Marc Tremblay argues that Quebec physicians have a debt to Quebec society because of the public funding of their training and that they are part of the problem in the health network. His letter will certainly have offended more than one doctor by his proposal to send an invoice to specialists to remind them of the cost of their training.
By emphasizing entirely the contribution of the state, the author does not recognize any autonomy for individuals who have followed these long studies. Instead, I suggest increasing the number of doctors trained to solve some of the problems raised by Mr. Tremblay.
Where Mr. Tremblay is more in line with most Quebecers is in deploring that doctors have been able, in past negotiations, to threaten to leave Quebec to extract concessions. But if the threat of doctors leaving Quebec carries so much weight, it is above all because of the gap in the workforce that is created by any departure. This would be true even if physicians had assumed all of their training costs.
And then, requiring doctors to reimburse their training if they leave Quebec, as Mr. Tremblay suggests, could encourage some to do so, feeling devalued. We wouldn’t be any further ahead.
If Mr. Tremblay wants us to reduce, in the long term, the power of doctors to threaten to leave Quebec, it is on the side of medical admissions that he should look.
Only a few years ago, the then Minister of Health, Gaétan Barrette, reduced the number of medical admissions, fearing to train “unemployed doctors”. In general, the government says it relies on models of medical staffing needs to set the number of places in medicine, supposedly ensuring that the question is purely actuarial.
Compensation savings
But it is misleading to estimate the numbers required and to think that we must train exactly this number of doctors. The estimate is necessarily imprecise, and the impact of an error in the estimate is asymmetrical. When too few doctors are trained, the population lacks services, and the doctors are overwhelmed. If we trained “too many”, the workload could be better distributed among the doctors, and the government would obtain more bargaining power, which would make it possible, for example, to reduce their remuneration without fear of departures. These compensation savings can easily outweigh the cost of training “excess” physicians. And all this, without demanding a refund from anyone.
Since doctors’ unions have not always opposed the increase in admissions, this might not seem to diminish their bargaining power.
But the shortage may have been such that admissions could be increased considerably before the break-even point was reached.
My proposal goes further by suggesting the eventual training of a number of doctors beyond the minimum numbers required. Such a strategy would require managing residency positions in a compatible way.
Of course, we do not create places in universities or internships in hospitals by snapping our fingers. But given the decrease in the number of places in the past, it is obvious that we have not always trained as many doctors as possible. Although I deplore Mr. Tremblay’s acerbic tone towards our doctors, I believe that it is legitimate to be uneasy about the balance of power created by the risk, real or perceived, of the exodus of doctors trained here. In the future, those who bemoan this bargaining power of doctors should suggest training more of them, rather than sending them a bill in the mail.