Quebec Healthcare/Bill 15 October 2022-

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Santé Québec CEO will be paid $652,000 a year during first two years on the job
The successful candidate will also enjoy an expense account, as well as a car and living allowances
…Calls for candidacies for several other members of the agency’s management team are also expected to be announced.
Quebec Health Minister Christian Dubé said recently that whoever ends up leading the Santé Québec may not necessarily be recruited from the health-care system.
Over the past few days, at least two potential candidates, neither of whom come from within the heath-care system, have been the topic of intense speculation.
… Interested people have until March 1 to submit their candidacy for the position of president and CEO of Santé Québec.
In the meantime, those wishing to be part of the board of directors have until Feb. 9 to apply. Calls for applications for management team positions will follow in the coming weeks. (16 January 2024)

28 May – 3 June
Prime: «Dubé ne veut pas donner l’impression que la FMOQ peut en obtenir plus»
Les discussions se poursuivent entre le gouvernement du Québec et la Fédération des médecins omnipraticiens du Québec (FMOQ) quant à la fin de la prime de 120 dollars pour la prise en charge de patients orphelins.
Allison Hanes: Orphan patients left dangling as Dubé plays hardball with family doctors
The GAP, a deal to compensate physicians for seeing walk-in patients, is about to expire Friday. Now the vilification of doctors intensifies.
It was only a few weeks ago that Premier François Legault and Health Minister Christian Dubé were boasting in a slick new video ad that since 2022 they’ve managed to slash emergency room visits by 1.5 million and help 900,000 Quebecers register with a family medicine group thanks to a new online tool.
Although there were suggestions their claims were a bit misleading, they were nevertheless touting the virtues of a new program, the Guichet d’accès à la première ligne (GAP). A one-stop shopping site launched two years ago, it has allowed Quebecers who don’t have a family physician to book an appointment with a doctor.
But less than a month after Dubé heralded its success, the GAP could collapse by the end of this week. An agreement on compensating physicians for seeing walk-in patients in their practices is set to expire. And with Dubé refusing to extend the financial terms, even in the interim while the government hammers out a new contract with the Fédération des médecins omnipraticiens du Québec (FMOQ), doctors may simply stop making room in their busy schedules for one-time patients referred by 811.
As Radio-Canada reported, the number of appointments available through the GAP could plunge from more than 17,000 this week to just over 5,000 next week.
At first glance, it seems odd that a minister would talk up a program so enthusiastically on the eve of it coming to a halt. But perhaps the timing of the video was no accident. If the GAP dies and frustrated orphan patients start clogging up still-overburdened emergency rooms again, there is little doubt about whom Dubé is going to blame: doctors.

22 May
Hotel magnate Christiane Germain appointed head of Santé Québec board
The 15-member board does not include any anglo leaders.
A hotel magnate has been appointed chairperson of the board of directors of Santé Québec, one of several pro-business appointments to the agency that will manage the province’s beleaguered health system.
The Quebec government on Wednesday announced the full composition of the board of Santé Québec, which Health Minister Christian Dubé has pledged will revolutionize health care in the province. This follows last month’s appointment of Geneviève Biron as head of the powerful agency, a choice that drew a mixed reaction, given that Biron had worked for years for her family business of private medical laboratories, Biron Groupe Santé.
Before Biron’s appointment, Dubé had said he wanted to recruit a “top gun” from the private sector. With Biron securing the top job, union leaders and the National Assembly opposition accused Dubé of opening the door to privatization of health care.
28 March 2023
Tom Mulcair: Another health care reform, another flop?
If the new Santé Québec agency is to have any hope of succeeding, it should be based in Montreal — away from the talons of the Health Ministry.

6 March
Requirements for receiving medical assistance in dying
The Act lays down very restrictive conditions that patients must meet to receive medical aid in dying, regardless of where they are receiving care. Several procedures must also be followed by doctors and health and social services institutions both before and while they provide this care.
The administration of medical aid in dying is possible only if all of the following requirements are met, for both the person and the doctor. …
8 June 2023
Quebec expands law for doctor assisted death, permits advanced consent
Changes also affect who can get the procedure and where
The law adopted Wednesday will permit people with a serious and incurable disease, such as Alzheimer’s, to apply for a doctor-assisted death before their condition deteriorates and prevents them from consenting to one. However, it could take up to two years for such a request to be processed.
The minister responsible for seniors, Sonia Bélanger, who tabled the bill in February, said the provincial government needs some time to ensure the new law is consistent with Canada’s Criminal Code,which requires final consent immediately before medical assistance in dying (MAID) except in some cases where the person’s “natural death is reasonably foreseeable.”

5 February
Fewer than one in 10 health workers willing to transfer to Santé Québec, survey suggests
Last spring, Quebec’s health minister estimated 30 to 40 per cent of the ministry’s 1,200 employees would voluntarily transfer to the new agency.
Under eight per cent of Quebec Health Ministry personnel are interested in transferring under current conditions to the yet-to-be completed Santé Québec agency.
Santé Québec is the agency created by Bill 15, Health Minister Christian Dubé’s overhaul of the health-care network. Under the reform, the agency would be responsible for the practical, day-to-day operations of the health and social services network. The Health Ministry would remain responsible for establishing policy.
Dubé is still looking for a CEO to head the agency. Last spring, the minister estimated that 30 to 40 per cent of the ministry’s 1,200 employees would voluntarily transfer to Santé Québec.
“He’s going to hit a wall,” SPGQ president Guillaume Bouvrette said on Monday in reference to Dubé’s prediction. “A large majority expect to use their right to return to the public sector in the event of a forced transfer.”

27 January
Lakeshore General Hospital embraces the future with HoloLens technology
Use of the HoloLens glasses have all but erased delays in treating ICU patients, giving hospital staff ideas about revolutionizing care at the hospital
The HoloLens 2—the most current model used by the Lakeshore General Hospital—allows a doctor to get on a video call from anywhere with a nurse in the ICU. Through the video call, a doctor can see everything the nurse sees in real time, allowing doctors to issue a course of treatment immediately rather than through a delayed process that would require doctors to physically visit the ICU.

20 January
Quebec’s top health-care mandarins earn much more than counterparts in other ministries
Aaron Derfel
Dr. Lucie Opatry, CEO of the McGill University Health Centre, is currently the highest-paid hospital administrator in the province, earning more than $402,000.
…in a harshly worded open letter addressed to Premier François Legault by the Association pour la défense des droits sociaux Québec métropolitain (ADDSQM), the group criticized the salary of the CEO of Santé Québec as excessive. … “This salary represents over 56 years of welfare benefits,” the ADDSQM added. “You will never experience our difficult living conditions, because you live in a different world with your indecent incomes. We see this as a good example of the inequalities that afflict our society.”

1 January
Quebec emergency rooms overflow as Canadian hospitals struggle with staff shortages, respiratory illness
Hospital emergency rooms across the country are dealing with a crush of that are being compounded by staffing shortages, causing some provinces to urge people to stay home to ease overcrowding.
In Quebec, ERs were at 125-per-cent capacity on Monday, according to Index Santé, a health-data website. The provincial health department has been telling people to avoid hospitals if they have a fever and encouraged them to be prudent during New Year’s celebrations to slow the spread of illness.
The province’s association of emergency-room doctors says occupancy rates are at unprecedented levels, and some hospitals are being overwhelmed with twice as many ER patients as they can handle.
Quebec’s Health Minister, Christian Dubé, said the public should stay away from ERs altogether, and instead seek care at family medicine clinics, or clinics led by nurse practitioners.


17-19 December
The MUHC’s chief surgeon on record-level wait lists, overcrowding in Quebec ERs
By all accounts, Quebec’s health-care system is under enormous strain. The CAQ government recently passed Bill 15 into law to try to make the system more efficient.
But in the meantime, emergency rooms are dangerously overcrowded and wait times for some surgeries are reaching record highs.
Dr. Liane S. Feldman, the surgeon-in-chief at the McGill University Health Centre (MUHC), spoke to CTV News Montreal anchor Maya Johnson Tuesday about the current situation in Quebec hospitals.
Aaron Derfel: Quebec’s health-care system now worse than ever
For much of this year — as Quebec’s health system has gone from bad to worse — Health Minister Christian Dubé has focused on a structural reform of the system, known as Bill 15. Now, ER doctors are accusing him of ignoring their pleas.
By every major indicator — from emergency-room overcrowding to record-high surgical wait times and the lack of available spaces in nursing homes — Quebec’s health-care system is now arguably the worst it’s ever been.
Although Quebec has made it a priority to tackle wait lists for cancer surgery, more than 4,400 oncology patients are still waiting for their operations, according to the Health Ministry’s own statistics. Of that number, more than 600 are waiting longer than the medically acceptable delay of 57 days, potentially putting their health at risk.
Even the wait list for so-called non-urgent surgery has now swelled to nearly 164,000 people. Almost 14,000 Quebecers today have been languishing more than a year for their surgery. At a year’s wait, a non-urgent surgery starts to become urgent. …
Two weeks ago, the Montreal Gazette reported an unprecedented five Montreal emergency rooms were filled to more than 200 per cent capacity. This, despite the fact there have been fewer ER visits by patients. The reason? Hospitals have fewer staff than before the pandemic.
Legault and Dubé’s bet is that Bill 15 — and with it, the creation of a new Crown corporation, Santé Québec — will go a long way to fixing the beleaguered health network. But no new agency can magically solve the huge shortage of staff that’s behind this crisis, and that might take years to resolve.
Quebec ERs ‘out of control’ as patient influx overwhelms hospitals, doctors say
Recent deaths in waiting rooms are the tip of the iceberg, ER doctor says
In a letter addressed to Quebec Health Minister Christian Dubé, the Regroupement des chefs d’urgence du Québec (RCUQ), the association of doctors in charge of the province’s emergency rooms, paints a dire portrait of Quebec’s ERs — calling the situation “out of control.”
Penned by RCUQ president Dr. Marie-Maud Couture, it says ERs have predictably and dramatically deteriorated.

8-9 December
Reaction mixed to Quebec’s new health reform
(CTV) The union of government professionals (Syndicat de professionnelles et professionnels du gouvernement du Québec or SPGQ), said it believes Health Minister Christian Dubé doesn’t realize that he won’t have the staff he needs to carry out the reform, in which he plans to create a new government corporation, Santé Québec.
SPGQ President Guillaume Bouvrette said he thinks government professionals have no interest in going to work for Santé Québec, at least not in the transition phase looming for many Health Ministry employees.
“The minister is implying that the salaries of those transferred to Santé Québec will be similar, but this is not true. In fact, the ministry’s professional staff earn 7 per cent to 14 per cent more than those in the health network,” said explained Bouvrette.
“This means that our members will receive half the salary increases provided for in the collective agreement, and the other half in lump sums until their salaries at Santé Québec are in line with the new agreement. This situation could last for many years,” he said.
Others, however, are looking at the sweeping with optimism.
The Quebec Federation of Chambers of Commerce (Fédération des chambres de commerce du Québec or FCCQ), considers Bill 15’s adoption and creating the Santé Québec agency “an opportunity to finally break down the silos in the health-care network in order to promote interregional workforce mobility and the adoption of innovative practices.”
“Employers in different regions have reason to rejoice with the announced arrival of network seniority. Finally, they will be able to recruit workers from outside their region whose spouse works in the health network, without being blocked by the fact that they must give up all their privileges linked to their seniority,’ said Charles Milliard, president and CEO of the FCCQ.
Overhaul of Quebec health care voted into law in predawn hours
Santé Quebec will run day-to-day operations of the health-care system when it is up and running in six months.
Mired in controversy right to the end, the government’s overhaul of the health-care system was voted into law in the wee hours of Saturday morning.
The final vote was 75 for, 27 against. All CAQ MNAs present at that hour voted in favour, all opposition MNAs voted against.
In the crunch of closure, a parliamentary process that suspends the normal way laws are adopted, about 400 clauses, some of them issues of coordinating Bill 15 with other laws, went through without the opposition being able to comment or amend them. The result, they said, is the bill probably has flaws that won’t come to light until it is implemented.
They said their work committee before the bill was adopted revealed a string of errors and omissions, including one that appeared in a surprise last-minute amendment that appears to endanger minority rights to services in a language other than French.
Dubé corrected it, but the McGill University Health Centre and the Quebec Community Groups network say minority rights could still be in peril because Santé Québec has too much power.
Quebec set to invoke closure to pass controversial health care reform
(CTV) The government had previously proposed extending the detailed study of Bill 15 for another four days next week — an “admission” that more time is needed, according to Quebec Solidaire (QS) MNA Guillaume Cliche-Rivard.
Last week, Dubé admitted to not understanding an amendment that affected the English-speaking community that he himself had presented.
He then had to back down on the amendment after Liberal MNA and opposition health critic André Fortin intervened.
Bill 15 petition tabled as CAQ races to the finish line
…cavalier treatment by a government focused more on command and control than care and compassion
(QCGN weekly update) After two weeks in circulation, our petition demanding more consultation on Bill 15 – the Coalition Avenir Québec government’s plan for the massive centralization of health and social services – garnered some 6,400 signatures, far surpassing my goal of at least 5,000. The bill was tabled in the National Assembly yesterday afternoon. (press release )
Public outcry makes it abundantly clear that Quebecers are upset at having their voices silenced in the management of their local health and social services institutions. The QCGN’s stance on the bill is echoed by numerous community and patient advocates as well as doctors, nurses and other health-care workers who have also shown strong opposition to many aspects of this badly flawed bill. Opposition MNAs from the Liberal Party, Québec Solidaire, and the Parti Québécois have spoken out against this bill, while six former premiers, representing both Liberals and the PQ, took the unprecedented step of writing a public letter urging the government to reverse course, calling the proposed legislation “dangerous.”
Over the past three months, the government has proposed hundreds of amendments to its own bill indicating just how ill-conceived it was. Health and social services are vitally important to all Quebecers and deserve more than cavalier treatment by a government focused more on command and control than care and compassion. It is truly disturbing to note that from a policy and regulatory perspective our community is not systematically consulted on changes that will have significant impact on the ability of English-speaking Quebecers to receive critical services in their own language.

2 December
‘Last-minute’ amendment to Quebec health bill would allow agency to revoke hospital’s bilingual status
(CTV) A new amendment to Quebec’s mammoth health-care bill would allow the new Sante Quebec agency to revoke a health-care institution’s bilingual status — a move English-rights activists say is shocking.
With only days left before the parliamentary session is set to end before the holiday break, the surprise amendment was introduced Tuesday during a parliamentary committee debate on the proposed legislation, known as Bill 15. The bill has more than 1,200 articles and there have been hundreds of amendments introduced since it was tabled last March.
The new proposal concerns communities that qualify, under existing laws, to receive services in a language other than French if the numbers warrant it. What was revealed this week, first reported by the Montreal Gazette, is that the government wants the board of directors at Sante Quebec to be able to revoke the status of institutions like hospitals if the minority community has shrunk below 50 per cent based on census data.

27 November
Bill 15 will be ‘the CAQ government’s Waterloo,’ town hall told
A petition calling for more public consultation on Bill 15 has surged past 3,400 names.
More than 150 people packed a town hall at Dawson College Monday night to express grave concerns about the potential impact of Bill 15, a sweeping reform of the medical system that would create a single all-powerful Crown corporation to run health care in the province.
The town hall represented a mobilization by the anglophone and allophone communities against the legislative overhaul by the Coalition Avenir Québec government.
Dr. Dinh Huy Duong, a cardiologist, told the town hall that he is deeply suspicious of Bill 15, and he predicted the reform will be “the CAQ government’s Waterloo.”
Emanuel Louis, president of the medical students’ association at the Université de Montréal, said he was worried about the possible negative repercussions of Bill 15 on the public health-care system.

24 November
Robert Libman: Legault in a jam against teachers and nurses
In the PR war for Quebecers’ support, the premier has shot himself in the foot with recent decisions that have damaged his credibility.
The government is caught in the paradox between the cost to taxpayers of absorbing a big increase in public sector salaries, and the belief by those same taxpayers that these professions need to be paid more. … The quality of our critical education and health care sectors and their ability to attract qualified personnel cannot afford to be weakened any further; otherwise, there is a risk of creating more social and economic damage. Employees who feel more valued are more productive. Investing in a more motivated public workforce — instead of one that feels cheated and underpaid — will pay long-term dividends. This trickle-down economic effect far outweighs the cost of current salary demands.

22 November
Quebec pushes to pass major health-care reform bill before end of session
Health Minister Christian Dubé acknowledges only half of the articles in the bill have been debated at the parliamentary committee since it was tabled in March. He insists three weeks is enough time to study and adopt the rest.
Opposition parties say 3-week timeline ‘not realistic’ to finish studying extensive bill

20 November
Join the growing chorus against Quebec’s health-care revamp
Bill 15 will hurt patients, researchers, communities and more. Sign the petition to stop the government from ramming it through.
Experts say Bill 15, tabled by Health Minister Christian Dubé, “will do nothing to address the crises in our emergency rooms, delays in surgeries, the lack of family doctors or other major and urgent shortcomings of our health care system,” writes Eva Ludvig, president of the Quebec Community Groups Network.
There is a strong possibility the government of Premier François Legault will invoke closure to ram Bill 15 — imposing radical change on Quebec’s health and social-services network — through the National Assembly before it rises for the holiday break on Dec. 8.
This 300-page bill, containing more than 1,100 clauses, is the second largest ever presented in the assembly. Have you heard about it? Do you know what it will do to community voices in the management of health institutions?
Probably not. That’s because there hasn’t been sufficient consultation on a mammoth bill that demands more careful study and significant public input before it becomes law.
That is why the Quebec Community Groups Network is urging all Quebecers to very quickly sign a petition demanding the government put an immediate hold on this proposed legislation — a bill that would trigger an even greater centralization of health-care management and dramatically reduce the role of the community in the governance of health and social services institutions everywhere in Quebec.

10 November
Quebec adjusts its COVID vaccination recommendations
830,000 doses have been administered so far
Quebec’s Ministry of Health and Social Services (MSSS) is now recommending vulnerable Quebecers get a single dose of the COVID-19 vaccine adapted for new variants.
“A single dose of the new vaccine, administered this fall, is now sufficient for a person to be considered adequately protected,” the ministry announced in a news release today.

1 November
Tom Mulcair: François Legault’s reckless war on excellence
People who want to see Quebec succeed have put forward proposals that could help. Too bad the premier is not one to listen.
(The Gazette) Last week, in an unprecedented move, all six living former premiers of Quebec penned an open letter criticizing certain negative effects of Legault’s massive health-care reform. They were sounding the alarm about the imminent threat to the pinnacle of the system: the university hospitals and specialized health institutions.
These true centres of excellence, like the CHUM (Université de Montréal), the MUHC (McGill) and the Montreal Heart Institute, have allowed us to hold on to some of our brightest and best graduates while recruiting top talent to Quebec. They’re a great success story we can all be proud of. All that could be lost as Legault hog-ties that excellence and puts it at the beck and call of civil servants in Quebec City.
Legault reacted badly to the premiers’ request to exclude some of our best institutions from the overreach of the very same bureaucrats who’ve driven our health network into the ground.
This would’ve been an excellent opportunity for thoughtful compromise. Those former premiers had nothing personal to gain from their proposal. Several are volunteers on some of the boards that would be eliminated. They collectively have a deep understanding of what could be lost if Legault pigheadedly pushes through with his scheme.

25 October

Former Quebec premiers Lucien Bouchard, Jean Charest, Philippe Couillard, Daniel Johnson, Pierre Marc Johnson and Pauline Marois argue in an open letter to Legault that “merging hospital centres and university institutes … impact on these institutions.”

Back off creating Santé Québec, six former Quebec premiers urge
“We feel that this … is a dangerous step away from the reform’s objective of making the health and social services network more efficient,” the ex-premiers say in an open letter.
Aaron Derfel
In an unprecedented move, six former Quebec premiers — Liberal and Parti Québécois alike — have issued a stinging rebuke against Premier François Legault’s proposed health reform known as Bill 15, urging the government to back down from creating a Crown corporation to oversee the health system.
“We feel that this complete or partial merger is a dangerous step away from the reform’s objective of making the health and social services network more efficient,” they write in the letter, published in the Journal de Montréal Tuesday evening.
“Through this merger, these (university-affiliated) establishments would lose their specific character and unique approach, particularly in terms of care for the population. It would also deprive them of their volunteer boards of directors, which have been dedicated to their success.”
The bombshell letter follows a high-level and discreet diplomatic effort since the summer by prominent Quebecers to persuade the provincial government to reverse course on Bill 15, the Montreal Gazette has learned. When that effort failed to sway Legault and Dubé, the six ex-premiers banded together to write the open letter.
Initially, one of the more controversial aspects of the reform would have been the abolition of 150 patient-rights committees across the province. Responding to criticism that their abolition would muzzle the voices of vulnerable patients everywhere, Dubé tabled an amendment in August that would let regional health authorities decide whether they want to retain the so-called users’ committees. On Tuesday, Dubé added yet more amendments.
The Gazette has also previously reported that access to health services in English would be at risk under Bill 15. The Community Health and Social Services Network (CHSSN) contends Bill 15 would weaken access programs for medical services in English.
Loi 15: «On veut qu’il la réussisse sa réforme, mais…» -Lucien Bouchard
…Celui qui a été à la tête du Québec de 1996 à 2001 estime que les amendements du ministre Dubé ne le rassurent actuellement pas du tout.
Sortie des ex-premiers – ministres Dubé maintient la ligne dure
(La Presse) Avec l’appui de François Legault, Christian Dubé maintient la ligne dure et n’a pas l’intention d’aller plus loin dans les amendements apportés mardi à son imposant projet de réforme, malgré l’insatisfaction de six ex-premiers ministres. Libéraux et péquistes lui demandent au contraire de les écouter.

Allison Hanes: It’s a ‘noble effort,’ but the PREMs formula disadvantages Montreal
The methodology to determine where new doctors can practice is deeply flawed, Dr. Mark Roper says. He’s going to court to prove it.
Dr. Mark Roper has been questioning the methodology that the government uses to determine how many new family physicians are needed in Montreal since he was involved in the complex process more than a decade ago. Quebec is the only province that dictates where doctors can practice using a restrictive permitting system known as PREMs, short for Plans régionaux d’effectifs médicaux. The aim is to ensure equitable access to care across the province — something Roper calls a “noble effort.”
… In 2019, Roper launched a court challenge of the PREM system. Though he lost the first round last fall, he and lawyer Julius Grey will be back at the Quebec Court of Appeal Thursday, armed with a trove of research that underpins his case. The numbers speak for themselves.

Dr. Mark Roper (posted on Facebook)
The RLS sub-region of Faubourgs – Plateau-Mont-Royal – St-Louis-du-Parc (632) is a unique medical region in Quebec. The worst rate of registration with a family doctor in the province is 60%. This is far from the Quebecois average of 79% and the best sub-region, Charlevoix has 92%. With a total population of 166,866 inhabitants, 67,012 citizens are orphans. Despite this serious situation, the MSSS calculates that there is a surplus of front-line family doctors in the territory of 21 full-time doctors.
Their calculations are simplistic. One family doctor on the front line for every 1,500 inhabitants translates needs 111 doctors, with is 132 is in place. But absent from the calculation is the effect of portability. Doctors in the territory have registered 67,004 Quebecers who do not live in the territory
It is surprising that businessmen like Mr. Legault and Mr. Dubé chose to follow the simplistic calculations of his MSSS. Mr. Legault considers that the doctors of the region do not work hard. His minister Mr Dubé follow[s] the same logic and transfer[s] the doctors to the 450 regions. For us, portability is a measure of water quality.
Speaking of the large regions, the population of Montreal has the worst registration rate with a family doctor in Quebec at 68%, far from the best region, Lac St Jean at 92%. There are more than 600,000 orphan Montrealers. Despite this situation, 382,954 patients from other regions are registered with family doctors in Montreal. If Montreal’s family doctors only saw its own residents, there would be an 86% enrolment rate.
At present the percentage of orphans in Montreal and several sub-regions is increasing. Montrealers without a family doctor (and doctors about to retire) are stuck with three options:
• Do without a family doctor and see an occasional walk-in clinic,
o It does little to address the complex needs of primary care and has poorer outcomes
• Go into the rapidly growing private sector
o The current rate is $3,000-5,000 per year for three visits and a blood test.
o It’s hard to swallow when your tax dollars are spent to provide health care to your fellow citizens in the 22 regions where enrollment rates are over 90%.
• Stop healthcare portability.
o It won’t be long before people in the regions insist that doctors in their area prioritize locals and send other patients back to their local areas where there is less shortage.
o This is a challenge because it is a core tenet of our health care system that encroaches on the doctor-patient relationship.
o There is no effort made by the government or surrounding areas to repatriate these patients despite the allocation of doctors for them in their areas.
To find the situation in your territory go to Where are the Family Doctors? (

7 October
Allison Hanes: As Quebec tweaks doctor permits, family medicine bleeds
The dreaded application process for the permits the government hands out to control where family doctors practise is about to kick off — something no other province does and something Quebec physicians have come to loathe.
Amid a worsening doctor shortage and lengthening wait times, the government is tweaking the procedure for allocating the permits in 2024 to make it a little less onerous.
Residents will be able to apply to work in two regions instead of one, which means they won’t have to put all their eggs in one basket. And they can find out what additional medical duties they’ll be assigned up front, like working in long-term care or ERs, rather than having them imposed after the fact.
According to the Fédération des médecins omnipraticiens du Québec, 49 more doctors retired, quit the profession, went to the private system or left the province than entered into service as family doctors in 2022.
… This deficit arose as a growing number of medical students have been shunning family practice.
“Every year we have between 160, 170, 180 training positions in family medicine that go unfilled,” explained Amyot. “In the past few years, there were about 50 students who, rather than put family medicine as their second choice, preferred to take a sabbatical year. Can you imagine, 50 students a year prefer to do additional specialty internships and then reapply for a residency in a different specialty the year after. This year, it wasn’t 50, it was 75.”
There are many reasons for this trend, including the requirement that family doctors commit to Activités médicales particuliers, which are additional duties in long-term care homes, birthing centres, emergency rooms or mental health facilities. But the complicated hoops new graduates have to jump through for a permit dictating where they can work is the biggest bone of contention.

28 September
Updated COVID-19 vaccine and flu shot free for all Quebecers this fall
Quebec is launching its latest COVID-19 vaccination campaign, making the updated shot available in seniors homes and long-term care facilities as of Oct. 2.
The rest of Quebecers will then have access to the vaccine the following week, along with the flu shot, free of charge in vaccination centres and pharmacies. The updated vaccine was created specially to better protect against variants currently circulating.

20 September
Le nombre de médecins de famille a baissé au Québec en 2022-2023
En entretien avec Paul Arcand, écoutez le président de la Fédération des médecins omnipraticiens du Québec, Marc-André Amyot aborder l’offre de soins dans les groupes de médecine familiale et les actions qui sont prises pour augmenter le nombre de médecins de famille dans le réseau.
Il souligne que c’est la première fois en 30 ans qu’une telle situation se produit et il explique qu’il s’inquiète de voir des médecins dans la fleur de l’âge quitter la profession médicale.

21 August
Quebec health minister to table 150 amendments to health-care reform bill
The clause-by-clause review of Health Minister Christian Dubé’s major health-care reform, Bill 15, resumed at the National Assembly Monday afternoon.
(Global) After hearing from several concerned parties in hearings last spring, the committee on health and social services will now continue to review the bill’s nearly 1,200 articles. If it’s adopted, the bill would make several changes to the province’s health-care system, including the creation of a new agency, Santé-Québec, that would oversee day-to-day operations.
Opposition parties have accused the health minister of passing the buck with this new agency, and fear it could lead to the further centralization of the health-care system, as well as a lack of accountability.
“We have to be realistic. The bill is tabled. It will be adopted eventually by the majority government, so this agency will be created,” said Parti-Québecois Health Critic Joël Arseneau.

28 June
Canadian-born family doctor struggles to come home through a wall of red tape
Canada is grappling with a severe shortage of family doctors — but Canadian-born family physicians working abroad are fighting to obtain the paperwork they need to practise here.
Dr. Stephanie DeMarchi, a general practitioner born in Hamilton, Ont., who has worked in Australia for the past 10 years, is one of those doctors. … But a tangle of red tape has made the process an arduous one. She’s been in a battle with Canada’s health-care bureaucracy for nearly 16 months to get the licence she needs to practise.

13 June
Québec tend la main aux médecins à la retraite
Évoquant « une crise majeure » dans les centres d’hébergement et de soins de longue durée (CHSLD), Québec lance un appel à la mobilisation des médecins à la retraite dans la grande région de Montréal.
Dans l’espoir de répondre aux besoins de prise en charge des patients en CHSLD, le ministère de la Santé, le Collège des médecins du Québec (CMQ) et la Fédération des médecins omnipraticiens du Québec (FMOQ) se sont entendus pour permettre aux médecins à la retraite de reprendre leur pratique sous certaines conditions.
Le mois dernier, la FMOQ sonnait déjà l’alerte et révélait que la cotisation au collège pour les retraités qui acceptent de prêter main-forte serait payée par le ministère. En date du 31 mai, on disait avoir besoin de 30 médecins pouvant prendre en charge 25 à 30 patients. On évoquait alors une tâche d’environ quatre heures par semaine.

31 May
Amendments submitted to Quebec’s health-care reform
Amendments are being submitted to Quebec’s health reform, Bill 15.
Health minister Christian Dubé says the status quo is no longer acceptable and that his reform is the answer to better access to care.
But opposition parties fundamentally disagree and they are not alone.
Dr. Steven Grover is a physician and researcher in Montreal.
He says Bill 15, the province’s health-care reform, fails to recognize the immediate short-term issue we’re facing, notably, “A shortage of health-care professionals and tremendous demand for health-care services as we come out of this pandemic.”
Grover says without addressing that, Bill 15 won’t help improve access to care, and neither will the bill’s move to centralize decision-making.
Bill 15 proposes to create Santé Québec, a provincial agency that would oversee the public health-care system.
Its role would be to provide services and manage resources.
The goal is to reduce wait times in emergency rooms, cut surgery waiting lists and improve the overall patient experience.
Besides not addressing staff recruitment and retention, the opposition criticizes the elimination of regional health boards where volunteers and health-care professionals act as checks and balances.

23 May
Quebec has lost nearly 21,000 health workers in less than two years
Aaron Derfel
Quebec Health Minister Christian Dubé’s spokesperson said the government hopes that with its proposed reform of the health system, known as Bill 15, it will be able to hire and retain more workers
The departure of so many workers in so short a period of time is placing Quebec’s health-care system under tremendous pressure, forcing hospitals to close 2,000 beds across the province and leading to record emergency-room overcrowding, as well as a growing backlog in year-long elective surgeries at the McGill University Health Centre.
On July 3, 2021, the government employed a total of 349,582 workers in the health and social services system. By April 22, that number had dropped by 20,823, or about six per cent. Most of the workers who quit the system were nurses. Their ranks plummeted from 68,078 to 62,821 — a net loss of 5,257 nurses.

19 May
After dreams crushed by Quebec’s controversial nursing exam, this candidate is ready to quit
An investigation by Quebec’s commissioner of professions, André Gariépy, concluded that there were major problems with the September exam.
“The reliability level of the questions in the exam is pretty minimal, and for a high-stakes exam like this one, it should be much higher,” he said
The report also concluded that the passing grade had been raised — from 50 to 55 per cent — without justification.
Gariépy said if the order had maintained the previous mark, more than 500 nursing students who failed would have passed.
Last week, OIIQ announced it is revising the exam in light of Gariépy’s report. The OIIQ said it will now rely on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) as an assessment tool starting early next year.
Nearly all regulatory agencies in the United States and Canada use the NCLEX-RN, and it has been around since 1994, the OIIQ notes. It has tested over six million people, making it a proven measurement tool, the order said.

16 May
Must be on waiting list for GP
Primary Care Access Point offers relief for ‘orphan’ patients, says Dr. Roper
Roper said the provincial health ministry has set up a new program, the Primary Care Access Point, to help people without a family doctor obtain a medical consultation or a health service.
Westmount Independent
In order to benefit from the program, a person must be on the waiting list for a family doctor, or be currently under the care of a group of doctors. Roper said the Primary Care Access Point makes it possible for those without a family doctor to have a single visit with a doctor just to regulate an immediate medical issue or to renew a prescription.
He said doctors in the community were asked by the health ministry to pitch in and help with the program.
“It’s a stopgap measure until the system changes and we’re able to freely recruit family doctors,” he said.
Regarding the provincial government’s latest reform of the public health care system, which proposes to place the existing
network of regional CISSS and CIUSSS agencies under a single agency known as Santé Québec, he said he was not optimistic.
The Primary Care Access Point can be found on the web at the following address:

9 May
Quebec health-network reform an ‘undeniable risk’ to care, union says
Increasing the mobility of health-care staff to work anywhere in the network could leave some regions understaffed, the union warns.
A proposed reform of Quebec’s health-care system tabled by provincial Health Minister Christian Dubé poses an “undeniable risk” to the maintenance of care, according to the Fédération interprofessionnelle de la santé
The FIQ, which represents 80,000 nurses and other health-care workers, has concerns about the maintenance of health care, partially based on the mobility offered in Bill 15.

1-3 May
Analysis: The unspoken crisis for ‘nos bâtisseurs’ in Quebec’s ERs
“Nobody wants to talk about the way the elderly are treated in ERs,” said a veteran Montreal nurse. “Absolutely, they’re suffering. And nothing is being done about it.”
Aaron Derfel
Far more than any other demographic group in Quebec, it’s the elderly — specifically those over the age of 75 — who are bearing the brunt of the province’s emergency-room crisis. And newly compiled Health Ministry statistics reveal the situation is getting worse for “nos bâtisseurs” — the endearment given in Quebec to our elders.
On Monday, the government announced a “home hospitalization program” … Those pilot projects are an expanded form of home care designed to cut down on the number of ER visits.
Such initiatives are no doubt helpful. But given the fact that Quebec hospitals have had to close 2,000 beds because of a shortage of nurses and that some doctors are quitting ERs, there is no short-term fix for the province’s ER crisis.
Home hospitalization program announced for Montreal, Quebec City areas
The initiative is part of the province’s effort to free up hospital beds.
The eight targeted regions are expected to be able to provide the service to patients by 2024, said Sonia Bélanger, the junior health minister responsible for seniors. If their condition allows it, patients who wish to do so can continue their treatment at home under the supervision of a medical team.
Thanks to remote connections, medical personnel can follow the condition of an at-home patient from a distance. Generally, a patient will be given an iPad linked wirelessly to sensors measuring blood pressure, heart rate, blood sugar and other indicators.

18 April
Ethics case dropped against Lachine Hospital physician: ‘It’s a big relief’
A Montreal leading physician is feeling relieved that he can continue speaking his mind about shortcomings in the health care system. The Quebec college of physicians has vindicated Dr. Paul Saba after complaints were brought against him by the McGill University Health Centre. The family doctor says he hopes the decision will encourage others to act as whistleblowers.
Dr. Saba has steadfastly defended his position and continues to vehemently defend community hospitals and local access to health care services.
“I have nothing but positive things to speak about the MUHC. I believe it was a bad decision on their part to have brought these allegations,” Dr. Saba said.
He says the decision by the College of Physicians should help other doctors or front-line health care workers to publicly speak out when they feel bad decisions are being made by health care administrators.

14 April
Group demanding action on reduction of services at Lachine hospital
The Save the Lachine Hospital Committee, a group formed by Dr. Paul Saba, is demanding action to address concerns about the Lachine Community Hospital.
“We need to reopen our emergency room 24/7, we will save lives by doing that,” Dr. Saba said. “The MUHC has a responsibility to save and secure the population on the West Island.”
The reduction of services at the hospital have been ongoing since October 2021, and in February of this year, the McGill University Health Centre (MUHC), announced ambulances in Lachine would be redirected to other health centres and ER operations would be reduced to 14 hours a day.

22 March
Quebec budget highlights
Cash for health care and seniors
Quebec will get an additional $4.7 billion in federal health funding over the next five years…. Of that, $3 billion will be used to improve health care, with almost half of that being used to expand new approaches developed amid the pandemic.
The government said it will make permanent the vaccination and testing clinics developed for COVID-19, extending their scope in a bid to relieve the hospital system. They will, for example, offer other types of vaccines and draw blood for testing.
In addition, $2 billion will be used to improve the lives of seniors and caregivers, increasing home-support services and access to adapted housing.
Another $565 million will go to support vulnerable Quebecers, with just over one-third of it going to increase mental health, homelessness, and addiction services.

25 February
MUHC mulls refocusing care at Lachine Hospital
Dr. Paul Saba, who practices family medicine at the hospital, worries the hospital will no longer serve the community.
Saba says there is enough medical personnel to keep the hospital a fully functioning community hospital, and that scaling back services would hurt people in need of care — whether in Lachine, the West Island or other parts of Montreal.

Aaron Derfel: Pandemic caused extra surgical backlog of at least 46,000 cases in Quebec
As of Jan. 28, nearly 162,000 patients were waiting for elective surgery, according to the latest Health Ministry figures.
Last March, [Health minister Christian] Dubé announced what he called a “refondation” or major reform of the health system, allowing for the private sector to play a greater role in the delivery of medical services. He noted at the time that more than 100,000 day surgeries had been carried out in private clinics in the previous two years. Those operations were all covered under medicare.
But Radio-Canada reported on Tuesday that the government refused to grant 15 permits in the past 18 months to private surgical clinics in the Laurentians, raising concerns the backlog may grow even bigger.

Hanes: Doctor has job offers in Montreal, but is blocked by ‘rigid’ permit system
Quebec’s PREM process not only undermines efforts to recruit doctors, it is actively driving some away from the province.
If a doctor were to work in Montreal without a PREM, he would take a 30 per cent hit when he bills RAMQ. He would also be barred from reapplying for a PREM for five years and be denied hospital privileges.
Short for Plans régionaux d’effectifs médicaux, these are permits that dictate where physicians can practise in Quebec, not to be confused with the medical licences granted by the Collège des médecins authorizing them to work.
Getting one is an extra hoop to jump through for new medical school graduates and physicians who want to come here from outside Quebec. Without one, doctors face penalties and restrictions — although they are allowed to work in the private system.

14 February
‘A bad decision that’s going to cost lives’: Health-care workers protest cutbacks at Lachine Hospital
As of Tuesday night, the Lachine Hospital in Montreal will no longer accept ambulances, instead redirecting them to other facilities. Walk-in patients will have access to an ER doctor until 10 p.m., and only for the next two weeks – as of March 1, the hospital with have no more emergency room doctors.
“We need hospitals that are close to the community. Is this a question of, ‘Is this to take our resources and transfer them downtown? Let them fix their own problems,'” [Dr. Paul Saba] said.

9 February
Opinion: This isn’t how to solve Quebec’s nursing shortage
We are sounding the alarm regarding a recent measure that will severely affect the future of nursing in our province.
Sydney Wasserman and Enora Ledieu
The Ministry of Health and Social Services negotiated in the latest contract that all new nurses who received their licences after Dec. 12, 2022, regardless of education level, will start at the lowest pay scale, echelon 1. For decades, new nurses who graduated with university degrees started their careers at a minimum of echelon 7, reflective of their higher education. This is a $6.44/hr difference, which adds up to $515.20 over a two week pay period, close to a 20-per-cent decrease in pay.
Nurses will leave Quebec. Since this announcement, many of our graduating nurse colleagues have expressed their intent to leave Quebec for jurisdictions where salaries, working conditions and government support are significantly better. Increasingly, nurses are already being driven out of the health-care system into private agencies, other provinces, or out of the profession of nursing completely. This salary decrease exacerbates an already dire situation.

Santa Cabrini pilot project to be extended to all Quebec hospitals
Staffed kiosks in entryway reduce pressure on ER by redirecting non-urgent cases to other services.
Quebecers have the right to be seen at the hospital of their choice, and emergency departments will not refuse to see a patient if their needs are not urgent. But the waits can be long, and non-urgent patients do slow down the functioning of emergency rooms, so the Health Ministry mandated the CIUSSS de l’Est-de-l’Île-de-Montréal — the health authority responsible for Santa Cabrini and Maisonneuve-Rosemont hospitals — to explore the concept of an onsite ER kiosk for referrals to other points of service.

20 January
Quebec health minister apologizes for end-of-life care for Robert Bourassa’s widow at St. Mary’s Hospital
Regional health board vows to investigate Andrée Simard’s treatment after family goes public with complaint
The family’s description of Andrée Simard’s treatment prompted Quebec Health Minister Christian Dubé to offer them his apologies “in my name and that of the network,” while the minister responsible for end-of-life care, Sonia Bélanger, said the responsible health board must “review practices at St. Mary’s Hospital so that a situation like this one never happens again.”
Simard, the widow of former premier Robert Bourassa, died last November, several days after being admitted to the hospital in Montreal’s west end.
Soon after Simard was admitted, it became clear she was going to die, Bourassa said in a lengthy letter to the hospital administration which she shared with the French newspaper, La Presse.
Denied a transfer to the palliative care unit, every request by the family to get appropriate care for Simard in her final hours turned into a pitched battle, Bourassa said.


29 December
With viruses overwhelming Montreal ERs, ‘we’ve had to virtually create space’
The associate chief of the emergency departments at the Royal Victoria and Montreal General hospitals said he thinks it’s the worst December he has seen.
A combination of three viruses and a shortage of staff have conspired to make this one of the most difficult Decembers in memory at hospital emergency rooms across Quebec.

5 December
What’s gone wrong: More than 800,000 Quebecers wait for family doctor
Four years ago, the CAQ promised a family doctor for every Quebecer, but in the last election campaign, it had to admit that wouldn’t be possible, which has left many people feeling lost in the system.
The head of the Primary Care Division at the MUHC, Dr. Mark Roper, says a full-time family doctor will make more than 2,000 diagnoses per year, everything from high cholesterol, to hypertension, to diabetes. By catching conditions and illnesses early, family doctors can prevent life-threatening complications such as stroke and heart attack, he said.
“For every 100,000 people who do not have a family doctor, we observe an increased mortality of 60 per year,” he said, adding that would mean 360 Montrealers die each year because of lack of access to a family physician.

1 December
Quebec health minister asks nurses to come back to help struggling health-care system
He is calling on nurses to come and help out at busy Info-Santé 811 phone line, which received around 10,000 calls on Wednesday.
Quebec needs more nurses to help answer 811 calls, health minister says
As pediatric emergency rooms continue to deal with unprecedented levels of sick children, family doctors and clinics are also overcrowded and overwhelmed. Many parents are exhausted just looking for someone to call and a place to bring their sick child.
During question period, Liberal health critic André Fortin criticized Dubé for his poor results and said emergency rooms are overflowing.
“In Repentigny this morning, Madame Speaker, it’s 181-per cent occupancy in the emergency room,” he said. “In Sorel, 194 per cent. In Buckingham, 208 per cent and in Mont-Laurier, 300-per cent occupancy in the emergency room.”
Fortin said that every day, up to 1,500 Quebecers leave a hospital emergency room without seeing a doctor.

23 November
Quebecers say it’s time for a mixed health care system. They’re right!
Beryl Wajsman
We’ll give the Premier this. During the campaign he made statements that the health care system would start looking at private sector assets to help the public sector. It’s now time to put the words into reality.
M. Legault, on almost any issue, makes clear that his decisions will be based on “social acceptability.” Well now he’s got it. And he needs it.
An Ipsos/MEI poll last week demonstrated that 73% of Quebecers support the adoption of a mixed health care system as exists in France and Sweden. Throughout Canada, 64% have come to that acceptance.
“If Canadians still worry about the excesses of the American system, they are ready to experiment with mixed models like those of France and Sweden,” says Emmanuelle B. Faubert, economist at the MEI. “In the Quebec context, this shows that there is a clear mandate for the CAQ’s independent mini-hospitals project.”
Events since the election have proven why. With the government still not being able to deliver on its goal of more health care at home, even paediatric emergency rooms have exceeded capacity. And this is not because of Covid. But a respiratory virus that happens often this time of year. It’s gotten so bad through the system generally that just this week Federal Health Minister Duclos announced the release of an emergency $270 million worth of health care transfers to Quebec.

20 November
Quebec parents struggle to get children’s antibiotics amid nationwide shortage
Respiratory illnesses in children are lasting longer than usual, says infectious disease specialist
Canada is seeing a nationwide shortage of antibiotics and children’s pain and fever medication as respiratory illnesses among young patients surge.
Amoxicillin — a first-line antibiotic used to treat bacterial infections in children — is on back-order in Quebec. It’s also used in Clavulin, which is in short supply.
Shortage of ‘first-line’ antibiotic hits as surge in children’s respiratory illnesses strains supply (7 Nov.)

14 November
Quebec’s college of physicians is urging people to wear masks in public as hospitals are battling a trio of respiratory viruses that are filling up emergency rooms.
The order is recommending masks be worn on a “voluntary and preventive basis” in public places, crowded private spaces and on public transit.
It says hospitals are facing a “triple threat” of viruses – COVID-19, influenza and respiratory syncytial virus, or RSV.
A report by the Canadian government for the week ending Nov. 5 found that levels of influenza and RSV across the country are higher than expected for this time of year.
Health Minister Christian Dube has formed a crisis group to try and reduce overcrowding at hospital emergency rooms across Quebec.

13 October
Allison Hanes: Montreal’s ER crisis is being made worse by new policy, doctor says
It’s intended to lessen pressure on ERs, but may be having the opposite effect in some cases, prolonging the stay of elderly patients in hospital wards.
A dearth of family doctors, a shortage of medical staff in hospitals, too few beds, an aging population with increasingly complex problems, a resurgence in contagious viruses besides COVID-19, and pent-up need from patients who were unable or unwilling to seek care for minor ailments due to the risks of the pandemic are all taking a serious toll on the fragile health-care system.
Noémie Vanheuverzwijn, a spokesperson for the Health Ministry, confirmed a new protocol was put in place last month aimed at freeing up hospital beds and helping clear emergency rooms, where patients line the corridors waiting to be admitted.
“Considering the progression of short-term bed occupancy by a clientele requiring an alternative level of care in the Montreal region, a specific accompaniment by a ministerial team has been in place since September to co-ordinate all the best practices required on the island of Montreal,” she said.
The change is part of a greater push to send patients home with support while they await openings in long-term care facilities or other transitional care.

Immigration regularization needed for the sake of public health
Status for all is an effective solution to the failures of immigration policy and the negative health impacts it has had on my neighbours.
(Montreal Gazette Opinion) As a public health nurse, I see every day how important access to health care is in stopping contagion and improving health equity. But as a resident of Parc-Extension, I see that many of my neighbours cannot access vital health care, simply because of their immigration status. That is why I am adding my voice to those of almost 1,000 health-care workers and health organizations from across Canada who have signed an open letter calling on Prime Minister Justin Trudeau to develop a comprehensive and inclusive immigration regularization program granting status to all migrants currently living in Canada. We are also calling on provinces to ensure universal access to health care for uninsured patients.
Sasha Dyck, RN, serves on the board of the local tenant advocacy group and is a cofounder of Park Extension Mutual Aid and a member of the Healthcare for All Network.

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