In the wake of the discussion on Bill 15 aimed at improving care, the government presented an extraordinarily simplistic and biased vision of specialized medicine. Here are the main received ideas that deserve to be realigned.
“Some 20% of specialists do not work enough. » We repeat this figure over and over again. How did we arrive at this percentage? Obviously, the Régie de l’assurance maladie du Québec (RAMQ) knows how many acts each doctor performs, being the sole payer for the vast majority of doctors. However, many specialists have teaching, research and administrative duties from their hospital department or department. Others are on parental leave. Undoubtedly, some delinquents exist among these doctors, as everywhere else. These should be identified by name and their practice examined to explain their apparent deviation. If it is true that these doctors do not work enough, the RAMQ has means to punish them, by reducing their remuneration, for example.
“Specialists should work more in hospitals, and in particular in the emergency room. The majority already work in the hospital: some need operating rooms, others technical platforms, for radiology, for example, which are difficult to access outside the hospital. Moreover, some doctors would like to work in a hospital, but are prevented from doing so by medical staffing plans, which provide for a fixed number of specialists in each establishment.
Thus, the services of certain young specialists are refused by hospital authorities on the pretext that there are enough doctors in their specialty. The service that would need such a specialist may argue that the members in place have other tasks than care and that an addition to provide this care is required, nothing helps…
“Specialists should work more in the emergency room. » Specialists are already on call throughout the hospital, including the emergency room, in their specialty. But it is utopian and dangerous to want to turn them into emergency physicians overnight. Do you really want a neurologist to stitch up your wound or a dermatologist to resuscitate you? Emergency medicine is a specialty in itself which some general practitioners have made their own. It is not true that specialists are above all generalists, as we sometimes hear. When you have been practicing a specialty for a few years, it is normal to no longer be able to provide primary care.
“Specialists should agree to work unfavorable shifts. » Typically, a specialist is required to do call duty in their specialty, usually 24 hours a day for several days, often a week. Do you find this “favourable”? Of course, the doctor will not necessarily be busy all this time, but he remains available. Some specialists, cardiologists or gastroenterologists, for example, will be in great demand; others, like dermatologists or rheumatologists, much less.
By emphasizing the supposed laziness of the specialists, we tend to attribute the delays for the operations to them. Many surgeons only have one operating day a week in their hospital, due to lack of staff in operating rooms and lack of beds and staff in intensive care and elsewhere in the hospital. The surgeons would only ask to operate more; that’s what they were trained for.
Currently, physicians are part of a dysfunctional care system with several cogs seizing up. They too suffer from it. To be able to restart the system, the “doctor” cog is essential. The government would be well advised to know and recognize the work of specialists to ensure their full cooperation. Thus, together, they will be able to make corrections where necessary.