Word from the President

 
Here is the President's editorial published in this edition of our magazine Le Spécialiste.
 

 

 

September 2017 – When September Comes Around…

When September Comes Around…

Activities are rapidly resuming while our summer at the Federation was busy following up on several files and preparing new ones, including the legalization of cannabis for recreational use. A Federal election promise, this should be done by July 2018.

The debate has just begun in Quebec starting with a public consultation in which the Federation will take part. From a medical point of view, several specialties feel directly concerned by the upcoming legalization of cannabis. It is in this spirit that we consulted you last June. Some 1,249 medical specialists answered all the questions in our poll; this is a reliable sample from a statistical point of view and the representativeness of the results allowed us to formulate the Federation's position on the subject.

You Have Spoken

As evidence that the subject has been widely covered by the media, close to 94% of respondents had heard of the Federal government's Bill C-45. While 63.7% are in favour of using cannabis for medical reasons, 58.3% are against the legalization of cannabis for recreational use. Some 71% disagree with the fact that the legal age for purchasing cannabis is set at 18 : 42.9% are of the opinion that the acceptable legal age should be set at 21, while for 40.2%, it should be set at 25 or older. It is thus clear that the option of setting the age at 18 must be rejected and set instead at 21 or older.

Close to 60% assert that the legalization involves stakes that worry them within the framework of their medical specialty and they have provided hundreds of comments on the matter. Some 68% believe that the legalization of cannabis should be accompanied by the same regulations as govern tobacco products; 79% believe that it should also be preceded by other scientific studies; 95% think it could have consequences for road safety while 89.7% believe it would affect the workplace. In addition, 84.1% believe that the legalization could become a public health problem and that it could increase the cost of care to the population (75.3%). Some 64.8% of respondents are of the opinion that the legalization could generate revenues for the government and that these revenues should allow it to invest in prevention (51.1%). Insofar as selling cannabis for recreational use, some 64.2% of respondents opted for a Crown corporation.

Our Recommendations in Summary

The Federation recommends that the government of Quebec mandate the Institut de la statistique du Québec to proceed with a new survey among youngsters at the high school level and publish the results before an umbrella act is adopted. Has use gone down, has it remained stable or has it gone up ? It is essential we take stock of the situation. We also recommend that the Institut national d'excellence en santé et en services sociaux be mandated to perform a longitudinal epidemiological study in order to compile a portrait of the state of dependence to the product according to the socio‑economic profile of consumers. We are of the opinion that the tetrahydrocannabinol (THC) content of cannabis or its derivatives should be established in the regulation and be submitted to control measures on the part of authorized producers.

We must insist on the need to equip ourselves with a truly integrated policy of prevention to act on all the determiners of health. The prevalence of chronic diseases that are avoidable generates significant costs for society. In the case of tobacco use alone, to which are attributed not only thousands of deaths per year, but also a significant proportion of these chronic diseases, the expenses generated are not compensated by the taxes it produces. Like the State of Colorado which instituted the Marijuana Tax Cash Fund at the same time as it legalized cannabis in 2012, the government of Quebec must profit from the new tax revenue it will generate from the sale of cannabis and its derivatives in order to equip itself with a real reserve to fund prevention and to promote healthy lifestyles. In order to be able to act on all fronts and to develop programs adapted to all types of clienteles, we recommend that a minimal and recurrent amount of $100 million be paid into this fund each year.

The legalization of cannabis for recreational use will have effects that are difficult to estimate. Will legalizing this substance result in an increase in the level of consumption, especially in young people? Will making this substance easily available result in making its use commonplace ? With regards to the major stakes for the health and safety of the population that the legalization of cannabis raises, it would have been greatly preferable if the government of Canada had not imposed such a restrictive deadline.

We will speak of this again, that's certain !

 

March 2017 – Times Are Tough

Times Are Tough

I've just left the Parliamentary Committee hearings and I can confirm that times are tough. In spite of the extraordinary efforts of the Board of Directors, the heads of the directorates and your medical associations, it is extremely difficult (as we already knew) to demonstrate to the population that we are defending their interests from day to day thanks to our professional independence.

We can't give up for all that ! The wants sanctions and regulations ? Much good may they do him... they'll just be easier to contest in court.

If a lesson in Demagoguery 101 interests you, I invite you to view the video of my unpleasant passage before the Parliamentary Committee on our portal (fmsq.org). Like an ex-smoker in front of a cigarette, the Minister has developed a reaction to medical specialists akin to an allergy, almost an anaphylactic shock. As he claims, medical specialists are untouchables... as in : the Minister refusing to shake hands when we came out of our Parliamentary Committee hearing. An action that had never been seen before, the reporters who were present couldn't believe it !

It's a lesson in how to manipulate the discussion so that physicians are once again and always taken for divas. And what about the opposition parties who oppose... common sense. The PQ and the CAQ refuse to recognize that physicians already have obligations and that they're subject to sanctions that are serious enough, like the non-renewal of privileges : without privileges, no PEM; without a PEM, no remuneration. As a sanction, it's difficult to be more extreme !

The CEOs and the DSPs were told to act as if Bill 130 had already been adopted. Very well. As for us, we will do everything to make sure patients are informed about the most serious failures of the system, whether it's the unacceptable length of waiting lists for an appointment or surgery and especially the cuts in services due to lack of resources because of the network's disorganization, or budget restrictions. Public opinion will decide who is telling the truth : the Minister with a big stick and threats, or us, as we continue to be committed to our patients.

We are sinking deeper into a climate of confrontation. We will have to improve our plan of attack to defend our rights. By obtaining a moratorium on CRDSs, we have shown that, although the Minister can impose laws and regulations on us, we will never be a party to the system's failures in the files where we are partnered.

What is quite amusing though is to see Gaétan Barrette take it out on the federal government regarding health transfers, specifically the lack of negotiations, the Canadian Health Minister being closed-minded, the harmful consequences of a hard line approach, broken election promises... Perhaps it's time to bring out a mirror so that he can see that what goes around comes around and that the two approaches are similar ! 

And, as long as we're at it, might this not provoke an introspection that would bring him to observe that his reforms – which by the way he refuses to evaluate – are not producing expected results. 

The year is starting off the same way it ended : in total chaos. Legislative bills and regulations are badly written, badly planned and completely disconnected from the reality in the field. Each time, we manage to defend your interests as well as possible within the disorganization imposed by the Minister. It is certainly not the best way of doing things and the Minister alone, because he really is alone, refuses to use common sense.

I remain convinced that the network's problems would surely be better managed by medical-administrative co-management, but on this issue as on many others, Gaétan Barrette (who used to be an ardent defender of co-management) has changed sides. Now, the Minister is only interested in his own flesh and blood : those he appoints... and controls !

To conclude, triumph without peril brings no glory ! Soon, the Minister will be forced to beg for our help so that his reforms produce results. He can't do it alone, especially with the way he treats everyone, including those closest to him. There is simmering discontent in his camp as well… 

 

I wish to shine a light on the work of the healthcare teams who took charge of the victims of the Quebec terrorist attack, whether from near or far. Everyone has earned our thanks and our congratulations, not only for having treated the victims, but also for saving lives. The fallout from this sad event is still present in their work environment and even time will not erase the horror from their memories.

Such difficult circumstances allow us to see that, once again, medical specialists mobilize rapidly to give the best of themselves in impossible and unlikely situations.

While the media and politicians constantly talk about the remuneration of physicians, very few of them have taken the time to salute the medical expertise that was deployed on that Sunday, during following days and even today. No matter what, we work for our patients !

December 2016 – Waiting for the Elections...

Waiting for the Elections...

Is this a new trend? After having denigrated physicians, pharmacists, healthcare workers, women, and young people, our Minister's new victim is democracy ! Will this be a last attack before the Minister dons his pre-electoral mask and distributes gifts that are not his to give ?

Last week, we witnessed another demonstration of the Minister of Health and his government's lack of respect for both their word and their signature. How is it possible to accept that a Minister calls a press conference during which he informs the main stakeholders involved that, on the one hand, negotiations for the renewal of the agreement start now, but that, on the other, he has already unilaterally decided to reopen our previous increase-staggering agreement (the one he himself signed in our name) under the pretext that the Treasury Board knows neither how to count nor how to make budgetary forecasts ? Pinch me, I must be dreaming !

What messages should we take away from this surprise declaration on a Monday morning which happened to be Halloween ?

The Minister's message : physicians are spoiled children who are too highly paid. They don't deserve anything else. They should be judged and lynched in the public forum without due process !

Medical specialists' message : this is a government that doesn't respect its signature, nor democracy. The right to negotiate is a fundamental principle in the world of unions, which has never been scoffed at in a press conference by announcing to the population in advance the results of what should have been a negotiation.

It's easy to turn the public against physicians if you always talk about money, but it's not as easy to justify the Minister's bad choices while he shamelessly cuts into patient care and puts the blame for his own decisions on hospital CEOs, who are scared more than anything that they'll lose their jobs.

If you think I'm exaggerating, let me add another chapter to this saga. Last week, AFTER the consultations on Bill 92, An Act to extend the powers of the Régie de l'assurance maladie du Québec and to amend various legislative provisions, the Minister tabled some sixty amendments that were not part of the initial Bill. All the stakeholders, including our Federation, who worked on developing white papers on this new legislation were completely duped. I insist : almost all the sections of the initial Bill were subjected to amendments tabled after the hearings! Will we be heard again regarding these new sections ? You've got to be kidding !

Don't waste your breath on possible misdemeanours by Donald Trump, the elected American President, and his future government, when there is so little respect here at home for the democratic principles that have allowed Quebec to protect the rights of all while respecting the interests of each.

All of this is so reminiscent of the enthusiasm with which the Minister of Health, an official representative of the government, used the same boast when he imposed Bills 10 and 20. Talk about it with the fertilologists, or even better with the infertile couples who received steep invoices for services that were noo longer insured from the moment these two Bills came into force. The amendments were so fuzzy that we had to wait three weeks before receiving the final text of the legislation and being able to explain to physicians and patients this pathetic new reality. Are we supposed to think that infertile couples are also a group of spoiled children ?

And the Opposition Parties have nothing to be proud of either as they rush into the trap laid by the Minister and join him to loudly proclaim our so-called status of spoiled children. They are happy to attack the former President of the FMSQ, who became a Coalition candidate, then a renegade Liberal and finally the Minister. As for us, we're just collateral damage.

All this aside, we are here to carry on with what led us to become physicians. I remember. Do you ? As the year nears its end, take a moment to remember the pride with which you entered this magnificent profession. Then, reflect forward to 2017 and think of all those who will need your medical expertise, those you will heal, those whose lives you will improve, those whose lives you will save, those you will bring into this world and, sadly, those you will accompany until they leave it. That's what being a medical specialist is all about, noo matter what the rest of the world thinks.

I would like to close by offering you my best wishes for the Holiday period. I must express my most sincere thanks to my entire team for all the work that was done this year : the members of the Board, the Directors and all of the Federation's employees. Let's all rest up during this end-of-year hiatus. Next year doesn't look as if it's going to be any happier !

 

September 2016 – Let's grab the opportunity !

Let's grab the opportunity !

We're off! I have to tell you that we were especially happy to be out of the eye of the media during the summer while the Minister was on vacation. Is it possible that the "Doctor Bashing" was maintained by the Minister himself ? Hem ! This period of calm has allowed us to seriously reflect on the decisive stakes that are on our agenda this autumn. We have modified our strategy at the Federation by emphasizing a positive leadership and our results, which have been translated and will continue to be translated into concrete measures in the public healthcare system. Our positions will determine whether we attain the objectives of the agreement reached with the MSSS.

At the time of writing this editorial, we are still awaiting the settlement of the delicate and unending issue of accessory fees. Our position is clear and it was confirmed last June at a special Delegates' Assembly. It had been expected that the Minister would publish a regulation that would settle the issue of accessory fees before the end of the parliamentary session, but this was not the case. We are, as always, in a collaborative mood, but we are also ready to become aggressive. We especially do not want to see specialized care services disappear. Some services to the population must remain within hospital environments, otherwise they risk disappearing completely, because our offices would not be able to absorb the costs of election promises. The FMSQ will not finance, from its own envelope, the budgetary cuts imposed on hospital centres by this government.

Renewal of Our Framework Agreement

Still noo news regarding the renewal of our agreement which expired on March 31, 2015. No one at the government seems to have been given the mandate to negotiate the next agreement. You can be sure the trailer clause is here to stay. There's always a limit to how much a government does not respect its signature, especially when we are quietly getting nearer the next elections.

We are now concentrating our energies on the enormous change that is underway, that involved in deploying the measures relative to the four areas selected as a result of our agreement with the MSSS as it relates to "Bill 20." At the Federation, the Professional Affairs (Dr Drouin), Economic Affairs (Dr Ouellet) and Legal Affairs and Negotiations (Maître Bellavance) Directorates are steering these issues admirably. This is a colossal enterprise that is in addition to every day challenges. I also wish to highlight the constant implication of the members of my Board of Directors : Dr Ferland, Dr Girard, Dr Grégoire, Dr Tousignant as well as the unflinching cooperation of the members chosen by the medical associations and their presidents with whom we have been vigorously working on these issues since January. Together, they have developed working and measurement tools that will allow us to reach our objectives. The work done up to now is considerable and I wish to thank everyone !

Our objective is to propose a new way of working that will help you optimize your practice : greater efficiency in case-management and follow-up of "the right patients at the right time." We have the opportunity to change the bad habits of our healthcare system. Whether it's because of "Bill 20" or the agreement that binds the MSSS as much as the FMSQ, cooperation is the priority and the Ministry has committed itself to correcting all obstacles and all problematic areas as we go along. We've never seen the like !

Winning Strategies Available to You

Along with the MSSS and to reach the objectives we aim for, we have identified centres that have modified how they operate in order to reach these targets. After having studied and evaluated the potential fallout on the network as a whole, we have chosen the changes to make and have done so with the help of needed resources. All institutions will benefit from these improvements and we will all come out of this reorganization as winners... especially patients. However, it will not be easy. This being said, we don't have a magic wand to get everything done at once.

We hope that this exercise rebuilds the confidence of medical specialists; we hope they will recover the urge to get involved, especially in these "new institutions", those that seem to have lost their soul. We have to recover the dedication to patient care that we used to have and seem to have lost; we have to impose it everywhere in our hospitals; we have to better understand and measure our waiting lists and insist on the resources needed to reduce them. This is the challenge we have set for ourselves... and the sceptics will be confounded !

We are undertaking, in particular with this issue of the magazine Le Spécialiste, an information campaign that will provide you with everything you need to know on these four measures and on how each of them evolves compared to our set targets. We will keep you regularly informed. Get ready for a flood of e-mails, webinars and information meetings.

You're not convinced? You're still unsatisfied? Your scepticism with regards to all these budgetary cuts is stronger than ever ? Thank God ! This is where you have to get involved and become the agents of change we need for the future (and for the excellence) of specialized medicine in Quebec. We are waiting for you.

It's back to work for everyone !

 

June 2016 – The Wind Has Turned

The Wind Has Turned

As if a tornado had just raged through, the Minister now finds himself in a surprising situation : the wind has died down, the damage is evident and we don't know if the tornado will return from the opposite direction. He, who did not want his name associated with settling the thorny issue of accessory fees, risks being linked with it anyway, but with results that are not as prestigious.

The situation cannot end well. Member's interests are different since 70% of our colleagues have never set foot in a private office : they work exclusively in hospital centres and cannot realize the span of its consequences. I must remind those who subscribe to magical thinking that the chasm associated with accessory fees was created during the shift to ambulatory care, when certain specialties were "invited" to move outpatient clinics out of hospitals in order to make room for other activities. We have no problem with continuing to provide consultations or minor procedures in our offices, but do you seriously think we are going to assume the financial responsibility out of our existing budget for all of the service cuts that are currently taking place within hospitals? Is there any use asking the question ?

The precarious balance between our social responsibility and the concrete challenges of accessibility is at the heart of our decisions. Yes, the Federation will do its part. We have said it and we will do it. The double line that the Minister needs to draw to set limits to the basket of healthcare services provided outside of hospitals cannot suddenly mutate into a broken line. Other methods of funding must be explored to implement the transfer of procedures that involve very costly technology. We will come up with solutions, because there are no0 hopeless causes... except in politics !

The school year will soon end and some are worried about their final results. Let's start with our Minister of Health : a network weakened by Bills 10 and 20, a smog so thick between administrators that communications are impossible, and a project to optimize laboratories (Optilab) launched without ensuring basic criteria were in place for the secure and efficient transport of samples and, especially without a working computer network to allow access to results. There is noo gold star in sight here…

As for us, we have taken up the challenge of the four working committees implemented within the framework of Act 20. The participation of your presidents and representatives is really impressive. Our four areas are developing satisfactorily : we are within delays, identifying problems and offering corrections as we go along. We decided to opt for a collaborative and positive approach, involving the promotion of medical leaders for each of the four working committees and making sure that the procedures they have developed with their teams can be applied in other centres.

We know we will meet our objectives. The basic principles are simple: prioritize and respect delays as well as available hospital resources to reach them. Finally, in my opinion, this is a collaborative and promising project that will give us back our faith and a taste for investing ourselves in the organization of care. Be on the lookout : we can make a difference.

As the summer vacation period approaches, your schedules are chock-full of clinics and additional on-duty periods. When your turn comes, take advantage of the time to spend it with your family and friends. It is always important to re-evaluate your schedule so as to conciliate work and personal life... please don't read this to mean "consider part-time work," rather surround yourself with people who will be able to help you with your non-medical duties.

I would also encourage you to reflect on your personal position as a medical specialist with regards to the profession you have chosen and the fulfilment of the obligations that are associated with it. If, like the great majority of committed physicians I work with, you do your duty in clinics, are on-call when needed, attend committee meetings, take on your CPD obligations and are attentive to the needs of your patients, you have found the antidote that will allow you to inoculate yourself against daily "doctor-bashing". We can all go to group therapy when our efforts in the four areas of improved accessibility produce concrete results. The media will then have to find another group to denigrate !

 

March 2016 – Stand Up for Ourselves

Stand Up for Ourselves

The new year started the same way the old one ended : "Doctor Bashing" seems to be here to stay. So, use your earplugs, take out your writing tools and don't hesitate to reply to these information manipulators. If we treated our patients with as little care for the truth… no, it's best not to think of that.

It will soon be two years since I took over the presidency. I know our issues and I understand them fully. I can also see where the Minister, the media and the oppositions want to lead us. We have to fight ! 

My opinion is that we have to take charge ! Our remuneration, with its spreading out, is right on target, the one we aimed at more than 10 years ago which was to reach the Canadian average while factoring in Quebec's and Canada's collective wealth. Remuneration rimes with obligation. We have to provide services and care to the population within acceptable delays. We have to fill our clinics, prioritize emergencies, make the most of our operating rooms and cover on-call duties despite the forced arrangements in "Act 10". We'll never be short of patients, since they are ageing and complex clinical situations happen more often.

However, our most unstable patient is the healthcare system and it's in a precarious condition. During this period when the budget year is being wrapped up, we witness cuts, each more ridiculous than the previous one, but some that are especially troubling. There is only one way of blocking the "creativity" of executives trying to disguise cuts in services : show your indignation and defend your patients ! Unjustified cuts in services are part of our daily lives, staff is exhausted and our patients are piling up. Our role in this circus is to "manage the traffic" according to the needs of patients... not to allow the executive to wrap up the budget, nor to help the Minister look good on television. I challenge you to find a single executive who will dare defend service cuts which impact patient care if you stand up next to your patients and their families.

There is no accounting rule that can replace your clinical judgment, unless the Minister states his position and clearly cuts the offer of services, as is being done right now for assisted procreation while medical infertility is indeed a disease. If it's your hospital that is disorganized, however, your choice is to either be an agent of change and take part in the decisions, or be a spectator and just endure.

Always present after 50 years

On December 14, 2015, the Federation turned 50 ! As we read the articles in the special edition of the Spécialiste, we quickly realize that even if the actors have changed, the script is the same, except for the finale. We are now well positioned insofar as remuneration is concerned and thus under close scrutiny. We have to deliver medical care that meets the needs of the population. In plain words, this means pertinence, quality, deliverables, close management, and commitment on the part of medical specialists.

The Federation is doing more than its part ! We are deeply involved in group purchasing and are working on a procedure that will make sure the chosen experts are representative of the equipment users. These same experts, who are well known within their medical associations and who might be you, will be able to explain the equipment choices and performances. By doing things well, group purchases will help us reduce costs even in the case of cutting-edge equipment.

We are also working with the INESSS to optimize the selection of expert groups and to ensure that representatives of our medical associations are among those who will help deploy new standards of practice during congresses and via the Federation's online learning platform. Unfortunately, the work performed by the INESSS has too often been shelved after umpteen hours of effort, which was not always in tune with our day-to-day reality. This new partnership will allow us to enrich the INESSS team with clinicians recognized by their peers. Get ready to be asked by your association to take part in a great adventure. Who, other than you, is more conversant with the changes occurring within your specialty ?

With the imperative of new ethical standards and CPD obligations, we are taking up the challenge. The Charbonneau commission, UPAC and the Auditor General have set the pace. In the era of social media where the news, good or bad, truthful, imaginative or completely false, lives only a few hours, we have to be lily-white. We are continuously on the radar and we have to redefine the rules of the game. The Federation's role is now that of a CPD catalyst, which means that we provide you with all the tools possible to help you apply the rules, compile your CPD results, and easily access Section 3 activities. We have met with university deans throughout Quebec to offer them all a partnership that will promote and highlight the excellent work performed by our academic colleagues. And all of this is available at a click of your finger. I know we are all very busy but also that your determination to remain the best is universal. I know you !

This is a stimulating situation we find ourselves in. As Philip VI of France once said, "Let he who loves me follow me !"

 

December 2015 – Why Isn't It Simple ?

Why Isn't It Simple ?

He's the Control-Tower Minister : he's everywhere, he meddles in everything and he wants to control everything. A character we have no choice but to live with... and it's not simple ! Plus, he still has a lot of projects in his files for 2016 and that's not simple either.

His next initiative is going to be activity-based financing. You can, however, get yourself immunized against this attack: just take back control of your hospital, wounded and weakened as it is by Act 10. No pain, no gain ! If you haven't already done so, it's really time to position yourself as a physician : attend every meeting whether it's your service, your department or the CPDP. As head, make sure you understand the dynamics of your budget, of purchases, of how to calculate operating costs, in order to be able to estimate the value of each episode of care in which you are involved. Who better than you would know the reality and the complexity of the services you provide? Surely you won't leave all of that solely in the hands of an administrator ?

So you think I'm exaggerating? Why don't you check with your colleagues in radiation-oncology who have been placed on this reducing diet since the spring of 2014 and who have to deal with the fact that only the first quartile of costs is taken into consideration to estimate the budget ? No matter ! We have to get ready, because that's the next rabbit the Minister will pull out of his hat. And, once again, the sights will be set on us when we're faced with a fait accompli. As soon as we have a better idea of what's coming, we'll try to put together training sessions so as to equip you with the tools you'll need to become indispensable in this financial exercise, which runs the risk of limiting you in your practice if it doesn't take into account all of your realities.

But, it's hard to navigate safely through all of these public accusations that try to pass us off as thieves and profiteers... On the one hand, the columnists, analysts, commentators and editorialists who never have to prove what they proclaim. On the other, the opposition parties, with Diane Lamarre out front, who gloat over everything they can add, or even invent, to label us crooks. And that's what partisan politics does! It's easy to give one's opinion, when what one believes has no serious consequences, when there is nothing to prove! It's a lot harder to provide a medical opinion, loaded with consequences for the life of a patient, at a time when there are no good answers, when we have to announce the fatal outcome, the sad fatality. As for me, I wouldn't swap my life as a medical specialist with anyone !

We don't have to demonstrate the specifics of specialized medicine, we deliver them ! In addition to what makes up our daily lives, think of the cutting-edge surgeries and research studies published by our Quebec peers. We offer a quality of care that is the envy of others. You know it and you see it, as soon as you leave Quebec for an international conference. Nonetheless, it's time for this defamation to stop. Tell these self-proclaimed right-thinkers to watch the excellent television series, De garde 24/7, which puts medical practice into perspective. I'd like to thank and warmly congratulate our colleagues, in both your names and mine, for their generous sharing of their daily lives, expertise, doubts, feelings, minds and, especially, hearts. Everyone is talking about it; comments are ecstatic (with reason); the audience is overwhelmed (we can see why); reporters are asking for more (as do we). So, what is the problem? Who, among all those who claim to protect the public, would want to replace these physicians, or would even be able to, in just one of these episodes ?

Since we're talking about expertise, a short word on our recent Interdisciplinary Education Day. What a remarkable event ! More than a thousand specialists getting together, interested in acquiring new knowledge and keeping up to date in their specialty, in order to become even better. In fact, I would like to congratulate the three recipients of prizes of excellence in the transfer of care, a REAL demonstration of cooperation and interdisciplinarity.

This is my last editorial for the year 2015. It's been a difficult year. But, to paraphrase Nietzsche, what does not kill us, makes us stronger! Even if the year 2016 doesn't herald anything positive, we are strong! I wish to thank my team : the members of the Board, our directors, the staff of the Federation, the delegates, the presidents and personnel of the associations !

For 2016, I've given myself leave to dream that Gaétan Barrette will put away his stick and realize that cooperating with physicians is the best way of making things right for the public health system; that Diane Lamarre will turn off her basely-partisan recording and will finally see physicians as an added value for Quebec; that all our detractors, of any stripe, will stop criticizing us for the pleasure of being read, seen or heard and will realize that, if it were simple, we would already know it !

I wish you all the best for the Holidays ! After what has happened in Paris, let us reflect even more on how our families cannot be replaced... Take good care of yours, especially when you're not on call.

 

Septembre 2015 – No matter what the weather is like, our autumn will be hot !

No matter what the weather is like, our autumn will be hot !

If it's September, it means the government is active again. Bill 44, An Act to bolster tobacco control; Bill 56, Lobbying Transparency Act; optimization of laboratories; group purchasing; accessory fees and activity-based financing are all within our target zone ! 

Bill 20

Of course, the consequences of Act "10", as well as the advancement of Bill 20 and its adoption, with our without a gag order, remain priorities for the Federation.

It's a case of déjà vu, you'll tell us... Each time our negotiations virtually stand still during the summer, we come back all the more motivated to arrive at an agreement, especially when we are convinced there is no reason to act otherwise. After all, accessible technical capacity has always been at the heart of our demands and remains the only concrete way of committing ourselves to guaranteeing positive and probative results.

How is it then that this particular stake has not yet been settled between us and the Minister of Health ? The answer is in the question ! If the Minister really wants to settle the challenges of accessibility linked to his famous Bill 20, "WE ARE READY" to commit ourselves to finding realistic solutions that will take into account the contingencies of Act "10".

For the moment, the leaner regimen is in fashion in hospital centres, even if the grand spectacle of budgetary targets unfortunately not met, or even exceeded, is only planned for the winter of 2016. For good reason, as forced marriages are not conducive to cooperation and collaboration. Let's cut now, we'll see later !

Speaking of solutions

Certain issues, the merits of which have been vaunted to us for a number of years, are late coming off the ground. A difficult gestation, repetitive complications, treatment plans with repeated changes have been the characteristics of computer projects, but it would seem we will soon see the results !

Quebec Health Record (QHR)

So much money, so many efforts... Information technology makes us dream of high-performance tools that would simplify life by lightening the administrative burden of record keeping. Copying medical information, allergies, medications and diagnoses directly from one form to another! All of this may not seem so complex on an individual basis, but it reaches out-of-control proportions when we try to tie everything together !

The dream will not be a reality tomorrow because the bottleneck has a name : confidentiality. With the objective of making sure than only healthcare personnel will be able to browse through all our personal secrets, we need a system with unassailable security. Collecting validated data in real time to allow us to remove wrong diagnoses that could modify therapeutic choices remains an objective that is difficult to reach. Who will be responsible for the validation? Don't you already have something else to do? And the patient who thought he wouldn't have to confirm his medical information each time ! That's rather ironic, isn't it ?

This being said, access to the QHR is advancing step by tiny step, with pitfalls along the way on the technical side as deployment advances in the large centres or as the limits of existing computer systems are rapidly confronted with a growing number of users. And yet, for a few medical offices where the installation was small scale, results are eloquent : medical specialists appreciate the access to laboratory results, to imaging and to lists of medications. The next step will be to access the summary form as soon as the patient leaves. This issue is on the RAMQ team's drawing board as they are validating the best way of transmitting this precious information. At present, hospital budget cuts also mean that it's impossible to hire staff to help physicians accomplish this task. The duty belongs to the attending physician who has to concentrate instead on signing out patients thus freeing beds. Some centres are better equipped and more productive than others. We need to know about your experiences and your successes in order to share them and use them to help us all become super-users! I'm a member of the working committee at the RAMQ that reviews the QHR's performance. Don't hesitate to write to me or to call me. It has to work !

QHR, DMÉ, OASIS, CHARTMAXX, and the others

For the moment, these are just strings of letters with little to connect them. Transitioning from hospital records on paper too often means obsessive digitizing, without reflection on the entire content of the record and without any evaluation as to its pertinence. As you know, this results in its load of frustrations when the physician is confronted with the reality that he will have to spend more time entering ID codes, waiting, waiting and waiting before being able to browse through a disorganized, unstructured file rather than spending time discussing with his patient. However, all the other provinces or countries that have made it through this necessary evil will confirm that it's associated with 2 to 3 years of suffering from which we cannot escape. Faced with adversity, let's move forward and be proactive – it will hurt less !

 

June 2015 – Social Accountability

Social Accountability

In this era of changes for the healthcare network that are as rapid as they are disruptive, it becomes easy for politicians and reporters to launch a new attack, this time on the professionalism of physicians and on their obligations towards the population. Some ask THE question "Since training a physician costs so much to taxpayers... shouldn't physicians have to sign up for public service, like joining the army, in order to pay back their (so-called) debt to society ?"

Whether it's wilfully or through ignorance, there's no mention of the fact that the future physician not only studies throughout his training, he's working during his residency! But, what is the real accountability of medical specialists towards their patients in a system where budgetary austerity comes ahead of social responsibility? How can the physician remain liable for the best possible use of the system and its resources when, behind closed doors, the administration cuts into patient care ? Our Minister of Health and his leader can continue repeating that they will not cut services to patients and to the population, but the facts speak for themselves : a single bath a week is enough... using a washcloth is good enough the rest of the time !

Not replacing staff members who are sick, inadequately planning external clinics, cutting back on operating rooms during the summer : no, no, there aren't any cuts in services to patients ! By the way, where is the Minister's social accountability ? In this period of austerity, a balanced budget forgives everything. It erases all traces of promises not kept.

This being said, we, medical specialists, are duty-bound to the population and we discharge our duty. We all have hospital obligations and, under the supervision of the board of directors, it's the role of department heads and the CMDP to define them, just as it's the role of the DPS to make sure we respect them. When all of us respect our promises, we meet our obligations and deliver quality. When an orchestra is well-rehearsed, everyone does his or her part at the right moment.

The quality of specialized medicine in Quebec is excellent, but it could easily degenerate if we, medical specialists, do not assume our place at the centre of our (new) institutions to defend our patients, especially in this period where it is easy to curtail our prerogatives.

We are responsible for giving our patients the required details regarding the difference to be paid if we really believe that a generic drug is less effective than the original. We are responsible for advising our patients if the excessive waiting period for tests risks compromising their prognosis. We are responsible for working hand in hand with our teams to prioritize urgent consultations and to find a way of monitoring this clientele. We are responsible for doing our work while involving and assuring ourselves that the second line is effectively on duty when our expertise is needed. We are responsible for providing second-line coverage, everywhere and at all times. All of this, of course, if we allowed to work !

How can we translate these obligations in our daily lives ? By becoming involved in our service or department, by taking our place on the CMDP and by daring to go to the President and telling him that the decisions he has taken are not adequate and to remind him that, even if his decisions are well within the framework of the Minister's operating specifications, a hospital centre is there to care for patients and not to shuffle papers. We don't need a contract with the hospital to remind us of this : no matter what some rightminded individuals may propound, yes, we do have a contract with patients !

I cannot close this editorial without mentioning Bill 20. It carries the smell of a gag order... again! We have made our representations and defended the interests of specialized medicine. There's no need for legislation. What the Minister is asking for is feasible, as long as the offer of services by institutions is at the height of expectations. This is the direction our negotiations have taken. However, to expedite our end of things, it will be much easier to reduce waiting lists when the issue of the technical component of accessory charges is settled, and this solely for the sake of transparency towards patients, physicians and the Collège ! Remember : 58% of the population has private insurance or participates in a group insurance plan.

The countdown has already started and July 7th is rapidly coming closer ! Even if the Minister has shown a certain openness, you will have to follow the Collège's new code of ethics to the letter starting on July 8th. It's up to you to measure the financial health of the services you provide in your offices since, according to the law, you will only be allowed to bill for bandages and medication... not for the necessary equipment, not for the sterilization of devices, not for the time your staff spends in the recovery room or elsewhere. Just like the Collège, we are saying that the ball is in the Minister's camp. He is fully familiar with the issue, in all its complexity, as he defended it repeatedly not so long ago. The question is "Will he drop the ball ?"

Have a great summer. Rest up well. Fall will soon be here with its many jobsites : massive departures of personnel, network disorganization, activity-based funding, relevance of tests, and judicious use of medication. We are still being threatened with the bat, but it doesn't scare us !

 

March 2015 – 2015 – A Year to Remember !

2015 – A Year to Remember !

After the short respite provided by the Holiday period, we were looking forward to 2015. To start with, because it's the 50th anniversary of our Federation's founding. Secondly, this year was going to be characterized by the negotiation of a new agreement, another step towards parity with the rest of Canada.

Unfortunately, 2015 started the way 2014 ended, with the same government tactics! We witnessed the gag order used to force adoption of Bill 10 and the continuance of Bill 20 which, if you will recall, was thrown at us when we had barely received the MSSS' request to start working on improving access to the second line. What a mess !

As soon as we came back to work in 2015, we denounced the reform which the Minister of Health is forcing down everyone's throat, and we started getting ready to "appear" on March 17th before the parliamentary committee on the subject of Bill 20. We have arguments and we intend to be heard.

In fact, our advertising campaign showing the under-performance of the healthcare system is making waves because the situations we depict are true! We all know people, whether in our families or among our friends, who were subjected to the system's shortcomings. Patients would like to have their surgery within six months; that's also the dream of all surgeons and attending physicians. But, we can't just perform surgery on the kitchen table! Let them try to cut our revenues, if they can't guarantee that we have the means to meet our obligations! Excuses will have to serve both sides. We will make it our responsibility to demonstrate the health system's daily failures. If there isn't at least one hitch in your day's work (lack of personnel, missing or defective equipment, lack of beds, patients not confirming, inaccessible computerized records, etc.) to allow you to care for all the patients on your list, it's probably because you work alone !

Was the Minister's great show worth the effort ? Absolutely not ! Our incentive measures delivered results in the past and we will keep working the same way, because it's by negotiating that problems are settled, not with the stick or the gag. Results are possible, if we work together. When the Liberals were boasting that they wanted a different kind of politics during the election campaign, they hid their real agenda, the one where everyone suffers... to reach a zero deficit.

But there's bad news for those physicians who became partisan politicians : the millions they're looking for won't be there ! The complexity of Bill 10 and its phantom regulations won't make it easy to implement them, even if everyone's head is on the chopping block on April 1, 2015. Too many changes at the same time risk making the pot boil over. Add to this upheaval, the arrival of the dysfunctional health record system because of which we waste an incredible amount of time looking for results in disorganized records, implementing the Optilab project (optimizing labs) without proper financing, managers that are so afraid of losing their jobs if they don't meet their budget that they're cutting everywhere, the MUHC moving and leaving the Neuro without anyone to cover on-call duties, the CHUM and its "challenges" and everything else.

The government is so busy making changes to the healthcare system that it forgets that hospitals are there to look after patients. One has to be really cut off from reality to thus attack the network from all sides. It's a case of delirium... the delirium of electioneering. There's only one reason to justify such a rush: the next elections. Time flies when you consider that the campaign to seduce voters generally begins 18 months before the election period. That isn't very long to obtain results that will give the Minister's notebook a gold star. The government thinks we'll forget its anti-democratic behaviour? Pencil this in your diary for October 2018 : A majority government ? NO THANKS… Because once elected, this government thinks everything is permitted !

Despite everything, keep your morale up and hold steady. There will always be patients who are very satisfied with our services and our care (90% according to a Léger Survey – Feb. 2015). Our profession is ranked fifth when it comes to people's confidence in us (Journal Les Affaires, Léger Survey – Jan. 2015). But, above all, there is the satisfaction of practising high-quality medicine in Quebec. For this reason, we will never give up! It's a shame politicians choose to lie about us and that too many people in the media try to go one better than the Minister. One would think that all these people treat themselves when they're sick !

We have to denounce these ex-doctors who have become partisan politicians and who take pot shots at the medical profession to bring it down. We have every reason to be proud of our profession and to do what they don't. Our satisfaction comes from arriving at a difficult diagnosis, from performing a complicated surgery, from giving back a quality of life previously lost to illness, from saving lives, from bringing Quebec babies into the world, from pushing research forward, from writing papers for recognized scientific publications, and more. Remember why you get up in the morning : are the stakes really worth it ? It's the future of our profession we are betting on. STAND UP, ALL YOU MEDICAL SPECIALISTS !

 

December 2014 – Back to the Drawing Board… Again

Back to the Drawing Board… Again

The Health Minister's latest : Bill 10. A concentration of powers for the Minister and an unequalled vacuum for the network's health professionals !

This "work" was prepared without consultations; worse, it's a personal creation. Will Bill 10 be adopted under a gag order? If not, why have insisted on having consultations at top speed, without any respect for the "invited" groups ? And if is so, everyone will be able to see the new way of governing with a "majority." And the Minister will finally be able to reign over the healthcare network.

Seriously, what's behind all this hurry? Why does each Minister of Health have to leave his mark when he's barely been elected? Where does this impulse to undo, without compromise, everything that seems to hinder the ministerial vision of governance come from? Unless the question is rather : for whom? With what aim? In fact, who believes (or wants to believe) that the powers the Minister is grabbing for himself will be temporary ? There is no temporary law. There is what is written, voted on and published. Everyone will have to live with this fact and, on the front ranks, the lucky ones elected to the CISSSs… while we hope they won't be made up of recycled members of the party… if the trend is maintained. Proposing such a legislative upheaval without making the effort to more clearly define the numerous regulations that will follow, will at least have had the effect of rallying the entire healthcare sector against this bill ! Everyone can't be wrong. Once adopted, rebuilding on top of ashes after having destroyed everything along the way is not a guarantee of success. On the contrary.

I insist: what do all who have held the title of Minister of Health have in common? Why have they all tried to rebuild the network to suit their own image? Why this hurry to undo and redo according to election deadlines ? The complex nature of the network requires more : it needs a very long-term vision, where all the actors will have responsibilities and will be accountable for their actions. No one has ever succeeded in building on shaky ground. You can try to fix the framework, reduce the load on the structure, stop certain activities, but when the foundations of the building are fragile, nothing will work.

It's been a long time since our Minister worked in a hospital. I don't recognize the setting he describes where physicians think only of making money and don't look after patients. Even if we agree to cut back the administrative structures that don't provide care to patients, we are far from thinking that hospitals in Quebec are filled with incompetent people. And when there's a will, or a pretence, of changing things, we all know that holding out a hand and involving people is more effective than pushing them down and threatening them. Let's be clear, rallying the people and respecting their expertise does not exclude the possibility of making them accountable. If the Minister wants to discipline the actors in the network, he needs to start with himself by curbing his own impulses.

It is not unreasonable to wish for a productive, accessible and effective system ! This objective of performance will not be reached without costs and the Minister knows it. In fact, we all know it. If medical specialists work more, they will see more patients, prescribe more tests or medications, and perform more surgeries. A waiting patient doesn't cost anything in the expense column. One has to have a shortened memory to forget that Schedule 38 had been negotiated to recognize weightier practices (our version) and that it was accepted to reduce productivity (the MSSS version). That being said, it still cost $40 million.
Medical specialists do work and we shall prove it. Two can play this game. Get ready ! We won't let anything go through that will stop us from practising our profession for the sole aim of guaranteeing votes…

The year 2014 has been exceptional ! Or should I say, it's been exceptionally troubling since the election of the Couillard government and the arrival of the new Minister of Health… Am I the only one with the disagreeable impression that this year will be followed by another one of the same ?

As for the Federation, we have also had an exceptional year, but in our case we can say it was exceptionally stimulating because of the challenges we have had to face. I would like to take advantage of these last few lines to thank you one and all for your support, your encouragement, your suggestions and your constructive comments. I fully appreciate, for having lived it, how rallying people to a cause allows us to accomplish great things. My thanks go to the members of our Board, to our directors and managers as well as to all our personnel who, again this year, answered the call as never before !

I wish you all the best for the Holiday period ! Health for you and yours and Peace on Earth.

 

September 2014 – Respecting a Partnership Goes Well Beyond Negotiations !

Respecting a Partnership Goes Well Beyond Negotiations !

The current state of relations between medical specialists and the Minister of Health, together with his government, is unheard of… One could even think that our former president is suffering from a kind of Kafkaesque anguish for a world that has lost its soul !

How can one move away so radically from an agreement negotiated by oneself, defended and signed with new collaborators, who are now Minister of Education and the province's Premier

This absurdity has gone beyond simple discomfort! I hear you and I read your comments : the situation has hit your deepest convictions. It has been a long time since I've seen so many medical specialists outraged by a situation that extends well past the question of remuneration. Physicians feel betrayed ! Nothing less. The love-hate relationship erases the feeling of ambivalence which prevailed when our new Minister took up his duties. How do you react towards a person who so staunchly defended us and allowed us to get closer to Canadian parity by 2016, when it's the same Minister who has just taken back what he got for us because he cannot balance his budget ? A problem that was due to his predecessors, who used the sums put aside for our agreement to 2016, in order to pay off a good portion of the scandal resulting from bad management at the CHUM and at the MUHC.

This autumn will be difficult. The government, in its quest for a balanced budget, will announce its restructuring based only on figures. It would be impossible to do otherwise, since we haven't been consulted. There is no negotiation committee nor has there been any real communications between the Federation and the government since the start of the election campaign. We have only heard partisan announcements, full of threats, the sole purpose of which is to make us bear the blame for the bad state of the Health budget. Every cutback will be for the purpose of "paying these lazy doctors." There will be no self-criticism with regards to the daily waste associated with bad management in hospitals.

Whether these attacks remain unheeded or not, you and I know we are worth more than that. Ask your patients what they think of you, it'll give you wings; and if you're not convinced, ask them what they think of our politicians...

Our patients need their medical specialists to treat them and medical specialists need a responsible government to access technical support centres. So we'll have to end up somewhere. These last few years have shown us that confrontation cannot be part of the equation, as illustrated by the mobilization effect it had on medical specialists in 2006, when a special law was tabled by Mr. Couillard. In fact, afterwards, we succeeded in working together on several difficult issues whether they were at the level of the round table on medical manpower planning or when negotiating within the framework of the creation of new procedures such as telemedicine, teleconsultations, group purchasing and the upcoming clinical access, to name but a few. These issues were dealt with over the years in a spirit of collegiality; all the pitfalls were circumvented as we moved along since the various representatives of both parties were of good faith and were determined to find solutions that would respect the budgetary planning. This method allowed us to work together with a common and constructive vision whose goal was a final product of which both parties could be proud.

Patients have, without equivocation, benefitted from this partnership since all the new challenges and issues come from you, from the field, from the day-to-day reality that forces you to change how things are done when methods become obsolete with time.

Our new government wants to change the rules of the game on the pretext that there is no other way of reaching a balanced budget. What a nice way of setting up lines of communications where all the dirty tricks are allowed, since the object is so noble… For us, it's a direct insult : our agreement is broken, our wallets are cheerfully emptied and the government wants us to swallow its never-ending lies by trying to make us believe there are no other solutions… This behaviour rips apart the bonds of trust we had with them. Medical specialists voluntarily offered to spread out the amounts provided for in the last two years of our agreement, in a REASONABLE fashion, but it seems that is never enough...

How will we be able to sit down with its representatives, with the same passion, to help them restructure the network ? This precedent will allow the government to change the rules of the game whenever it wants and to find a reason to justify itself afterwards... This is the real challenge : respect for one's word. For its word! And to defend ours, we will stand and remain standing to the end, no matter what !

Because WE keep our word !

 

June 2014 – Let's Set the Clocks Back... to Normal

Let's Set the Clocks Back... to Normal

At the time I started my practice, I became aware that, to improve medicine, not only did we have to pursue research, but we also had to take an interest in how care was dispensed. That's why I also became involved in improving our conditions of practice. I have to admit that there's a lot to do for specialized medicine. Being away from a full-time practice lets me see other aspects of how the healthcare network operates. Taking a step backwards to better go forwards, is wise, I am told.

I have always thought that things happened because we took care of them. And, as the Greek philosopher Seneca said, "It is not because things are difficult that we do not dare; it is because we do not dare that they are difficult." I therefore decided to take control of my fate and to get involved. I have been the head of a department, an associate professor, president of my medical association and vice-president of my Canadian learned society. I knew that not all physicians had this need, like I do, to be up to date with what is going on in our profession. But, I was never more surprised than when I took on the presidency of the Federation and realized how many medical specialists did not know, or only slightly understood, how the organization mandated to represent them operates, and even protects them from decision-makers and payers, namely the government and the RAMQ.

I am therefore taking advantage of this space to invite you to review what you know about the Federation.

A Brief Historical Reminder

To start with, next year, the FMSQ will be 50 years old. It was, in fact, founded in 1965 by physicians who wanted to protect themselves from the government's desire to impose a salaried status and other conditions that would disadvantage the profession. This was all the more important since the Collège des médecins at that time had a double mandate : that of protecting the public and that of defending the interests of physicians. This double mandate could only result in inappropriate and, I must say, debatable stands.

The FMSQ is a professional union regrouping associations of physicians practising in one of the medical specialties recognized in Quebec. From 11 associations when it was founded, the FMSQ today represents the members of 35 affiliated associations working in one of the 53 recognized medical specialties in Quebec. The FMSQ's mission is to defend and promote the interests of medical specialists, members of the affiliated associations, on the economic, professional, scientific and social levels.

The FMSQ will always defend a strong and effective public system and gets involved in a range of subjects when our expertise can make a difference. During the last few years, we have dealt with issues that have a direct impact on medical specialists such as remuneration, negotiating conditions of practice, organizing services, optimizing operating suites, extra fees, the logistical needs of the new CHUM, the price of medications, physicians incorporating themselves, continuing professional development, and many others. We have also brought a "medical" light to bear on social issues including end-of-life care, abortion, the wearing of religious symbols, and assisted procreation. The positions adopted by your representatives have been extensively discussed with association presidents; we aim to represent, if not all members, then at least the majority.

Other organizations, including the QMA and the MQRP may so claim, but only the FMSQ is recognized as the negotiator for medical specialists by the MSSS. We represent you and that's why it is to your advantage, not only to follow us, but also to inform us of any problems you are experiencing, or to which you are witness, in your care environments.

Who Decides for the Members ?

I recently received emails from members saying they had never voted for a decision taken by the FMSQ. The FMSQ is a federated organization, a group of associations. Each medical association affiliated with the FMSQ is proportionally represented at the Delegates' Assembly, the highest decision-making entity within the Federation. The delegates, issuing from each specialty, including association presidents, speak for you and vote in your name. It is in fact the Delegates' Assembly that elects the members of the board of directors, that votes on the financial statements, on regular and special membership dues, that discusses the major objectives of negotiations, that votes on agreements with the government and so on.

The trust you have in your elected representatives and their solidarity with your peers are at the heart of your Federation's operations. There is also a key principle in the work we accomplish : confidentiality. This rule applies to every serious organization and does not in any way impact the "transparency" of its governance. However, it must be understood and recognized that discussing internal decisions, agreed-upon strategies, or actions being considered in public is neither acceptable nor desirable. Finally, I cannot insist too much on the mutual respect we owe one another. Expressing an opinion, even one that is emotionally deep-seated, must be done with respect for the opinion of others and for the decision taken. My presidency will be guided by these keywords.

Finally, I invite you to remain close – or to come closer – to the FMSQ to help us look after the "real business" of medical specialists !

Proudly yours !