“We’re not lying: it’s much more lucrative in the private sector. The public, we see that… I don’t want to say it unkindly… but it’s almost volunteering. It’s less efficient, it’s less productive, we’re stuck working on call, coming home in the evening, working weekends. It’s like our good deed that we’re doing there. »
Many readers swallowed their coffee wrong when reading this quote in The Press, last week. It was from orthopedic surgeon David Blanchette, a private clinic owner who threatens to give up his hospital job for good if the government prevents him from shuttling between the public and private sectors as he pleases.
The Minister of Health is in fact considering various measures to curb, or at least slow down, the phenomenon of two-tier medicine in Quebec, according to information revealed by our parliamentary correspondent, Tommy Chouinard.
The quote from Dr Blanchette is shocking, it’s true. To the public, an orthopedic surgeon earns an average of $514,266 per year.
PHOTO ALAIN ROBERGE, LA PRESSE ARCHIVES
The Dr David Blanchette, in 2014
“I think there are a lot of people who would like to volunteer at that salary,” quips… the Dr Blanchette himself, painfully aware of having expressed himself badly. “That’s not what I meant at all. I wanted to talk about less efficient conditions [au public] and difficult access to operating rooms. I really chose the wrong term. »
I wish to believe. And I do not want to overly burden a doctor who has undoubtedly expressed out loud, in an awkward manner, what some of his colleagues are thinking quietly. Anyway, it’s not the Dr Blanchette, the problem.
Nor is it the fact that a growing number of doctors are doing like him by withdrawing to practice privately before subsequently re-engaging. Not only that, anyway.
The basic problem is the universal and free health system which is slowly disintegrating, before our eyes, without anyone doing anything about it – or very little.
Tommy Chouinard forwarded me a sample of the outraged emails he received and it reassured me a little: not everyone has lost their ability to be scandalized.
15 years ago, the whole of Quebec would have torn its shirt in the face of such comments. The universal health system, collective pride, was a sacred monster that should not be touched under any circumstances. Private care was taboo. Not anymore.
In Quebec, private medicine has gradually been trivialized and normalized. Celebrated, even. With good reason, some will say: in the hospital, patients of the Dr Blanchette must wait three years for an operation requiring hospitalization. At the private clinic, “there isn’t really a waiting list,” says the orthopedic surgeon. The patient can choose the date of his operation.
For a patient condemned to languish three long years in pain, the choice can quickly become obvious. All he has to do is swap his sun card for his credit card.
For the same treatment, often offered by the same doctor, you now have the choice: pay top dollar or wait for months, even years. This is exactly the two-tier medicine that Quebec rejected, out of concern for fairness. For a long time, we refused to allow commercial logic to infiltrate our health system.
What happened ? Quebec has become the Canadian champion of private health care. Clinics that charge for services covered by the Régie de l’assurance santé du Québec (RAMQ) are proliferating.
For $5,000 per year, you are entitled to all-inclusive: family doctor, health check-ups and follow-ups. You can also pay à la carte: $250 per consultation, $25,000 for a hip replacement… There is something for everyone.
The exodus towards the private sector is gaining momentum. There have never been so many “non-participating” doctors in the RAMQ. In January, Quebec had 720, most of them family doctors. In comparison, all other Canadian provinces have… a dozen, according to a disturbing survey conducted last year by the Globe and Mail.
Ontario prohibited its doctors from disaffiliating with the public plan in 2003. In Alberta, a supposed paradise for entrepreneurship, patients who want to seek treatment more quickly must fall back on the United States or… Quebec.
How did Quebec get there? If only one doctor had to be blamed, it would probably be Dr.r Jacques Chaoulli, this Franco-Quebecer who waged an epic fight – hunger strike included – in favor of the privatization of health care.
In 2005, the Supreme Court agreed: Quebecers who languish on waiting lists for months should have the right to take out private insurance for care covered by the public plan.
The Chaoulli ruling, which only applies to Quebec, has had a limited legal impact. But he opened a breach. Since this judgment, the privatization of health care has enjoyed increasing social acceptability in the province.
Mind you, it didn’t really improve the state of our network.
Even today, the Dr Blanchette pleads what the D had pleadedr Chaoulli before the Supreme Court: the delays, to the public, are inhumane. Among his patients awaiting an operation, there are workers on forced unemployment. There are elderly people who risk losing their homes and ending up in CHSLDs because they are no longer able to move around on their own.
There are plenty of tragedies caused by these damn waiting lists.
The health system is failing everywhere. If so many people go to the private sector, it is because the public is incapable of treating them within a reasonable time frame. Who can blame them?
Private medicine is “a valve” for the public system, its defenders tell us. It has the immense advantage of reducing waiting lists. And then, for surgeons, it is better to operate in the private sector than to sit around waiting to work in the public sector. The health network is in such bad shape that surgeons have little access to operating theaters, which are often closed due to a lack of nurses and respiratory therapists.
This is all correct. But it is also a vicious circle.
If there is such a shortage of labor in the network, it is in part because many health workers choose to migrate to the private sector, where they do not have to carry arm a network that lacks everything.
However, the more dilapidated the network, the more workers will make the jump to the private sector, and the more dilapidated the network will be…
In the short term, it’s true, the private sector can be the valve for the public. But in the long run, it won’t save him. If we continue to let it grow, it might even finish him off.