The Dubé reform is doomed to failure if the government does not review the method of remuneration of doctors, pleads a group of executives in a brief in the form of an indictment against the excesses of what they call “the medical system”.
The Association of Supervisory Staff of the Health and Social Services Network (APER) judges that “if doctors were employees of the network”, rather than self-employed workers, they would understand it better and make it more efficient.
“Doctors don’t have time to manage their own schedule, they cancel appointments or surgeries at the last minute, arrive late demanding to have the staff in place even if we have to pay them overtime, are in no way supervised with regard to the number of tests, etc. “, Can we read in a brief filed Tuesday evening which mainly targets medical specialists.
The group, which represents 1,400 middle and senior managers in the network, was the last group on Tuesday to participate in the parliamentary committee on Bill 15 and the creation of the Health Quebec agency.
Minister Christian Dubé welcomed these comments by saying that he did not want “to debate doctors”. However, he asked the APER to tell him what “levers” he could give to the managers of the network so that they can impose certain decisions on the doctors, which is not possible for the moment.
The 1971 Compromise
In the eyes of APER, the dysfunctions of the system result from the compromise concluded in 1971 between the State and the doctors who were granted the status of independent worker. This “major concession” created two distinct systems: the “medical system” and the health and social services system. “These two systems work in parallel and they don’t like each other”.
APER adds that the reforms of the past 25 years have “slashed” the resources of the health and social services system “without affecting the medical system to the same extent”.
The Barrette reform notably resulted in the abolition of more than 2,000 management positions. It also constitutes a greater “trauma” than the pandemic itself among the members of the group, according to an internal survey.
Heads of clinical departments in the crosshairs
The Association of Supervisory Staff also protests against the powers that Bill 15 would give to heads of clinical departments (doctors) in hospitals. The latter would have authority over the heads of departments, executives.
This risks, says APER, causing “chaos” because doctors are “overwhelmed”, have “no training in management and very little interest in the subject”, etc. At present, managers and doctors work in co-management.
The director of APER, Anne-Marie Chiquette, said that co-management was working very poorly, but Minister Dubé insisted that things were going well “in 80-90% of cases”.
APER is the second group of executives to denounce this aspect of the bill. The Association of Managers of Health and Social Services Institutions (AGESSS) asked the Minister to maintain the principle of co-management of administrative and clinical governance “without subjecting one sector to another”.
Remember that Bill 15 aims in particular to entrust medical specialists with more “population responsibilities”.
Initially reluctant, the Federation of Medical Specialists of Quebec (FMSQ) has shown itself to be more and more open to collaboration within the framework of PL15 in recent weeks.
She has just concluded an agreement with Minister Dubé to reduce waiting times for surgery.