Do doctors work enough? Are they overpaid? As negotiations begin with the federations of general practitioners (FMOQ) and specialists (FMSQ), these questions distract attention from what is essential.
The how much matters less than the how.
The priority is how doctors should organize care to better care for patients.
The proof is in: the support model is a failure. This is what will need to be revisited.
In 2018, the CAQ government confronted specialists to reduce their remuneration and create an institute to identify irrelevant medical procedures.
This time, the confrontation risks being with the FMOQ. Because too many vulnerable patients do not have a doctor, and those who do have a doctor struggle to see him.
Before going any further, a reminder of the overall picture.
Health is increasingly eating into Quebec’s budget. 35 years ago, it accounted for a third of public spending. It’s now more than half. There is therefore less money left for other state missions such as education.
The health budget is increasing faster than state revenues. In constant dollars, it has jumped 33% in 10 years. And the trend will continue because of new treatments and drugs as well as the aging of the population.
As the President of the Treasury Board, Sonia LeBel, reminds us, pumping more money will not be enough to solve our problems.
What share of the budget goes to doctors?
A decade ago, a peak was reached in the share of the health budget used to pay doctors. In 2016-2017, 21% of the budget was used to pay them. This rate has since decreased. It will drop below 15% next year.
Quebec recently submitted its preliminary offers to the FMOQ and the FMSQ.
In principle, everyone assures that the priority will be access to care. But this remains to be verified at the tables…
This time, the interests of the FMSQ converge with those of Quebec. She says she is a victim of lack of staff and resources. Its members must, among other things, limit operations because of the lack of nurses and equipment. If we equip them, patients’ waiting times will decrease and their remuneration will increase.
The FMSQ is clever. She says she shares the fight of the Minister of Health, Christian Dubé, against bureaucracy. Examples: the delay in approving a new treatment or the refusal to open an operating room at the end of the day so as not to pay overtime…
Moreover, François Legault received the president of the FMSQ, Vincent Oliva, in his office.
With the FMOQ, it will be complicated.
Of course, if specialists offer more care, general practitioners will not complain. Patients who fail to see a specialist often end up in their office, adding to their workload.
General practitioners will also be helped by two bills from the CAQ government. There is that of Mme LeBel, which breaks down barriers between professions and authorizes certain professionals to perform procedures currently reserved for doctors.
And that of his colleague Jean Boulet, Minister of Labor, who will reduce a little the administrative work imposed on doctors – the majority of the paperwork will remain, however deplores the FMOQ.
But the most complicated part remains to be done. The support will need to be reviewed.
Physician remuneration is complex. The federations receive a global envelope. They then essentially decide how to distribute it among their members.
This time, Quebec wants its say. The current system pays off for a general practitioner who decides to perform more simple procedures, such as those offered in a walk-in clinic. But why would anyone want a doctor to treat their child’s ear infection?
The CAQ government has given up on promising a family doctor for every Quebecer. He would now like to guarantee it only for vulnerable patients. For others, we will rather aim for care by a health professional.
This was precisely the goal of the Front Line Access Counter (GAP). He had to refer patients, when relevant, to healthcare personnel who are not doctors. But it doesn’t work. In almost 80% of cases, people still consult a general practitioner. The reason: other professionals are not available.
To remedy this, it will be necessary to allocate a larger share of the budget to them. But the CAQ government will return to the charge with an old commitment: to modify the method of remuneration to encourage patient care.
The FMOQ says its members are overwhelmed. There would be a shortage of 1,500, and this deficit is widening due to more retirements than hires. The choice of general medicine is not attractive enough, deplores the FMOQ.
Like Quebec, this federation says it is fighting first to improve access. However, it remains to be seen whether it will demand more money before opening its game, and whether it will agree to modify the current system which exhausts some of its members and which enriches others.
The cards will soon be put on the table.