Among medical specialists, psychiatrists will be the first to feel the effects of the Dubé reform of the health system, the former Bill 15, which now requires them to provide a minimum number of hours of work per week in hospitals.
The modalities remain to be negotiated, but they will be inspired by the model of family doctors, which relies on two options — offering 12 hours per week to public establishments or as many weeks per year in the regions —, indicates the president of the Association of psychiatrists of Quebec (AMPQ), Claire Gamache.
In the jargon of the health network, we refer to these obligations as “specific medical activities”.
If the area is remote, psychiatrists may only be limited to 10 weeks, but a two or three hour drive will require more work hours. And the incentives will be convincing, namely the threat of a potential drop in income of 30% in the event of refusal.
This is quite a change for the profession. Of the 1,200 psychiatric doctors who work in Quebec, around 200 practice exclusively in offices, especially in large urban centers. Some work in clinics specializing in autism or ADHD, for example; others, in family medicine groups.
A situation denounced by Mme Gamache, because this leaves too much of a burden on psychiatrists who work in hospitals, according to her. The latter inherit the heaviest cases and “hold the network a little at arm’s length,” she says. Especially since “we know that, in the coming years, we will have problems in child psychiatry, so everyone will have to evaluate children in emergencies”.
The Quebec government wishes to establish a “better balance of medical responsibility towards the population,” the office of the Minister of Health, Christian Dubé, was told.
No immediate impact?
The impact of this change will, however, be neither “huge” nor immediate, warns the president of the AMPQ. First, because the negotiation with the government could stretch until the end of 2024. Second, because some psychiatrists do not want or cannot make this shift. “There are many who are of a certain age and who will have to be supported. Some have already written to us and left the network because they were not capable.”
In an open letter published in October, a group of 40 psychiatrists argued that it was a mistake to force them to work in hospitals. “Psychiatrists working in the community treat several thousand patients each year who are covered by health insurance. This frees up emergency rooms and psychiatric services,” they wrote.
This change will, however, necessarily have an impact on the next generation, since students and future psychiatrists will adopt this new model of care from the start. “It’s a way of preventing the future from having fewer new psychiatrists leaving the hospital network at the very beginning of their practice. »
The idea of bringing psychiatrists back to hospital settings is not new: it has been discussed for a good ten years. Under the remuneration agreements signed with the Quebec state, medical specialists must guarantee a minimum of services in all regions. And since this objective was not achieved in psychiatry, the profession was obliged to find solutions, especially since the use of emergency doctors did not make it possible to meet the demand.
Which leads to another issue in the upcoming negotiations with Quebec: not only must the AMPQ bring psychiatrists back to hospitals, but it must also ensure that they are not all destined for hospitals in large centers. In Minister Dubé’s office, it is also emphasized that the new formula must take into account the “needs of each region”.
In Quebec, nearly 6,000 people are currently waiting for a psychiatric consultation, including 4,000 within deadlines that do not meet the Ministry of Health’s targets.