By Ruby Pratka
Local Journalism Initiative
The Coalition Avenir Québec government intends to table a bill requiring new graduates of Quebec medical schools to work for a certain period of time in the province’s public medical system before the holiday recess, a spokesperson for Health Minister Christian Dubé has confirmed.
On Nov. 6, Premier François Legault said in a National Assembly news conference that he was ready to use the notwithstanding clause, if necessary, to make sure the new law was applied and new doctors graduating from one of the province’s four medical schools either practiced in the public system or reimbursed part of their tuition. “This is too important. We have a lack of doctors. There’s a lack of doctors everywhere. Well, the doctors who are trained at Quebec taxpayers’ expense must practice in Quebec.”
In a statement, the Ministry of Health and Social Services (MSSS) noted that 775 of the province’s 22,479 practicing doctors practiced exclusively in the private sector, “a tendency that was particularly pronounced for new doctors.” It’s also possible for a doctor to alternate between public and private practice multiple times a year, or to leave the province and practice elsewhere.
“While too many Quebecers are still waiting to be treated, too many doctors decide, early in their careers, to leave the Quebec public network. We will take steps to ensure that the population has access to the care they pay for. Our government has the courage to take all necessary steps to strengthen doctors’ commitment to the population and our public network,” Dubé said in a statement. “This measure is part of a series of other measures to strengthen our public network and attract our professionals to work there, early in their careers.”
“We remind the government that the best way to retain specialist physicians in the public health network is to give them the means to provide care. Currently, the lack of technical platforms and personnel, among other things, too often prevents specialist physicians from practicing properly. And let us add that if this type of obligation were to apply to physicians, it should also apply to other health professionals, many of whom are also leaving the public sector for the private sector,” wrote the Fédération des médecins spécialistes du Québec in a statement. The Fédération des médecins omnipraticiens du Québec, the province’s family doctors’ union, preferred not to comment until the bill was tabled.
Dr. Pierre Fontaine is a resident pediatrician and a consultant doctor on the board of Médecins québécois pour la régime public (MQRP), which advocates for increased investment in the public medical system. “We were very surprised when this came out,” he said. “It’s a good thing that the minister is realizing the importance of the problem of young doctors going private.” MQRP also called on the government to consider expanding the law to other health professions.
“Ideally, we want the only medicine to exist to be public medicine,” he added. “The more doctors that leave the public system, the longer wait times will be.” Fontaine also said Quebec should consider overhauling its permit delivery system, which sometimes creates situations where “people who want to do family medicine [in the public system] are offered a permit for a CHSLD or to do obstetrics.”
Fontaine said he doesn’t think most graduating doctors will “desert” the province if new requirements come into force. “It will be a minority of doctors who have already made a prior decision to practice elsewhere.”
“When doctors’ training is financed with public funds, it’s normal that they give back,” said Pierrette Messier of the Bedford Pole Health Committee, who, like Fontaine, said she believes the only medical system should be the public system.
She said she believed the bill would help bring doctors to underserved regions of the province. “We’re a big, big province where there are a lot of remote regions, and this will probably help. I think [the new proposal] is sensible. We’ll see how it’s put into practice.”
“I can’t comment on a bill I haven’t seen, but we really want to solve the problem of getting doctors into the region,” said Townshippers’ Association executive director Denis Kotsoros. “It’s expensive to train doctors, and to see them jump out of the system right away is disappointing. I can understand [the government’s] frustration, but we have to be rational.” He pointed out that it remained to be seen how the bill would affect anglophones, graduates from out of province or doctors from francophone communities outside Quebec who study in Quebec as part of university partnerships. “What does this mean for francophone communities outside Quebec?”