In a context where health measures linked to COVID-19 have influenced the mental health of Quebecers, competition from the private sector in the provision of psychotherapy services is harming access to care in the public network, according to a new study by the Institute for Socioeconomic Research and Information (IRIS).
IRIS estimates that about half of the province’s approximately 9,000 psychologists have an exclusive or “mixed” private practice. According to the institute’s calculations, the number of psychologists employed by the health and social services network has fallen from 2,500 to less than 2,100 in the last decade.
“Working conditions in the field and income have become much better in the private sector,” explains Eve-Lyne Couturier, researcher at IRIS and author of the report. “The government offers very little to keep professionals in the public network. This is why we are seeing an exodus of professionals from the public to the private sector. »
According to the researcher, the possibility of combining public and private practices poses a problem, because the private sector takes responsibility for the least burdensome and most profitable cases, while the public sector must take charge of the more complex and expensive cases.
A vicious circle “
Julie Lepage, psychologist who launched her private practice this summer after having practiced publicly in a school environment, confirms the difficulties stated by Mme Couturier. “The problems have really increased since the pandemic. There is a lot of distress in families […] Schools have no budget. We work in really difficult conditions. We don’t even have the basic means. »
Beyond budgetary questions, Mme Lepage deplores the organization of work in the school environment. ” The directors [d’école] do not give us our professional autonomy, she explains. We also did so much paperwork that we couldn’t see our students. »
In addition to a difficult working environment, the exodus of psychologists to the private sector is explained by inadequate remuneration in the public sector, according to IRIS. The institute observed a 50% increase in suggested prices on the website of the Order of Psychologists of Quebec compared to 2021, to settle between $120 and $180.
Christine Grou, president of the Order of Psychologists, believes that the increase stated in the study is erroneous. “There has been no surge in prices in recent years,” she maintains. The prices listed on the website had been the same for at least a decade and were recently updated, so the increase seen in the study did not occur entirely since 2021, she explains.
However, IRIS speaks of a “vicious circle” to describe insufficient service in the public sector and rising prices in the private sector. As the public network is incapable of providing the necessary services to the population, they turn to the private sector. However, increased demand in the private sector is pushing prices up, which is harming the accessibility of services and the retention of psychologists in the public sector, explains the report.
The Coalition of Psychologists of the Quebec Public Network estimates the pay gap in favor of the private market at 44%. “The basic problem comes from a lack of major recognition in terms of salaries and not from the increase in private prices,” explains Karine Gauthier, president of the coalition, which campaigns to curb the exodus of psychologists from the network. public to private.
But it’s not all about money. “It wasn’t the salary that attracted me [en pratique privée] “, says psychologist Julie Lepage. It was more professional autonomy that tipped the scales. “I manage everything. My clients, my schedule and my rates. I am in a clean, quiet environment, I have good customers. We are not experiencing major behavioral and attachment problems. I have full autonomy. »
Possible solutions
To improve access to mental health care in Quebec, IRIS proposes that psychotherapy care be covered by the Régie de l’assurance santé du Québec (RAMQ). This universal coverage should, however, be accompanied by an improvement in the working conditions and autonomy of psychologists in the public sector.
IRIS adds that “extending the basket of services offered by RAMQ to include psychotherapy should be accompanied by a ban on private insurance [pour des actes déjà couverts par la RAMQ] and mixed practice. According to IRIS, this system, already imposed on doctors, could make it possible to repatriate nearly 3,000 psychologists to the public network.
Before discussing the inclusion of psychotherapy care in the RAMQ offer, it would first be necessary to carry out a salary catch-up among psychologists in the public network, underlines Karine Gauthier, of the Coalition of Psychologists of the Quebec Public Network. Otherwise, forcing psychologists to choose between the private and the public could accelerate the exodus towards the private sector, according to her.
As for the president of the Order of Psychologists of Quebec, Christine Grou, she thinks that we must rather attack the sources of the problem, and not the structure of the regime itself. “The conditions of practice and the salary conditions are the two main factors that cause psychologists to leave the public network to work in the private sector,” she says. It is therefore necessary to target these factors to improve the attraction of the public sector, according to Mme Grou.