Tabling of the Auditor General of Québec's Report : Preliminary Response from the FMSQ
Montreal, November 27, 2015 – "We will take the time to read the report and to analyze the hundred or so pages that concern us, since we did not get access to it sooner despite the several requests we put in for it. It is obvious, however, that the document has made the rounds, based on the amount of ink that has been flowing in the media. To start with, we deplore the fact that of the 6,000 or so auditing hours spent to complete this exercise, only two were spent by the Auditor General's team in a meeting with representatives of the Federation, on November 3rd," commented the President of the Fédération des médecins spécialistes du Québec (FMSQ), Dr Diane Francœur.
Agreement on Averaging
In 2014, the Couillard government forcibly re-opened our Agreement to again spread out the sums that were due to us to reduce the short-term pressure on public finances by again putting off the payment due dates for an additional period of 7 years. This was what the government wanted and this was what it got. The Auditor General cannot therefore conclude that the government's projected savings did not materialize, since savings were not the objective. We even offered, and gave back to the government the amount that should have been paid during the 8th year of this new re-averaging agreement, an amount totalling $350 million. This basic fact was ignored in the report.
Calculation Errors by the Conseil du trésor
The Auditor General indicates that the Conseil du trésor made errors in the calculations it performed to determine the sums to be paid out within the framework of the re-averaging agreement. If there were errors, they did not come from us. It is important to emphasize that already in 2008, the FMSQ had asked the Ministère de la Santé et des Services sociaux (MSSS) to set the evolution of medical practice estimate at 2.5%, something the MSSS refused to do. As already indicated by the Minister of Health, this excess in expenses was used for services to the population and, in reality, reflects our increased productivity.
Measures of Accessibility
Contrary to what the Auditor General says, it is relatively easy to measure the impact of each of the measures of accessibility implemented after the Agreement of 2007, if only by looking at the number of medical acts performed. Within the framework of the public audiences and individual consultations preceding the adoption of Bill 20, we tabled a white paper on March 17, 2015. One section of this white paper (pages 6 to 8) provided specific statistics on the various accessibility measures that were implemented. If the Auditor General's team had taken the required time to meet with us, we could have gone over each measure and explained the results in full detail.
Beyond these numbers, the effects of a measure can be looked at in many ways. Teleconsultation, for example, is one of these measures. It allows a patient in a remote region to consult a medical specialist by videoconferencing, without having to wait, without having to travel, without having to pay for a place to stay for him or her and their family. For this patient, the benefit is tangible and can be found at various levels. Has the objective of accessibility been met? The answer is yes. Has the target been reached ? The answer is again yes.
Administrative Pressure on the RAMQ
The evolution of medicine, research, technology, the number of medical specialties, the services offered must be reflected at the level of coding medical acts which, in order to be transparent, are labelled in such a way as to be exact and precise. Coding more loosely would simply produce the opposite effect. The complexity of coding medical acts and the rules that apply to this process are the framework in great part that sets the RAMQ's terms of payment. The Auditor General should have congratulated us for having established a certain automatic "control" at the root.
Parity With the Rest of Canada
Starting in the 1980s and through successive special laws adopted under all governments, a gap appeared and has been dug progressively deeper between the average remuneration offered to physicians in Québec and that which is offered in the rest of Canada. In 2003, a process of comparative analysis was initiated and spread over four years, resulting in the government's recognizing the existence of such a gap and agreeing to the necessity of correcting the situation. It was in 2007 that the government finally signed an agreement with the medical federations in order to correct the level of remuneration of physicians, an agreement which, we repeat, respected the government's capacity to pay. The Auditor General says that it now becomes necessary to undertake a new evaluation of the situation. The Federation is totally ready to take part in such an exercise, at any time.
The Auditor General does her job and we respect this. However, an approach that is strictly based on an accounting analysis remains fragmentary and needs to be put into perspective because, in the end, too many aspects are not taken into account. This picture risks, once again, devolving into the commonplace. We are now, and will always continue to be, available to explain our agreements to the Auditor General, if she is interested.
The Fédération des médecins spécialistes du Québec represents more than 10,000 medical specialists certified in one of the 59 recognized medical specialties.