Waiting lists for operations | Dubé launches a new catch-up plan

(Quebec) At a time when the two medical federations are criticizing his reform, the Minister of Health, Christian Dubé, has reached an agreement with one of them, the Federation of Medical Specialists of Quebec (FMSQ), to accelerate the catch-up surgical interventions.

This agreement, which will be unveiled on Wednesday but whose The Press has obtained details from a reliable source, has one main objective: to bring the number of patients who have been waiting for surgery for more than a year to the pre-pandemic level of 2,500, to here on December 31, 2024. There were 17,512 as of March 31.

A year ago, Christian Dubé said he was going to return to the pre-pandemic rate this spring, but the results are not there. The agreement with the FMSQ aims to reach the target once and for all by the end of next year.

It plans to optimize the use of operating rooms, in particular by granting bonuses to staff who agree to work overtime on a voluntary basis for evening shifts, weekends and holidays.

About $400 million will be invested to catch up. The sum comes from savings generated by the Institute for the relevance of medical acts, an organization created in 2020 to eliminate inappropriate or unnecessary medical acts.

To ensure that the target is reached by December 31, 2024, each health establishment – ​​the CISSSs and CIUSSSs – will have an objective to meet and will have to adopt an action plan. An intermediate target will also be set for each. For all of Quebec, it will be to reduce the number of patients who have been waiting for more than a year to 7,600 by March 31, 2024.

“All the doctors are worried”

The agreement comes as doctors, including the FMSQ, criticize Minister Christian Dubé for keeping them out of decision-making places by “centralizing” powers in his vast health reform. They fear that a “coercive” approach will lead to an exodus towards the private sector.

On Tuesday, the FMSQ, the Federation of General Practitioners of Quebec (FMOQ) and the College of Physicians all said that Bill 15, which aims to make the health and social services network more efficient, seems to want to “dilute » their voices and even « evacuate » the doctors from the decision-making roles of the health establishments.

At the center of their grievances: the reduction in the weight of the councils of doctors, dentists and pharmacists (CPDP) in the organization of care and the “disappearance” of medical co-management.

“When you look at the bill, the principle of co-management disappears at the higher hierarchical levels and that is a mistake. Our network can count on excellent managers, but they need a medical counterweight,” lamented the president of the FMSQ, Dr.^r Vincent Olive.

The FMSQ said it “understands the direction” that Minister Dubé wishes to take in his reform, but that there is “a gap” between his vision and the legislative text.

The two federations, like the College of Physicians – a professional order – are asking Minister Christian Dubé to back down on the CPDPs. They must keep their current responsibilities, they said during the consultations in the parliamentary committee.

“All doctors are worried about that,” said the president of the FMOQ, Dr.^r Marc-Andre Amyot. The latter, moreover, launched a full-throttle charge against the minister’s bill, which risks “aggravating” the shortage of general practitioners. According to him, the legislative text seems to have been drafted “by civil servants” and does not take into account the reality of general practitioners.

Christian Dubé said he was “surprised” by the words of D^r Amyot, replying that the FMOQ brief appeared to have been written by “lawyers”.

Keep doctors away from power

At present, the CPDPs have direct access to the CEOs of health establishments to advise them on the organization of clinical care. They can also have a “watchdog” role to ensure that administrative decisions respect the needs of patients, explained the D^r Olive.

With the reform, the CPDPs would report to the medical director and the interdisciplinary council of the establishment, which comes “to remove the doctors in the field” from senior management.

It is moreover this medical director (a function created in the reform) who would have the power to impose administrative sanctions for any breach committed by a professional, including doctors. The federations are fiercely opposed to this function, which for the time being falls under the CPDP, being entrusted to the future medical director of an establishment.

In this regard, the FMOQ accused the minister of using a “coercive” rather than a collaborative approach. The union of general practitioners spoke of an “authoritarian” and “centralizing” reform.

For its part, the College of Physicians considers that the bill, in terms of clinical governance, “concentrates the powers in the hands of a restricted group of managers, resulting in a real risk of arbitrary decision” since “the same people will be responsible for both granting privileges and determining sanctions” for physicians.

It is also the medical director who can decide on the use of the resources allocated to the clinical department. We know that Quebec has in its sights to link the license to practice of medical specialists to the performance of “specific medical activities”, such as the obligation to be on call. On this subject, the FMSQ has softened its tone and says it is ready to collaborate with the minister.

Dubé stands firm

In parliamentary committee, Minister Christian Dubé did not comment specifically on the requests for the CPDPs. In a press scrum, however, he argued that he was not going to “change to change” his bill. “Does that mean that just the CPDPs don’t want to change [et que] everyone else has to change? he asked.

The minister also denied wanting to diminish the voice of doctors. “It tickles me a little when you tell me that you have the impression that we are taking away the voice of doctors,” retorted Minister Dubé in response to the College of Physicians. “Is it because we give voice to other professionals? “, continued the minister.

The College reiterated that it supports a sharing of responsibilities between all the professionals in the network, but that, in its view, the bill does not place enough emphasis on clinical and administrative co-management.

Consultations on Bill 15 resume on Tuesday.