The $120 premium for the care of new patients, which is the subject of the dispute between the government of Quebec and the Fédération des médecins omnipraticiens (FMOQ), was provided for in the 368e letter annexed to the framework agreement expiring on March 31, 2023, which itself covered 53 specific agreements and 792 miscellaneous agreements.
Only a handful of initiates manage to find themselves in this Kafkaesque labyrinth, which was the price to pay for doctors to agree to participate in the health insurance plan, which specialists had even welcomed with a general strike in 1970 right in the middle of the October crisis.
Even though the medical profession has accustomed us to a fierce defense of its privileges, it was shocking to say the least to hear that general practitioners were ready to reduce the number of appointments available for peanuts.
This pass of arms with the Minister of Health, Christian Dubé, who also rolled the mechanics at the general council of the CAQ, before relenting, looked more like a warm-up before the real test of strength, when the negotiations for the renewal of the framework agreement.
Beyond the billions at stake, the question is to know whose interests the health system should serve and whether the government is really determined to ensure that these are those of the population.
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In an interview given to The Press in 2016, the “father of health insurance”, Claude Castonguay, returned to the negotiations of 1970 and the balance of power of doctors against the State. Their pre-eminence had even increased over time, he observed, to the extent that they had obtained the right to distribute the wage bill granted to them themselves, which was not the case initially. This is how we saw the appearance of these “jacket”, punctuality and even meeting bonuses which caused a scandal.
Mr. Castonguay believed that it was time to “decide that our health system is not the property of doctors, but of Quebecers, and that it should be seen, analyzed and managed according to Quebecers and patients.” However, he noted this: “we are not progressing in this direction because everything that affects doctors in the slightest must always be negotiated with the two medical federations”.
In 2018, the abandonment of the fee-for-service method was part of the CAQ’s health commitments, as was the reduction to 90 minutes of waiting time before seeing a doctor in the emergency room, that access to a family doctor for each Quebecer or that the billion that a CAQ government was going to demand from specialists.
In an interview with Radio-Canada in November 2019, Prime Minister Legault wanted to be determined. “We really need a new agreement, a new method of remuneration, with family doctors paid per patient rather than paying them per procedure […] If necessary, there will be a special law. »
Last Wednesday, at the National Assembly, the leader of the PQ, Paul St-Pierre Plamondon, asked him three times if he intended to keep his promise concerning the method of remuneration. Seeing him slipping in all directions without answering the question, we understood that this reform has as much chance of being achieved as that of the voting system.
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However, others have succeeded. Over the past year, the vast majority of family doctors in British Columbia have abandoned fee-for-service payment in favor of a formula focused on the needs of the patient. Their association believes that the new model is a success.
Mr. Dubé shook up the structures with the creation of Santé Québec. He also undertook to eliminate the use of private employment agencies, causing a dramatic staff shortage on the North Shore and the disaster formation of a flying team.
During the last round of public sector negotiations, the government demanded the introduction of greater “flexibility” into collective agreements. The Quebec Interprofessional Health Federation (FIQ) is still resisting, but it will have to agree one day or another. In short, everyone must change their practices, except doctors.
Is it so abnormal that the Ministry of Health — or the future agency — has access to medical clinic data to ensure that patients who are supposed to be treated for a fee are actually seen? Doctors are always ready to collaborate in change, as long as it does not concern them. Nothing must change in the kingdom of Hippocrates.
There was a time when the government might have been able to rely on public opinion to change the rules of the game, but the precipitous drop in its popularity and the need to demonstrate tangible improvement in health services before the next election now make a war with doctors very unlikely, which could have the opposite effect. After a last stand, Mr. Dubé risks experiencing the same fate as his predecessors, who had to give up their weapons one after the other.