Christian Dubé’s managerial talents were already well known. The pandemic made it appear that he was also an excellent communicator. We are now discovering its political sense.
During the 2018 election campaign, the CAQ promised that every Quebecer would have their family doctor before the end of their first term. Not only has the Legault government never come close to achieving this objective, it has not stopped moving away from it.
The Minister of Health surprised many by revealing that the number of “orphans” was not 800,000, but rather 1.5 million. In politics, we tend to downplay problems rather than magnify them.
Suddenly, abracadabra, it doesn’t matter anymore, as if we had been trying for years to solve a false problem. The important thing now is that everyone can have access to a doctor, no matter which one, within 36 hours.
Mr. Dubé gives the impression of having rediscovered the egg of Columbus, allowing his government to avoid a war with the medical profession within a year of the next election.
Doctors may have lost much of the esteem they had enjoyed for decades, it is the government that would have paid the price for the chaos into which a confrontation would have plunged the health network. Doctors are lucky not to appear on the ballot.
According to Mr. Dubé, the problem would not be that they do not work enough, as claimed by the Prime Minister and Gaétan Barrette, but simply that the appointment system is poorly organized. It is therefore useless to attack them. For the moment at least.
If the government had decided to individually penalize those who do not take care of enough patients, the medical profession would have come to the fore as a whole.
By giving the physicians themselves the responsibility of ensuring that sufficient time slots are available for appointments at all times in one or more family medicine groups (FMGs), Mr. Dubé at the same time instructs them to make the police. The more hard-working will have to put the slippers in line, otherwise they will have to work extra hard themselves.
However, nothing guarantees that the trends observed in recent years will be reversed. The youngest, especially women, who attach more importance than their elders to family-work balance, will not want to give up a quality of life that the income from even a reduced practice allows them to maintain.
The numbers show that older doctors tend to see the most patients. As they retire, who will look after them? We do not care less for the quality of life acquired at a younger age when we get older. We just take advantage of it in a different way.
If physicians are required to spend more hours in their clinics, they will necessarily have to spend fewer hours in hospital, as is the case in Ontario, even though the workweek is roughly the same. Unless they are unnecessary, the duties they are currently doing in the hospital will have to be taken on by others. This brings us back to Quebec’s glaring delay in the training of specialized nurse practitioners (IPS) and to the more general problem of the distribution of work in the network.
The old good guys and bad guys still work. After the Prime Minister’s threats, doctors could only welcome the change in tone announced by the bill that Mr. Dubé presented on Thursday. They are however right to be a little dubious. If the results are not there, the use of the hard way will become even more justified in the eyes of the population.
The minister wisely postponed the reform of the method of remuneration, which can only complicate matters further. Sooner or later, however, we will have to review the very favorable conditions that were previously granted to doctors to make them accept the creation of the health insurance plan.
In the meantime, the desire to see the health network regain its efficiency and harmony is such that everyone is ready to cling to the slightest hope. Even though we know that there is always something behind a magic trick, we applaud anyway. Until the next election, the government is asking for no more.