GPs or specialists, doctors do not want future medical directors who would be appointed by Quebec in the reform proposed by Health Minister Christian Dubé. Doctors say they are concerned about the rise of coercion and authoritarian leadership in healthcare settings.

For their part, representatives of the College of Physicians of Quebec (CMQ), the Federation of General Practitioners of Quebec (FMOQ) and the Federation of Medical Specialists of Quebec (FMSQ) expressed their concern at the arrival in Québec of the senior physicians agency appointed by the future Santé.

In their opinion, these administrators would be the symptom of a centralizing will, as they would be the agency’s spokespersons. Currently, it is the principle of co-management that drives the management of healthcare institutions, where administrators make decisions in collaboration with the Council of Physicians, Dentists and Pharmacists (CPDP). These councils are composed of professionals elected by their peers.

“All physicians are very concerned about this concentration of power in the Medical Director,” said FMOQ President Dr. Marc-Andre Amyot. He also expressed concern at the loss of independent and powerful voices such as the current CPDPs and heads of general medicine departments.

“Administrators need a clinical counterweight,” emphasized FMSQ President Dr. Vincent Oliva, who fears too much power will be concentrated in the hands of the future state-owned company Santé Québec.

The President of the Medical Council, Dr. Mauril Gaudreault, earlier in the day advocated maintaining the principle of shared management between doctors and administrators on the network. The minister argued that co-management must be part of the culture of the network and not necessarily the subject of a draft law.

However, several participants pointed out that while co-management was so essential in the Minister’s eyes, it was not reflected in the spirit of PL-15.

Likewise, the CMQ believes that physicians promoted to decision-making positions must be well-trained, well-surrounded and, most importantly, have the necessary resources to ensure effectiveness.

threatened desertion

In both the FMOQ and the FMSQ, it was suggested in the parliamentary committee that a reform leading to the imposition of a constraint environment for physicians could lead to numerous retirements or departures from the private sector.

There is a fear among GPs that doctors will be forced to return to hospitals at the end of their careers. They are expanding their practice by continuing to see patients in the clinic and may choose to return home.

“It is the population that is being punished in all of this,” warned Dr. amyot.

Among experts, Dr. Vincent Oliva rather suggests that the coercive approach is ineffective with doctors and that something else needs to be done. He pointed out that medical specialists need to “shake the machine” at their facility on a regular basis so that their patient has access to the best equipment, the best medication, or the best home care.

According to him, the current version of the PL-15 “condemns” those doctors who dare to oppose the management. He believes that several specialists could opt for the private sector.

Dub is listening

Ahead of the resumption on Tuesday of the special consultations on the reform of the health network, the minister had every intention of hearing the professional associations, medical associations and unions who will appear before elected officials this week.

In a scrum just before the hearings began, Mr Dubé said he wanted to talk about “subsidiarity”, a principle according to which the upper echelons only have to retain those tasks which the lower echelons cannot carry out. Once again he wanted to make it clear that his goal is to decentralize the network, while the opposition perceives the opposite.

In particular, Bill 15, entitled “A Law to Increase the Efficiency of Health and Welfare Services”, provides for the establishment of the Santé Québec Agency, a government body responsible for overseeing the operation of the network. The department would then retain its role of dictating policy and setting budgets.

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