at the MSSS.
Payment of fees:
The FMSQ and MSSS must forward a letter authorizing the RAMQ to pay the billings submitted by the retired physician, in accordance with the relevant letter of agreement.
Retired physicians’ contribution:
In 2006, 61 retired physicians, representing 12 specialties, accounted for 5,930 replacement days in 58 hospital centres.
