Quebec healthcare

Written by  //  September 15, 2017  //  Health & Health care, Québec  //  No comments

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15 September
MUHC board: Barrette has 20 candidate names in hand, will pick 10
A recruitment committee submitted a list of 20 names to Barrette on Thursday, the deadline set by the minister.
By Aaron Derfel
(Montreal Gazette) Initially, Barrette intended to appoint the new board members by the end of July, but he decided to prolong that process after complaints by the Central Users Committee of the MUHC that he wasn’t consulting the community.  In response, Barrette struck an eight-person committee, headed by prominent Montreal lawyer David L. McAusland, to submit a list of candidates.
One of the criticisms of the old MUHC board was that it did not adequately represent the mosaic of Montreal’s cultural communities and visible minorities. As part of Barrette’s administrative reforms enshrined in law, he must appoint board directors who represent the “socio-cultural, enthno-cultural, linguistic and demographic composition of the user population.”
He must also ensure the board “be composed of an equal number of women and men.”
Yet when Barrette formed the eight-person recruitment committee, he did not give it the explicit mandate to ensure such a representation. Instead, he required that potential MUHC board members have backgrounds in governance, finance, real estate, quality management and user experience of social services.
The appointment of the new board members is critical, because the board must recommend a new executive director of the MUHC. That position has been vacant since September 2016, when Normand Rinfret retired. Martine Alfonso (a former physiotherapist who was later promoted to associate executive director of the Montreal Children’s Hospital) has been serving as interim head of the MUHC.
Under Barrette’s legislative reforms, the health minister has gained the ultimate power to appoint not only the board members to a hospital but its executive director, too. Thus, the fate of the MUHC will ultimately depend on Barrette.

14 September
Royal Victoria Hospital closes two more ORs, wait times to grow
Wait times for surgery at the Royal Victoria Hospital — already among the longest in Montreal — are expected to grow even longer as the hospital closes two more operating rooms because of an acute shortage of nurses, the Montreal Gazette has learned.
In an internal memo sent Wednesday evening, the interim executive director of the McGill University Health Centre warned of the logistical hardships now facing the Royal Vic, and expressed concern about the impact of potential delays on the health of surgical patients.
“A challenge upon us currently is related to the adult operating room (OR) team at the Glen site,” Martine Alfonso said.

28 August
Aaron Derfel: Quebec agency monitoring superhospitals costs taxpayers $27 million
(Montreal Gazette) It’s an obscure government agency with an annual budget of more than $2 million and a staff of nine. Its mandate has been to keep a lid on superhospital construction costs.
Yet since the creation in 2005 of the Bureau de la modernisation des CHU, the total costs of building Montreal’s two superhospitals, as well as the expansion of Ste-Justine Hospital, have tripled. What’s more, the bureau’s mandate will continue into the foreseeable future despite the fact that the projects are either nearing completion or finished.
Today, the real costs for the three projects have soared to $7.1 billion despite the oversight of the bureau.
The total price tag of the CHUM superhospital — which includes the cost of the land, decontamination, construction, management fees and the acquisition of new medical equipment, among other expenses — comes to nearly $3.1 billion. Building the CHUM’s research institute ended up costing $85 million more than projected, bringing that project’s price tag to $555.4 million.
The final price tag for the Ste-Justine expansion is $939.6 million. As for the MUHC, although officials have often cited the figure of $1.3 billion, the real cost for the full redevelopment will rise to $2.463 billion.

25 August
Superclinic opens in NDG on Sept. 11
There will soon be a new superclinic at the Queen Elizabeth Health Complex.
(CTV) Quebec’s Health Minister Gaetan Barrette made the announcement Friday morning, saying the goal of the expanded clinic is to help patients who do not have family doctors.
The government wants patients to head to superclinics instead of going to hospital emergency rooms.
It will operate from 8 a.m to 8 p.m., seven days a week, with patients able to get radiology, blood tests, and other medical work done on site instead of having to go from place to place for medical exams. Additional nurses and technicians will help with the extra workload, thanks to personnel subsidies.
“It is the first superclinic that will be opening in the McGill network and in the English speaking community,” said Health Minister Gaetan Barrette, who said it is a good option for people who don’t have their own family doctor.
Dr. Mark Roper, the director of the superclinic, said the purpose is not to provide people with family doctors.
“The access to a family doctor remains a challenge, and especially for our area because we have a lot of patients from other regions registered with our family doctors,” said Roper.

31 July
Fundraising revenues plunge at MUHC amid problems at superhospital
(Montreal Gazette) Total revenues plunged by 29 per cent or $27.4 million, amid a barrage of negative publicity at the MUHC.  Reports surfaced of escalating tensions between the MUHC and design-builder SNC-Lavalin, culminating in a  $330-million lawsuit that the engineering firm filed against the government.
… in the months after opening, doctors complained of new medical equipment sitting idle and unused operating rooms as MUHC management was forced by Quebec to cut tens of millions of dollars from the operating budget.
Fiscal 2015-2016 proved to be a difficult fundraising year for the foundations of some Montreal hospitals — largely because of declines in investment income — but Revenue Canada tax filings show that the MUHC suffered the worst by far. …
In a perfect storm of bad press for the MUHC, Porter’s death on June 30, 2015, made international headlines just as the superhospital was grappling with reports of embarrassing glitches at the Glen site and the news that the volunteer auxiliaries that raise funds were being forced to pay rent by the private consortium.

18 July
Barrette forms committee to recruit MUHC independent board members after mass resignations
The committee will be led by David McAusland, a lawyer and former chairperson of the Montreal General Hospital Foundation.
It will include seven other community representatives and one from the ministry of Health and Social Services: Dr. Olivier Court, Dr. David Eidelman and Dr. David Mulder of the MUHC, Jonathan Amiel and Isabelle Marcoux from the Montreal Children’s Hospital Foundation, Anna Martini from the MUHC Foundation, Seeta Ramdass from the MUHC Patient’s Committee, and Pierre Lafleur from the ministry of Health and Social Services.
Interested candidates must submit their applications before Aug. 16 at 5 p.m

13 July
Unions press Barrette for seats on MUHC’s revamped board
Meeting between health minister, unions follows resignation of 10 MUHC board members earlier this week
Unions at the McGill University Health Centre are asking Quebec Health Minister Gaétan Barrette for a seat at the table — three, in fact — as he seeks to address the problems at Montreal’s largest hospital.
Barrette is “open to the idea” of appointing labour representatives to the MUHC board, union leaders said Thursday.
“We represent nearly 10,000 employees, and there should be a permanent representation for these employees.
I felt there could be an opening,” Manuel Fernandes, a representative for the CSN labour federation, said following a meeting Thursday morning.
Afterward, union representatives said they remain concerned about the strained relationship between Barrette and the hospital. “The government and the MUHC leadership are not on the same page, and right now nothing is going to change,” said Denyse Joseph, head of the nurses union.
Gaétan Barrette calls emergency meeting with unions amid turmoil at MUHC

12 July
Anglo-rights group working with Barrette to replace MUHC board
The QCGN, founded in 1995, successfully lobbied Barrette to amend his controversial reform on hospital governance — known as Bill 10 — to give anglophones more of a say in the appointment of board directors. A key figure in that campaign was Eric Maldoff, a former board member of the MUHC who is currently a director of the QCGN.
“Our health and social services committee is chaired by Eric Maldoff,” Chambers noted. “He has been talking to the minister about some names” to sit on the MUHC board.
What is the QCGN, the anglophone-rights group working quietly to reshape MUHC?
Montrealers learned this week that the Quebec Community Groups Network (QCGN) has been quietly working behind the scenes with Health Minister Gaétan Barrette to reshape the leadership of the embattled McGill University Health Centre.

10 July
Ten independent board members of MUHC resign en masse
(The Gazette) The 10 independent members of the board of directors of the McGill University Health Centre resigned en masse Monday, saying they have been hamstrung by Quebec Health Minister Gaétan Barrette.
The departures of more than half of the 19 board members followed a wave of public criticisms Barrette levelled at the MUHC for its chronic failure to rein in its deficits.
The board said it cannot function effectively with a health minister who threatens trusteeship and refuses to speak to them directly.
“He considers us an impediment. Our only interest is what is best for the MUHC and the community. It’s better that we resign,” board member Glenn Rourke told the Montreal Gazette of the official decision made earlier in the day “with much regret.”
The board represented the community and its expertise, “it was a good board,” Rourke said. “But the real power lies with the minister. The board couldn’t even name its chair or CEO.”
The abrupt move leaves the MUHC rudderless. It has been without a permanent executive director since last September when Normand Rinfret retired. Martine Alfonso, who once headed the Montreal Children’s Hospital, is serving as interim director.
The last straw leading to the exodus was a series of “hurtful” events topped by Barrette’s media release of several reports on the MUHC commissioned by the Health Department — the latest called for trusteeship of the MUHC —  without providing the board the courtesy of seeing them first.
For example, the board was kept in the dark about results of a government report by Claude Desjardins, who recommended putting the hospital under trusteeship, and by Dr. Arvind K. Joshi, which noted a unanimous distaste for more mergers and called for an immediate decision to turn around the MUHC’s leadership and budget.

5 July
MUHC report: Distaste for another merger ‘almost unanimous’
There’s no interest in another structural reorganization or merger of the English-language mega-hospital, and its leadership and funding must be turned around “immediately,” concludes the “Joshi report” into the future of the McGill University Health Centre
(Montreal Gazette) Dr. Arvind K. Joshi, the former executive director of St. Mary’s Hospital, submitted his 41-page report in late April to Barrette after six months of extensive consultations of the MUHC community, including patients. Barrette had asked Joshi to step in with non-partisan consultations after two proposals at a public hearing in October aimed to turn the MUHC into a larger, mega-conglomerate by merging it with west-end health organizations — the West-Central Montreal CIUSSS and the West Island CIUSSS — that run the English-language health institutions in the western half of Montreal. …
The report stressed several problems not specific to the MUHC but which were raised repeatedly during Joshi’s consultations: Quebec still does not have a shared, uniform information system, unresolved issues with hospital funding, which is not activity-based but rather a global sum that doesn’t take into account the volume of patients, and difficulties in medical staffing of institutions with a teaching mission, as well as confusion among medical practitioners and users about who in the network is responsible for certain services.
Specific to the MUHC, the report noted “a climate of unhealthy competition seems to be incubating within the network and should be managed otherwise than by restructuring.” And, the CIUSSS and the MUHC “administrations have often been absent and unreachable since the last reform.”
It warned that issues from last reform have not been resolved and would be exacerbated by a new merger. Participants fear “community disengagement” and a diminishment of an institution dear to the community, the report said. In the wake of the last reform, “there’s a generalized feeling of misapprehension and suspicion that a major change will be imposed without consultation or transparency.”
The report noted the MUHC has been under pressure to meet its budget, incurred a deficit of more than $40 million in 2015-16, leadership is faced with several challenges, and “employees and professionals feel targeted and demoralized.”

26 May
John Rae, the super hospital’s quiet philanthropist
By Tracey Arial
(The Montrealer) Which Montreal powerbroker convinced private investors to donate massively to the MUHC super hospital through years of political turmoil, fraudulent leadership and the pullout of key players?
John Rae, a man unafraid to laugh at himself.

Editorial: Fixing the MUHC
The uncertain status of the McGill University Health Centre is causing anxiety, both within the venerable hospital network and among the community it serves.
The administration is grappling with cuts to services and programs to meet its budget. It claims the MUHC is being underfunded based on a 10-year-old plan that doesn’t take into account present-day patient volumes.
Health Minister Gaétan Barrette says the MUHC suffers from a”problem of leadership” and needs to be “stabilized.
While they bicker, patients suffer. The MUHC users’ committee is sounding the alarm about diminished service, including unacceptable delays. Prevention and support programs have been cut. Morale has plummeted among doctors, nurses and staff, who patients report are doing their best under trying conditions. Unions have organized petitions, and the foundations that raise money for the hospital network have called on Barrette to address all the worry.

25 May
No funding boost coming for MUHC, Gaétan Barrette says
Health Minister Gaétan Barrette says he won’t boost the funding of the McGill University Health Centre despite the pleas of cancer patients and the physically disabled at an emotional news conference Thursday.
Although Barrette acknowledged that the government is flush with $300 million in additional health funds, he argued that it wouldn’t make sense to use some of it to cover the MUHC’s budget deficit.

18 May
Opinion: MUHC can and must do better for our community
By James Shea & Geoffrey Chambers, QCGN
(Montreal Gazette) Let’s be blunt. Within the MUHC and across Quebec, English health care isn’t working to its full potential. The MUHC is afflicted with morale, managerial and other chronic issues. Holdovers from the Arthur Porter era have utterly failed to build the case for what we have long needed — a well-thought-through organizational redesign that is patient-centred. To accomplish the turnaround in governance and accountability that the MUHC so sorely needs, we require active engagement.
Whining is pointless. The Quebec Community Groups Network wants a productive debate and positive results on this and a variety of issues such as history curriculum, government services in English, bilingual signs, electoral map changes … the list is long. The way to achieve such progress is through evidence-based arguments, hard-nosed, fair-minded bargaining and a viable plan.
In health care, we need a system that doesn’t regularly drop the ball or needlessly escalate levels of care. One that doesn’t rule out the most promising option for oncology treatment because of the postal code of that patient’s home.
The MUHC needs an integrated, patient-centred approach that fosters continuity of care. Leading health-care systems are taking full advantage of available technology, techniques and tactics. Ours is most definitely not.
A modern system prevents or minimizes hospital stays. It delivers appropriate services as close to the front lines as possible. It allows and motivates staff to do better what they do best. It heals, it doesn’t hinder. It encourages, it doesn’t impede. It also saves taxpayer dollars. Instead, the MUHC status quo argues that co-ordination with the rest of the network is an imposition.
See also Allison Hanes: Treatment of MUHC is symptom of bigger problem

20 April
Quebec must invest in MUHC as it did with Bombardier: patients’ group
(Montreal Gazette) Like Bombardier, “the MUHC is a Quebec institution with world-renowned clinical care, teaching and research”
News of the strained relations and budget cuts have raised concerns that the MUHC will find it increasingly difficult to recruit talented physicians and researchers from around the world. At the same time, though, there are signs of a grassroots mobilization to compel Barrette to restore funding to reflect the increase in the MUHC’s clinical volumes.
A number of prominent Montrealers have begun writing to their Liberal MNAs, the Gazette has learned. The users’ committee is also devising a strategy to raise public awareness, and Montrealers are making their concerns known through social media.

17 April
An appalling situation with apparently no resolution in sight.
Relations between health minister and MUHC sink to new low
In the latest flashpoint, a group of prominent doctors has warned Barrette that the sharp funding cuts to the MUHC are endangering patient care.
(Montreal Gazette) The group urged Barrette to restore funding to the MUHC, sending him an urgent letter on Feb. 5. Barrette responded two months later, on April 10, but did not indicate whether the government would boost funding to reflect the MUHC’s current bed-occupancy rate of 95 per cent.
The government decided last year to finance the MUHC at an occupancy rate of 85 per cent, based on a 10-year-old plan that did not foresee the increase in clinical volumes that the hospital network is now facing as Quebec’s population ages.
At stake is not just the clinical mission of the MUHC, which is in charge of a vast area stretching from western Montreal to the Ontario border and to the far north of Quebec. The funding cuts also imperil the MUHC’s teaching and research mandates at one of the most vulnerable points in its history, say doctors and managers.
Adding to the pressures is the fact that McGill’s medical school was placed on probation (for separate reasons) by Canadian and U.S. accrediting bodies for the first time in its 188-year history in June 2015. And the Research Institute of the MUHC has been without a permanent director since Vassilios Papadopoulos was appointed dean of the school of pharmacy at the University of Southern California last year.
The Glen site superhospital, which opened to great fanfare in April 2015, is not using all of its operating rooms because of a lack of funding. Some of the high-tech medical equipment has been mothballed.
Patient rooms have been closed, and more than 1,000 elective surgeries have been postponed. Surgeons now have do paperwork late in the evenings after dozens of secretarial positions were abolished. This summer, the MUHC will close the 23-bed stroke and traumatic brain injury unit at the Montreal General Hospital as part of $21 million in budget cuts.

26 January
Health Minister Gaétan Barrette carves out deal with medical professionals
… an 11th-hour deal with doctors, dental surgeons and pharmacists over the ban on medical accessory fees that comes into effect Thursday.
The province’s two main physicians federations cautioned that there’s still no global agreement on out-of-pocket fees that patients once paid, and there will be negative consequences for services.
Under the ban, extra medical fees will be illegal for services covered by the Régie de l’assurance maladie du Québec, which administers the public health and prescription drug insurance plans and remunerates health professionals. That includes, for example, fees related to eye examinations, vasectomies, colonoscopies, mammograms and childhood vaccinations.
Barrette has come under heavy criticism for abolishing fees in January without first reaching agreements with doctors and allocating more resources to hospitals to pick up the patient load as private clinics stop providing certain tests and services.
Last month gastroenterologists stopped performing colonoscopies in their private clinics, radiologists cancelled ultrasound appointments, and pharmacists discontinued blood tests. Recently, children’s clinics in Montreal stopped vaccinating kids over the fee dispute — about $10 a shot for vaccinations — causing a back up of two months at some local health clinics.
23 January
Two years in, Quebec health reforms have brought malaise
By Brian Gore, family physician in Westmount
The health-care sector in Quebec has too often struggled to digest the many tectonic structural shifts when government reforms are implemented. We are told that they are required because of hospital deficits, administrative deficiencies, system-wide inefficiencies and lack of access to both primary and specialty care.
Successive governments have been eager to accuse physicians of professional self-interest and hospitals of budgetary mismanagement that urgently require extensive and rigorous corrective measures.
The introduction of Bill 10 in April 2015 saw the most extensive reorganization of health-care institutions ever in Quebec: the centralization of all health-care services, the integration of local institutions into much larger multi-centre administrative structures all under the ultimate control of the minister, the abolition of the regional health boards, the abolition of local hospital senior management and the elimination of all their boards of directors.
Certain efficiencies may have been achieved, but there is an evident malaise among the professional and non-professional staff that these new vast management organizations are far too large and managers have lost too much direct contact with their staff. Many of these merged institutions are suffering as a result of the absence of on-site senior management. Too much time is being spent in the reorganizational process very possibly at the expense of patient care. The human consequences of this massive reform for both the providers and their patients need to be more closely evaluated.
And then, there is Bill 20, passed in 2015. The measures concerning family physicians are scheduled for implementation on Dec. 31, 2017. Unless 85 per cent of Quebecers register with a family physician and confine 80 per cent of all their primary care medical visits to their own physician or clinic, the law goes into effect. All aspects of office practice will be entirely regulated by the ministry, from hours worked, daily numbers of patients seen, rules of practice, how patients should be followed and control of scheduling, to name but a handful of the changes that loom. As well, the financial penalty for not achieving these targets will be a 30 per cent cut in fees. The entire responsibility for reaching these targets remains with the doctors.
Family physicians have the distinct impression that Health Minister Gaétan Barrette wants us to fail, thereby allowing him to enact these coercive and punitive measures.
Implementation of this bill may cause a wave of retirements, relocation of family physicians elsewhere in Canada and drop in family medicine resident enrolment in Quebec programs.
Finally, with the stranglehold and complete control of medical manpower exercised by the ministry, we are seeing too many of our future generation of physicians trained here being forced to leave Quebec. There are too few hospital positions available.
It certainly appears that our health minister has the firm conviction that he has a unique vision and solutions for all the perceived shortcomings in the network. Perhaps, it is time for him to cease pointing blame, tone down the rhetoric and adopt a more collaborative approach with physicians and hospital administrators.
Related
Opinion: Bill 10 could create chaos in Quebec’s health-care system
Bill 20’s Band-Aid solution: Montreal doctors still weighing their future
13 January
Fini, les vaccins en pharmacie
(La Presse) L’abolition des frais accessoires, qui entrera en vigueur le 26 janvier au Québec, entraînera une série d’effets pervers, préviennent des intervenants du réseau de la santé qui reprochent au ministre de la Santé, Gaétan Barrette, de ne pas les avoir suffisamment consultés avant d’imposer son règlement.
9 December
Cancer patients find joy in ‘big yellow house’
(CTV) The new location for the West Island Cancer Wellness Centre is now open.
They’re calling it the big yellow house, in contrast with the little yellow house that operated for the past seven years in Beaconsfield.
The new building has room for about 600 people each year, and serves clients from Montreal, the south shore and west of Montreal.
The Wellness Centre offers many services including yoga, massage, family therapy and treatment from a nurse.
It is funded entirely by private donations, including $3 million needed to build the new centre.
28 November

Quebec Health Minister Gaetan Barrette at the opening of a legislature committee on health (Bill 20), Tuesday, February 24, 2015 at the legislature in Quebec City. THE CANADIAN PRESS/Jacques Boissinot

Quebec Health Minister Gaetan Barrette at the opening of a legislature committee on health (Bill 20), Tuesday, February 24, 2015 at the legislature in Quebec City. THE CANADIAN PRESS/Jacques Boissinot

Quebec to spend extra $20 million to reduce surgery backlogs
With hundreds of Quebecers still waiting at least a half-year for elective surgery, Health Minister Gaétan Barrette announced on Monday that the government will invest an extra $20 million in annual funding to reduce surgical backlogs.
But the money will come with strings attached to it as hospitals must demonstrate that they can balance their budgets. Barrette, in particular, delivered a stark warning to the deficit-ridden McGill University Health Centre if it wants to continue to receive the additional funds.
“If they reflect correctly, they will get the money,” Barrette told reporters at the Jewish General Hospital.
“It’s about (commitments). I’m waiting for them to show they’re really ready. I don’t want excuses. I want results.”
The MUHC has been ordered to make $28.1 million in spending cuts, but anticipates a $10-million shortfall because of an unexpected increase in patient volumes. Barrette has chastised the MUHC repeatedly for exceeding its budget, saying “it’s impossible to run a network that way.”
27 November
Opinion: Quebec’s abolition of annual checkups is unwise
(Montreal Gazette) I consider family medicine a unique specialty. No other specialist will review all the systems you have other than the family doctor. No other specialist will sit and talk to you about any problem that ails you. No other specialist will be able to examine any part of you.
Yet the government feels it is not necessary to perform this general review unless you are already sick with a disease that falls into a specific category.
Maybe abolishing the annual exam won’t make a difference. Maybe the number of preventable deaths will not change. But none of us are microscopes. None of us can see inside of you. The best way to know when to test for the abnormal is if we know you, your medical history and your family predisposition. And this can never be done unless we see our patients on a regular basis.
– Dr. Cynthia Stolovitz practices family medicine in Montreal.
5 November
Coupes à Sainte-Justine
« J’ai honte », dit la présidente du Conseil des médecins, dentistes et pharmaciens
(La Presse) Dans une lettre ouverte adressée aux médias, la présidente du Conseil des médecins, dentistes et pharmaciens (CMDP) de Sainte-Justine, la Dre Valérie Lamarre, critique sévèrement les nombreux changements et coupes effectués dans son hôpital au cours des derniers mois.
« J’assiste à ces mesures, qui transforment votre hôpital en un établissement qui n’a plus les moyens de poursuivre votre vision, et j’ai honte », écrit la Dre Lamarre en s’adressant à la fondatrice du Centre hospitalier universitaire (CHU) Sainte-Justine, Justine Lacoste-Beaubien.
1 November
Editorial: Punishing the MUHC punishes patients
(Montreal Gazette) Patient volumes in oncology, obstetrics and the emergency room, in particular, have outpaced the MUHC’s funding. The hospital now faces a $10-million budget shortfall, above and beyond a $28.1-million cut it is struggling to implement.
Health Minister Gaétan Barrette said he won’t bail the MUHC out. He noted that the hospital consistently exceeds its budget, a fixed amount allocated by the government. He wants the hospital to refer patients to care closer to home, arguing the government has invested in making specialized services available outside Montreal for this purpose.
But what Barrette fails to acknowledge is that he is making the MUHC into a victim of its own popularity. The same thing happened in 2014 when the previous Parti Québécois government penalized the Jewish General Hospital for its sterling reputation. In what become known as the “postal code” policy, the hospital was forced to divert some patients from Laval, the South Shore and the West Island who came to its Segal Cancer Centre. As with the Jewish then, patients are coming to the MUHC because of its top-notch care and state-of-the-art facilities — which their tax dollars helped build. And why shouldn’t they?
Under the Canada and Quebec health acts, patients have the right to choose where they seek care. Several factors can come into play, including the institution’s reputation and how quickly care is available.
For anglophones, language can also be a consideration. The MUHC offers quality care in both French and English. But it has a special vocation serving the English-speaking community. All else being equal, anglophone Quebecers from anywhere within driving distance might reasonably feel their needs can be better met at the MUHC or the Jewish than at a francophone hospital closer to home.
And what about the third axis of the Quebec government’s health reform, which was supposed to be activity-based funding? If health dollars followed patients, for hospitals like the MUHC and the Jewish, funding would match their patient volumes.
Barrette is putting the MUHC in the untenable position of having to redirect patients — or suffer the financial consequences.
What is the point of investing in the hospital of the future if the operating budgets are going to be slashed, the number of doctors cut, beds closed, surgeries postponed, cutting-edge medical equipment sidelined and patients turned away?
Punishing the MUHC because it is delivers excellent care ultimately punishes patients.
The topsy-turvy world of hospital budgets
Jasmin Guénette, Vice President of the Montreal Economic Institute
(Montreal Gazette) As in most of the rest of Canada, hospitals in Quebec currently receive their funding in the form of global budgets based essentially on the amounts they spent in the past.
This kind of lump-sum funding leaves hospitals with a tough choice: Limit admissions or go over budget. There is no incentive for hospital administrators to innovate and become more efficient, since an innovation that reduced expenditures would lead to an equivalent decrease in the hospital’s next budget. On the other hand, an innovation allowing wait times to be reduced and more patients to be treated entails increased pressure on the fixed budget.
Almost all other industrialized OECD countries fund their hospitals to a large extent based on services rendered.With such activity-based funding, hospitals receive a fixed payment for each medical procedure, adjusted to take into account a series of factors like geographic location and the severity of cases. The more patients a hospital treats, the more funding it receives. Generally speaking, in countries where activity-based funding is widely used, there is more competition between medical facilities and quicker access to care.
Health Minister Gaétan Barrette has said that the Quebec government wants to adopt activity-based funding for medical facilities in the health network. This would make a lot more sense than demanding that MUHC doctors refer oncology and ER patients to other hospitals, as the Health Ministry is currently doing.
But getting rid of Quebec’s anachronistic funding of its hospitals through global budgets, while a step in the right direction, should be accompanied by other, complementary measures such as mandatory quality reporting for hospitals. Giving patients and referring doctors access to the information they need in order to determine the best hospital for each case would allow for some healthy competition, leading to quality improvements throughout the system, as has happened in Germany in recent years.
31 October (update of 20 October story)
‘There will be no forced marriage,’ Barrette says of MUHC merger
Barrette said he was “pleased” with the “two slightly different visions” by Morin and Rosenberg, adding that he appreciates that they want to improve upon his reform last year that merged health institutions across Quebec to save more than $220 million in administrative expenses.
Barrette also announced that he has appointed Dr. Arvind K. Joshi, formerly executive director of St. Mary’s Hospital, to carry out a consultation on the two proposals to avoid any appearance of bias.
Two of Montreal’s most powerful health-care leaders laid out competing visions Wednesday night of leading the McGill University Health Centre in a massive reorganization that would involve merging the MUHC with the city’s west-end health organizations. … the two high-ranking managers outlined their proposals again in what amounted to a semi-public audition in front of dozens of board members.
Rosenberg, head of the West-Central Montreal CIUSSS, insisted during his presentation that his proposal does not call for a merger but rather a “regrouping of three organizations” — his CIUSSS, the West Island authority and the MUHC.
Rosenberg labelled his proposed organization the McGill Health Network, with a single board of directors and a budget of $2.5 billion. He also pledged that each hospital’s foundation would remain intact (including the one at the Jewish General), and that large institutions in the McGill network would each have an executive director — a departure from Barrette’s reform.
30 October
Government accuses MUHC of treating too many patients: source
By Aaron Derfel
The Quebec government is faulting the McGill University Health Centre for taking on too many cancer and emergency-room patients, and is refusing to fund the MUHC for what it calls “volume overruns,” the Montreal Gazette has learned.
The MUHC, as a result, is facing a shortfall of more than $10 million, in addition to the $28.1-million budget cut it must implement in the 2016-2017 fiscal year, a highly placed source said.
The Health Department is demanding MUHC doctors refer oncology and ER patients to other hospitals in the Montreal region, but those institutions are also grappling with government-imposed budget cuts. The cuts have occurred even as the government reported a $2.2-billion surplus last week, well above the $1.4-billion figure it forecast in the summer.
Emergency-room admissions at the MUHC superhospital have soared by 30 per cent since it opened in April 2015, yet the government is balking at increasing its funding and is holding the hospital network to patient volumes cited in a 2007 clinical plan, the source said.
The MUHC runs the Cedars Cancer Centre, which provides ultra-specialized care. The pressure on the MUHC to refer cancer patients to other hospitals follows a decision in 2014 by the previous Parti Québécois government ordering the Jewish General Hospital (which is not part of the MUHC) to “repatriate” patients from its Segal Cancer Centre to hospitals in Laval and the West Island.
That decision came to be known as the “postal code policy” – an allusion to where a patient lives as a criterion to receive medical treatment – despite the fact both the Quebec Health Act and the Canada Health Act do not impose restrictions on where one can seek care.
27 October
MUHC to make $28M in cuts to make up for budget deficit
Cuts to be made over 2 years, health centre not ruling out trimming back staff
(CBC) The MUHC will also look at ways to trim back expenses such as the renegotiation of contracts with suppliers, he said.
“There are many things that are being contemplated,” he said in a phone interview.
The MUHC’s annual budget is roughly $850 million.
14,000 glitches to fix: MUHC on a challenging first year at the Glen site
MUHC nurses ‘in total distress’ thanks to cuts, union says
Fahey acknowledged the shortfall comes in part from cost overruns from the move to the new superhospital. He said a drop in funding from the province also contributed to the deficit.
24 October
I cannot remember EVER being so angry over a healthcare news item
Doctors sue MUHC over delivery quotas they say threatens babies
Specialists risk suspension if they don’t refer patients to other hospitals once monthly quota reached
(CBC) Four doctors with the McGill University Health Centre are suing for discrimination and $50,000 each in moral damages as new quotas limit the number of deliveries they can perform.
Doctors Alice Benjamin, Robert Koby, Dawn Johansson and Andrew Mok are not part of the hospital’s pool of on-call obstetricians and gynaecologists. They say that makes them targets for discrimination.
These doctors have 35 to 40 years experience and follow high-risk pregnancies, but according to the new rules once they reach their quota of 14 deliveries per 28 day period, they are expected to refer their patients to another institution.
If they don’t, they could be suspended for up to two weeks.
In the lawsuit, the four specialists claim patients “are forced to experience undue stress when they announce last-minute changes at a critical time to them.”
The rules were adopted in June as part of budgetary measures by the MUHC.
Different rules for in-house doctors
The 14-person group of in-house doctors in the division of obstetrics have similar quotas imposed on them, but if they go over their delivery quota they are not threatened with suspension the way the four specialists are.
The in-house doctors can perform 2,400 deliveries per year, or 171 deliveries each. Meanwhile, the four obstetricians who are not part of the in-house group can perform 700 deliveries per year, or 175 each.
According to Jean-Pierre Menard, a lawyer specializing in patients’ rights, these quotas were never up for public debate and violate a patient’s right to choose their institution.
He says quotas at the MUHC are increasingly becoming an issue but that this would be the first time quotas enter into litigation.
“The MUHC is trying to reduce the level of service it is offering to the population, what you are seeing in this suit is one case of that,” Menard told CBC News.
27 September
Opposition grows as Quebec pushes forward with centralized medical labs
Medical professionals across the province are sounding the alarm about the Quebec government’s plan to centralize all medical laboratories — even as hospital personnel and union leaders have been summoned to meetings in medical establishments throughout Quebec on Wednesday about the government’s controversial Optilab project.
26 September
‘It’s risky,’ critic says of medical referral reform
(Montreal Gazette) Quebec is launching a new, centralized system for referring patients to medical specialists in Montreal on Oct. 31.
Doctors’ concerns include whether patients and GPs will be able to choose the specialist they want and how an added layer of bureaucracy will affect the overburdened health care system, since the government is not adding physicians or operating room times.
The short answers are that the new system is supposed to improve efficiencies within the existing pool of doctors and that GPs will still be free to refer patients to a specific specialist, although the referral must go through the Centre de répartition des demandes de services (CRDS), the regional dispatch centres for all referrals. But since the system is brand new and its mechanisms are still not fully understood, doubts persist about how those issues will be handled in practice.
But the associations representing medical specialists and GPs hail the new system — called Accès priorisé aux services spécialisés (APSS) — as a welcome improvement.
The federation negotiated the mechanics of the new APSS system with the health ministry last November, following the adoption of Bill 20, the health reorganization law. The guidelines specify a patient must have access to specialized services within the waiting period established for their medical condition, and that all family physicians and medical specialists must use the APSS system.
The system is set to debut in Montreal for the nine most requested specialties: cardiology; gastroenterology; neurology; nephrology; pediatrics; ophthalmology; ear, nose and throat; orthopedics and urology. Each specialty was involved in creating a referral form, which will indicate the patient’s identity, pertinent clinical information, the reason for the consultation and whether the referral is general or directed to a particular specialist or institution.
Phase 2 of the system, for which referral forms are being drawn up, will include the fields of dermatology, endocrinology, pulmonology, rheumatology, hematology-oncology, microbiology, psychiatry, general surgery, gynecology and internal medicine.
20 September
Largest Canadian study on dementia hopes to develop new treatments and interventions
… launches Wednesday with a goal of developing new interventions to slow or halt diseases that affect more than half a million Canadians.
The clinical study on neurodegenerative diseases is being conducted by the Canadian Consortium on Neurodegeneration in Aging. It will be administered by the consortium’s scientific director Dr. Howard Chertkow, a neurologist at the Jewish General Hospital.
A network of 350 researchers across the country is mobilizing in an attempt to untangle some of the mysteries of age-related brain diseases such as Alzheimer’s and other forms of dementia.
The goal is to enrol 1,600 participants at 30 sites in Canada to study dementia in all its forms, in the hope of creating strategies for early detection and intervention and improving the lives of those living with dementia.
The $8.4-million study is funded by a $31.5-million grant awarded for the creation of the Canadian Consortium on Neurodegeneration in Aging in 2014 by the federal government through the Canadian Institutes of Health Research. It’s a good start, but Chertkow said funding for dementia research in Canada, at 15 cents per person each year, is way below the U.S. level of $4 per person each year.
“We are trying to get Alzheimer’s and dementia on the front burner in terms of policy,” he said. “It’s a political issue of national importance.”
The intersection of an aging population with a higher incidence of dementia and an already overburdened health-care system makes dementia not just a debilitating illness, but an economic challenge.
Chertkow said participants in the Comprehensive Assessment of Neurodegeneration and Dementia study will answer detailed questions about diet, exercise and stress to determine what increases resistance to dementia. Education provides some protection, as does speaking many languages, he said, while stressful events can be a trigger.
Dementia by the numbers
141,000: Quebecers living with dementia
564,000: Canadians living with dementia
937,000: Canadians expected to have dementia by 2031
45 million: People worldwide with dementia
135 million: People expected to have dementia by 2050
$1 trillion: The expected cost of treating dementia in 2018, which would qualify as the 18th economy in the world if it was a country.
Every three seconds, there is a new case of dementia in the world.
At age 85: 35 to 40 per cent of people will have dementia.
18 September
Boshra: We deserve clearer answers about the proposed MUHC merger
It’s true that, outside of those proposing and trumpeting the virtues of the triple merger between the MUHC, the West Island CIUSSS and the West-Central Montreal CIUSSS  — a move that Barrette has said would yield “a very pleasant situation,” and, hey, when has he ever led us astray? — news of yet another possible fusion of health-care institutions, so soon on the heels of the massive reorganization that Barrette’s Bill 10 ushered in last year, seems to have been welcomed with all the alacrity generally reserved for a measles outbreak.
Patients-rights groups are alarmed about the impact on care such a merger could have, and that they have so far been completely frozen out of any consultations on the matter. (“It’s frustrating to be shut out again,” said one exasperated spokesperson.) MUHC employee unions are outraged.
… the dearth of even the broadest of strokes — is such a merger truly in the offing, and if so when? will the public be consulted? how might it affect current institutions and their patients? who will ultimately be in charge of the new health-care behemoth? — are questions that we can and should get answers to. Our reporting, none of it contradicted by officials, has ensured that this particular merger genie is out of the bottle, and it will not be going back in, regardless of how many wishes the gatekeepers at the MUHC or the health minister’s office might make.
8 September
Montreal Neuro spearheading new ALS treatments and practices
(Montreal Gazette) … this is actually an exciting time on the drug development front for ALS. There are a host of promising drugs on the horizon and new protocols in treating patients that are all striving to prolong their lives.
“There’s no expectation that we’re going to find a cure for ALS tomorrow,” said Dr. Angela Genge, director of the Montreal Neurological Institute’s ALS Clinical Research Program. “But there is huge excitement about some of the potential new drugs in the pipeline.”
The hospital is now in the early stages of a $5-million fundraising campaign to help the MNI become a centre of excellence in ALS research and clinical care, which Genge says will allow it to be involved in early drug development and will enable “patients from across Canada to come here to get the newest therapies.”
The hospital’s ALS clinic, the largest in the city, typically sees two to four new patients a week, and about 300 to 400 a year.
6 September
MUHC patients’ committee worried about ‘rumoured’ hospital merger
Candidate for MUHC CEO job proposes major administrative shakeup
A proposal to reorganize part of Montreal’s health network, less than 18 months after the last major overhaul came into effect, is drawing frustration from the patients’ committee for the McGill University Health Centre (MUHC).
Dr. Lawrence Rosenberg, one of the candidates to take over as CEO of the MUHC  is proposing to create a new network of all McGill-affiliated hospitals.
That news came as a shock to Amy Ma, co-chair of the MUHC Central Users’ Committee, who said patients were never told that the selection committee would have a mandate to consider administrative mergers.
Ma said patients have had no say in the months-long process to find a replacement for Rinfret, whose term officially ended last week, leaving the MUHC without a permanent CEO.
Rosenberg said he told the MUHC selection committee he would only take the job if he could create an “integrated McGill academic health network.”
Currently, the nine McGill-affiliated hospitals are under three different jurisdictions:
The Montreal Chest Institute, Montreal Children’s Hospital, Montreal General Hospital, Royal Victoria Hospital, Montreal Neurological Institute and the Lachine Hospital all fall under the MUHC banner.
The Douglas Mental Health hospital and St. Mary’s Hospital are part of the Montreal West Island health board (CIUSSS de l’Ouest-de-l’Île-de-Montréal) and the Jewish General Hospital is part of West Central Montreal Health (CIUSSS Centre-Ouest-de-l’Ile-de-Montréal).
At least one department head from a McGill-affiliated hospital expressed concern to CBC that smaller institutions would be swallowed up in the new proposed bureaucracy.
1 September
Lawrence Rosenberg to be new head of triple-merged MUHC: sources
By Aaron Derfel
Dr. Lawrence Rosenberg, the former executive director of the Jewish General Hospital, is poised to become the next head of the McGill University Health Centre, the Montreal Gazette has learned.
Rosenberg would replace Normand Rinfret, who is set to retire on Sept. 2 after steering the MUHC through the most tumultuous period in its history. But Rosenberg’s appointment would be no simple matter as he would usher in major changes to the health system. … Rosenberg would also merge the MUHC with two large health organizations in the next three to five years: West-Central Montreal Health (of which he is currently the executive director) and the West Island health authority. Those two organizations — each known as a CIUSSS, by their French acronym — were created on April 1, 2015, under Health Minister Gaétan Barrette’s cost-cutting reforms, and are also the products of mergers themselves.
After the fusion of the MUHC and the two CIUSSSs are completed, Rosenberg would ultimately become the second most powerful figure in the health system after the minister himself. As head of the new mega health organization, Rosenberg would preside over 10 hospitals that cover the western half of Montreal — including the MUHC superhospital — as well as numerous CLSC clinics, rehabilitation centres, long-term care facilities and other health and social services institutions.
… Rosenberg …  [is] a physician and … also understands the importance of research, having worked in research himself at the MUHC, and finally, he’s a McGill person.
14 July
Toronto foundation doubles funding for Alzheimer’s research
(Globe & Mail) the W. Garfield Weston Foundation, which underwrites the institute, is doubling down with a second $50-million investment, similarly aimed at bridging the gap between early science and viable diagnostic tools or treatments. The move should cement the institute’s role as a conduit for advancing potentially groundbreaking science that might end up sidelined in a federal funding system that favours safe bets.
… Another grantee, Howard Chertkow, director of the Jewish General Hospital/McGill Memory Clinic in Montreal, added that the institute differs from other funding agencies in its level of hands-on involvement and attention paid to projects.
Internationally, not-for-profits have been important in the neurodegenerative field for launching younger researchers and taking approaches that are off the beaten path.Compared with government funding agencies, not-for-profits can often more easily send their money across borders in search of the best science.
12 June
Some MUHC equipment to sit idle, nearly 50 beds to close in summer
It’s Canada’s most modern hospital, equipped with $255 million in cutting-edge medical machines and more than a dozen operating rooms, some of which were designed to carry out robotic surgery.
Yet this summer, the $1.3-billion Glen site of the McGill University Health Centre that opened just over a year ago will close as many as 10 of its 13 operating rooms, shut the doors to 47 patient rooms and let some of its most expensive medical-imaging equipment sit idle during weekdays — all because of a shortage of staff and a lack of funding.
Meanwhile, the need for the superhospital’s specialized medical services remains as high as it has ever been — with nearly 300 cancer patients waiting for surgery and more than 700 other adults facing delays for other operations that require hospitalization, according to the government’s own statistics.
“We’re trying to do the best we can with the limited funds available,” Ian Popple, a spokesperson for the MUHC, said in an interview Friday.
Outgoing executive director Normand Rinfret is to declare at Tuesday’s annual general meeting that the MUHC will post a $40-million budget deficit for the fiscal year 2015-2016. In radio interviews last week, Rinfret lamented the MUHC’s difficult financial situation and said that because of budget cutbacks, only nine of the 13 operating rooms are functioning.
But the Montreal Gazette has learned the MUHC’s predicament is far worse than Rinfret has stated. Although it’s true nine of the 13 ORs have been functioning since the spring, that number will drop to five as of June 24. And during the two-week construction holiday in July, only three ORs will be running, before going back up to five and then to nine after Labour Day.
The superhospital has a total of 500 single rooms for patients. From June 24 to Labour Day, however, 47 rooms will be closed as part of the budgets cuts.
What’s more, the MUHC has still not received government funding at the Glen site for a wide range of medical-imaging equipment, including a positron emission tomography machine to detect cancer, two MRI scanners, two CT scanners and at least one ultrasound device.
In fact, a CT scanner sits idle in the emergency room during weekdays and is used only at night and on weekends, sources have told the Gazette. Emergency patients in need of a CT scan for head and other injuries during weekdays must be wheeled to the second floor’s radiology department, which is already short-staffed. The superhospital’s ER is much busier than the MUHC anticipated, with the medical staff sometimes resorting to calling a Code Purple — a designation for when the ER has reached its limit and can no longer take more patients.
30 May
Quebec to do away with annual health checkups
Quebec is following the lead of other Canadian provinces in doing away with the annual head-to-toe physical for healthy adults as of June 1 — a move at least one doctor is questioning.
Historically, doctors in the public system were able to bill Quebec’s medicare board for what is known as a “major complete,” or annual checkup. As of Wednesday, however, the major complete will no longer exist, to be replaced by a periodic exam available only for so-called vulnerable patients, like people with such chronic illnesses as diabetes.
The change is part of a streamlining of doctors’ fees under medicare negotiated between the federation of GPs and the Quebec government. It also reflects a number of scientific studies that have concluded that the annual physical has not reduced deaths or the morbidity rate, defined as the frequency with which diseases occur in the general population.
25 March
Health Minister Gaétan Barrette not budging on MUHC’s seasonal bed cuts
‘It was planned that way. It was agreed upon, and that’s the way it will be. OK?’
Quebec Health Minister Gaétan Barrette is dismissing concerns about the impact of dramatic bed cuts on patient care at the McGill University Health Centre.
“The plan was the plan, and they have to abide by the plan,” said Barrette, referring to a 2007 clinical plan signed by the MUHC and the province.
MUHC seasonal bed closures will mean longer waits for surgery, doctor warns
Top MUHC official warns bed cuts, seasonal closures only way to meet budget
Budget cuts pushing MUHC doctors to the limit, top surgeon says
Barrette’s comments come a day after it was revealed that the MUHC would have to cut dozens of beds in the summer and holiday periods – more than a quarter of the year – in order to meet the budget imposed on it by the Health Ministry.
Some surgeons predict the 14 weeks of “seasonal bed closures” could double wait times for cancer surgery and cause even longer delays for non-urgent surgeries.
21 March
Bed closings at MUHC much worse than disclosed, document shows
The bed closings at the McGill University Health Centre are far worse than previously disclosed — with the MUHC being forced to slash the total number of hospital beds from 853 in early January to as low as 719 this summer, the Montreal Gazette has learned.
The MUHC agreed under a 2007 clinical plan to decrease the total number of beds to 832. However, the Health Department decided late last year to make deeper bed cuts, advising the MUHC that it would only fund the hospital network at an occupancy rate of 85 per cent — despite the fact that its real occupancy rate rises to as high as 95 per cent.
In a Feb. 10 letter, Dr. Ewa Sidorowicz, associate director-general of the MUHC, told staff that the number of beds would be trimmed to 799 as a result of the government’s new funding formula. Sidorowicz also warned that there would be temporary bed closures on top of the permanent ones, but did not provide any figures.
The Gazette, however, has obtained an internal MUHC document that reveals that once the temporary bed closings are factored in, the total number of available beds will be tantamount to 779 averaged throughout the year. And during each temporary closing of beds — to be taken for a few weeks in the summer, the Christmas-New Year’s holidays and spring break — the number will be reduced to as low as 719.
“I’m absolutely concerned,” said Amy Ma, co-chair of the MUHC Central Users’ Committee, when informed of the latest bed cuts. “There’s not much slack left in the system. This is definitely going to have a devastating impact on patient care.”
The consequences are expected to be far-reaching — from 1,500 fewer elective surgeries a year to an increasing number of Code Purples in the emergency room. A Code Purple is declared when an ER can no longer accept patients because of severe overcrowding.
As of Jan. 26, the MUHC cut the total number of beds at the Montreal General, Montreal Neurological and the Glen site superhospital from 853 to 832 — in keeping with the 2007 clinical plan.
4 March
Jewish General Hospital closing 22 beds
Next month the Jewish General Hospital will be closing 22 beds.
The agency in charge of the hospital says it has no choice but to close one unit as it deals with budget cuts.
“We’ve calculated that we can cut a 22-bed unit without it having any bad effect on access to care,” explained Dr. Louise Miner, Director of Professional Services of the CIUSSS Centre-Ouest-de-l’Ile-de-Montreal.
In 2014-2015 the hospital cut $23 million from its budget, and was told to cut costs again in the current budgetary year.
An outside firm was hired by the hospital this year to figure out where it could best cut costs — a move that was frowned upon by Health Minister Gaetan Barrette.
“If they are closing beds for budgetary issues there is a problem over there. There must be a problem over there since they went public that they hired people to help them manage,” said Barrette. “They cannot – anybody – cut services in order to get back to a balanced budget.”
He said he will take a closer look at what the JGH is planning.
“The funding in that hospital is no different from the funding in other hospitals, and other hospitals do manage within their budgets.”
The beds being closed are reserved for older patients with relatively minor medical problems, but are not part of the geriatrics department.
In January the JGH opened its new critical care wing, Pavilion K, at a cost of $429 million.
The new wing of single-patient rooms increases the number of patients cared for at the Jewish General Hospital by an estimated 40 per cent.
It also includes five new operating rooms.

2015

11 November
Quebec’s controversial health care bill passes at National Assembly
Bill 20 removes IVF from provincial Medicare coverage
After months of talks, the National Assembly on Tuesday passed its controversial bill that will restrict access to in vitro fertilization and increase the number of patients Quebec doctors have to take on.
It was not a unanimous decision — 63 members of the Liberal caucus voted for it, while 48 MNAs voted against it.
Health Minister Gaétan Barrette tabled the bill last year.
Originally the bill proposed a patient quota for family doctors, but that was tossed out in May. However, Barrette said doctors would still have to find a way of making sure 85 per cent of Quebecers had a family doctor by 2017.
Quebec family doctors won’t have to meet patient quotas
Louis Godin, president of the Fédération des médecins omnipraticiens du Québec (FMOQ), said in May that the federation will introduce alternative measures to help guide family physicians and ensure they stay on track to meet the 2017 target.
Some of the attenuation measures to help boost Quebecers’ access to healthcare include superclinics and a guarantee that anyone needing to see their doctor would be able to see him or her within three days.
17 September
Quebec’s Bill 20: A Political and Medical Conflict
(McGill International Review) One of the main ideological clashes in Bill 20 has to do with the balance between family doctors’ workload and the accessibility of clinic healthcare. Barrette argues that public access to family medicine could be increased by adding extra workload to doctors in Quebec, based on the premises that they work less relative to other provinces across the nation. Barrette also notes that “60 per cent of general practitioners in Quebec work less than 25 weeks a year”. According to a study conducted by C.D. Howe Institute, the Quebec doctors only work 34.9 hours weekly – around 8 hours less per week compared to the national average. Not only do they work less, the average number of patients a doctor visits in Quebec is 1,081, the lowest of all provinces in Canada, while the average number of patients per doctor is 1,750 in Manitoba and Saskatchewan. Barrette believes that there is a positive relationship between a doctor’s working hours and the number of patients he/she receives, which affects the accessibility of family healthcare, especially when 15 percent of Quebec’s population does not have a family doctor compared to only 4 percent in Ontario. Therefore, the logical solution for a politician wishing to solve social problems in the health sector, such as overcrowded emergency rooms due to [the] low number of patients received by family doctors, is to propose a minimum quota policy.
On the other hand, medical practitioners argues that the increased workload does not necessarily solve the problem. Whilst the medical field also raises concern on the relatively low access to healthcare in Quebec, “[the] quota system … [is] essentially forcing [physicians] to serve more patients with the same or fewer resources”, argued Nebras Warsi, the executive president of the Medical Students’ Society of McGill University. Simply adding extra workload to family doctors endangers the quality of public healthcare delivery, which in return could create more problems, instead of improving said quality, as opposed to what Barrette argues. To the medical practitioners’ mind, Barrette’s solution is not a comprehensive, but rather an idealistic approach.
Also, medical practitioners accuse Barrette’s inability to recognize that family doctors in Quebec are struggling to balance non-clinical hours work with clinical work. Not only do doctors have to conduct clinical visits, they are also expected to spend their time in paperwork, research, and teaching. The bill only addresses a singular aspect of a family physician’s regular work – clinical visits. Therefore, setting a minimum patient quota is a trade off between a family doctor’s time for non-clinical work, clinical work and personal life.
26 May
Specialists threaten to sue Barrette over Bill 20 quotas
Operating rooms closed too often to meet increased demand, federation saysThe head of the federation of medical specialists says the group will sue Health Minister Gaétan Barrette if he tries to impose surgery quotas without ensuring operating rooms can meet the demand.
“How can you ask a doctor to work more if the OR is closed? Tell me, how can you do that?” said Diane Francoeur, head of the Fédération des Médecins Spécialistes du Québec (FMSQ), in an interview with CBC’s Daybreak.
“He can give us as many quotas as he wants,” said Francoeur, “If there’s a shortage of nurses, or no beds… Summer is coming and usually [operating rooms] are closed for two to three weeks during the summer.”
2 April
Opinion: Bill 20 is a symptom, not the underlying problem
Today, Quebec is taking steps to reduce the expense of health care despite having the lowest expenses per capita in Canada, according to the Canadian Institute for Health Information (CIHI).
Bill 20 has the potential to degrade the health care of Quebecers in a way that dwarfs what was done by the “Virage ambulatoire.”
Health Minister Gaétan Barrette is using the excuse of “access” to justify Bill 20 in the same way then-Health Minister Jean Rochon used the “Virage ambulatoire.” But access is not the problem; it is a symptom of a poorly designed delivery “system.”
Rochon and Barrette were and are only the messengers for the opaque operations of the Ministère de la Santé et des Services sociaux (MSSS). What is proposed in Bill 20 are simply more ways to control the primary purveyors of health care, the doctors. It is not a solution to the problem of access, nor to the real problem of providing safe, effective, efficient and equitable health care to Quebecers.
26 March
Medical students shying away from family practice under Bill 20: poll
When it came to choosing a medical specialty, Valérie Charbonneau ticked off family medicine.
A resident at Pierre-Le Gardeur Hospital in Terrebonne, she made general practice her first choice two years ago because she hoped it would give her the most time with her patients, she said — time to get to know them, explain which pill to take, when and why.
But Charbonneau said she might have picked differently had she known about the bill Quebec introduced last fall, which would slash income for family doctors unless they meet a patient quota and other obligations.
“With the quotas and all that, it’s clear that my relationship with patients, the time I spend with them, my ability to care for them, they will be affected,” she said.
Charbonneau and her old classmate Jordan Volpato, a resident at Cité-de-la-Santé Hospital in Laval, had a hunch they weren’t the only ones worried about the patient quotas in Bill 20, so they emailed a questionnaire to students of Quebec’s four medical schools.
Of the students who intended to go into family practice, 46 per cent said they wouldn’t have made it their top choice after Bill 20.
Charbonneau and Volpato said the results were representative enough to show the prospect of patient quotas is discouraging some students from specializing in family medicine.
19 March
Bill 20 alternatives proposed by Quebec family doctors
More super clinics, abolishing mandatory ER work chief among FMOQ’s proposals
Quebec’s federation of general practitioners says it’s trying to get a message through to Health Minister Gaétan Barrette. … says Barrette’s approach to increasing the public’s access to family doctors is flawed.
Chief among its proposals is getting the government to stop requiring GPs to work in emergency rooms or other medical institutions. Under the term “specific medical activities,” GPs must spend 12 hours a week working in ERs.
The FMOQ is proposing a gradual stop to mandatory emergency room work for its 8,800 members. If that happens, doctors could spend more time on first-line health care and seeing patients in clinics.
The proposed Bill 20 is a health care reform bill that places a quota on the minimum number of patients a doctor must take on, requires specialists to offer consultations beyond emergency rooms and docks the pay of doctors who refuse to comply with these rules.
The FMOQ is also proposing the government double the number of “super clinics,” from 50 to 100, particularly in the greater Montreal region. Godin said it would cost about $250,000 to create each clinic.
Super clinics are staffed by nurses with special medicine-prescribing powers and the ability to perform certain exams.
The organization said changes such as these would mean quicker, better access to family doctors without flooding ER waiting rooms.
26 February
Gaetan BarretteBill 20 would drive docs away from teaching, deans say
The province’s plan to thrust patient quotas on family doctors will drive family doctors away from teaching and research, deans of Quebec’s four medical schools warned on Wednesday.
McGill’s dean of medicine Dr. David Eidelman, plus his counterparts at the Université de Montréal, Université de Sherbrooke and Université Laval, threw cold water on Health Minister Gaétan Barrette’s proposal to rework the health-care system, Bill 20.
While they supported the reform’s goal of making sure each Quebecer has a family doctor, they told a legislative committee that the bill is “unacceptable” until it recognizes the hours of work doctors put into education.
“The bill focuses on clinical productivity alone,” Eidelman said. “The danger is that some of our clinical teachers will have no choice but to give up their educational activities and move entirely to clinical work, which will create a risk to the population because we depend on these teachers to create the next generation of excellent clinicians.”
The bill would compel family doctors to see a minimum of patients or take a pay cut of up to 30 per cent of their quarterly income. Barrette has suggested that family doctors should have a roster of 1,000 patients per year—twice the number of patients they have registered now, according to him.
The federation representing family doctors say they already have a caseload of 1,000 patients.
Dodging accusations of wanting to introduce “assembly-line” practices in medicine, Barrette said he wouldn’t subject every doctor to the same quota, making exceptions for those who treat the chronically ill, who teach or conduct research. All the details will only be revealed in regulations, however. These almost always come after a bill becomes law and spell out how it should be applied.
24 February
Bill 20 committee told patient quotas not the solution

Health Minister Gaétan Barrette said he wants to legislate to force doctors in this province to work “full-time,” noting 60 per cent of Quebec doctors work less than 25 weeks a year.
The president of Quebec’s association of young doctors, Pierre-François Gladu, openly defied the minister on the first day of hearings and challenged him to come up with examples of patient quotas elsewhere.
20 February
Quebec government and doctors brace for Bill 20 hearings
Health Minister Gaétan Barrette first tabled the bill on Nov. 28. In December, hundreds of general practitioners took part in emergency meetings in Montreal and Quebec City. They are outraged they would be required to take on a minimum of 1,000 patients or risk losing up to 30 per cent of their pay.
“The workload of a family physician in Quebec is 50 per cent higher than the workload of a family physician in Ontario or elsewhere in Canada,” said Louis Godin, President of the Quebec Federation of General Practitioners.
Barrette responded that on the contrary, 60 per cent of general practitioners in Quebec work less than 25 weeks a year.
7 February
Bill 10, controversial health reform bill, passes in National Assembly
Bill 10 merges health boards, should save government hundreds of millions of dollars
A health care bill that’s controversial with some anglophone rights organizations has passed in the National Assembly.

It was voted on just after midnight on Saturday, with a vote of 62 for and 50 against.
Bill 10 abolishes the boards of individual health institutions, mainly hospitals, and merges them into 28 regional boards. It’s expected to save the government of Quebec $200 million per year.
However, the anglophone rights group — Quebec Community Group Network (QCGN) — warned that eliminating boards at individual health institutions will weaken them to the point where anglophones will not have any representation.
In November, former Liberal MNA Clifford Lincoln called Bill 10 unfair and unjust, saying the provincial government is pushing it through too quickly.
“It’s such a huge reorganization of the health system that it buries the individual, it buries the client, it buries the patient, it buries the individual institutions and their boards into one, big, mega-reorganized system,” Lincoln told CBC’s Radio Noon.

2014

20 December
Quebec doctors to fight Bill 20
(Global TV) Around 800 family physicians gathered in Quebec City to say ‘no’ to Bill 20.
The legislation would require family doctors to take on a minimum of 1,000 patients or risk losing up to 30 per cent of their pay.
Health Minister Gaetan Barrette insists it’s the only way to improve access to healthcare in this province.
Barrette argues Quebec doctors are lazier than their peers in Ontario.
He says 60 per cent of general practitioners in Quebec work less than 25 weeks a year.
“We would not have to table Bill 20 if doctors were working fulltime and were adapting their practices to satisfy the needs of the population,” he told Global News.
16 December
Opinion: Bill 20 will turn every patient in Quebec into a number instead of a person
Tara McCarty, BSc, MD CM, CCFP
At first glance, Bill 20 seems like a great plan — “a family doctor for every Québécois,” promises Health Minister Gaétan Barrette. Once we get into the logistics of it, however, we can see that Bill 20 will create a system that will dramatically change patient care for the worse.
As a result of comments by Barrette, family doctors have been portrayed in the media as “paresseux,” or lazy. As well, many misleading statistics have circulated. …
He has arrived at this absurd number by neglecting to factor in the time that family doctors spend teaching students in school and residents in the hospitals, time spent working in hospital administration, doing research, attending conferences, being on call, or providing services to refugees or out-of-province students.
His numbers do not factor in all the time that doctors spend with their patients to explain an illness, to check labs, to call specialists and to facilitate access to tests and to care.
Essentially, these numbers don’t account for the time that good doctors spend doing the things that make them good doctors. …
As well, GPs in Quebec would be forced to ensure a minimum “adherence rate” of 80 per cent — this means that at least 80 per cent of a patient’s visits must be to their own family physician, as opposed to a walk-in clinic or a hospital.
Our regional hospitals in Quebec are almost entirely run by family physicians.
They run the paediatrics wards, the internal medicine floors, they deliver babies in obstetrics and work all hours in the emergency.
If they are forced to cut their hospital practices to only 12 hours a week because they have to take on patients and follow them, the hospitals will not be able to stay open.
These doctors are the pillars holding up the hospitals in the regions, and this new law devalues their essential, important and specialized work.
This law is an attack on family practitioners. A large proportion of GPs today are women with young families. I am one of them. These young female physicians, same as women in other professions, are often not working the incredibly long hours of their male counterparts.
13 December
Quebec doctors say Bill 20 will jeopardize future of family medicine
(Canadian Press via Global News) The Quebec Federation of General Practitioners is speaking out against Bill 20, the Liberal government’s proposed health care reform plan.
On Saturday, family doctors took an official stance against the new measures affecting their clinical practice.
They say the bill questions the future of family medicine and quality of care.
They fear that young people are choosing other areas of study and many physicians are retiring early.
Bill 20 would impose a minimum number of 1,000 patients to doctors.
The CAQ will suggest the minister instead adjust doctors’ pay according to the number of patients they see and change the law to allow doctors to delegate more work to paramedical staff. The opposition party will also ask that Bill 20 be split in two, because the other part of the bill – restricting access to in vitro – is equally important and needs to be thoroughly studied.

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