On July 8, an article in the Montreal Journal reported a decline in the average income of family doctors1concluding by the very fact that the latter work less and less. The thinking behind these hasty conclusions: if these professionals, paid per act, see their income decrease, it is simply because they perform fewer acts, therefore work less.
The Dr Gaétan Barrette, with his well-known sense of nuance, confirms: “A drop in income in medicine is the consequence of a drop in the workload. There are always no questions to ask. Society agrees to pay doctors well for their role, but in a context where there was a volume of activities at stake,” he says, considering that this era is over.
With such a statement, the Dr Barrette completely ignores the profound transformation of the work of doctors. Work that is not only measured in acts or dollars, but in doctor-patient relationships, in human careoften unpaid, in so-called invisible work, which escapes statistics.
This drop in remuneration is notably associated with an increasingly heavy clientele, with increasingly complex problems, which take time to understand and resolve. To an alarming proportion of mental health disorders.
To increasingly high expectations of the entire population, in a faltering network that is currently trying to rebuild itself, and whose resources are insufficient. Perhaps if all this were considered, we could see that, on the contrary, a majority of doctors work more.
This disembodied perspective of medicine, reduced to a succession of acts, and the concept of “productivity”, has always been at the center of the discourse. This reductive vision of “medicine-business” completely denies the very essence of medicine, family or specialized: the doctor-patient relationship.
Quality of life or quality of care?
During a recent appearance on the radio show Everything can happenon June 22 on Radio-Canada, Dr Barrette lamented the fact that “there are many doctors who have chosen time over money.” Again, while more and more doctors are aiming for a better life balance, a reduction in the number of procedures performed often means that each procedure takes more time for the doctor performing it.
The complexity of aging patients, the increasing number of chronic and complex conditions at all ages, the explosion of mental health disorders, in particular, are all situations that require more time from the doctor. For Pierre Le Coz, a “watch in hand” care approach is contrary to the duty of humanity. It is reassuring to note that doctors still prioritize this humanity; it is also disturbing that they are criticized for it with an accounting vision of medicine.
Invisible work and traditionally female skills
The regularly decried drop in productivity is more often observed in the so-called “care” disciplines, characterized by traditionally feminine skills: listening, empathy, reflection, attention to detail, compassion. These dimensions of medical work have always been underestimated and undervalued, which inevitably leads to significant variations in remuneration between different practice profiles. They result in a significant load of invisible work, i.e. not apparent, unpaid, and therefore not recorded. It is nonetheless essential for quality care.
Taking the time to listen to a patient, to understand their reluctance to a treatment, to explain it to them adequately is certainly time-consuming, but will often save the patient many subsequent appointments – and costs to the network.
As the immense transformations of the Dubé reform begin, it is essential to modernize our view of medical work. The vision focused solely on “productivity” must give way to a positive vision of the network, collaborative work and a recognition of the contribution of all health professionals. Minister Dubé will have the opportunity in the coming months to demonstrate to us that he has fully grasped the importance of this.
1. Read “Falling Income: Quebec Family Doctors Have Been Working Less for Three Years”
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