Should Quebec end medical school quotas and hire more doctors?

A new study suggests Quebec needs to end medical school quotas and hire more doctors if it hopes to improve health care in the province. Thursday, March 15, 2018. File/Global News

As opposition parties hammer the Quebec government over perennial problems in the health-care system, a new study indicates the province doesn’t have enough doctors and should loosen its control over medical school admissions.

With Quebec’s hot economy and record-low unemployment, the issue on which the opposition has chosen to attack the Liberals in the lead-up to this fall’s general election has been health care.

Quebecers face a daily barrage of health-related news, from nurses who claim to be overworked, to doctors who say they are paid too much.

Then there are the stories about interminable wait times in emergency rooms and the months and months it takes to get a family physician.

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Patrick Dery of the right-leaning Montreal Economic Institute says in his study it is time for Quebec to end its medical school quotas and hire more doctors.

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Health Minister Gaetan Barrette says too many medical students are graduating, which prompted him to cut admissions last summer.

But Dery, whose study was released Thursday, says Barrette was wrong to do that because Quebec has significantly fewer medical practitioners than most developed countries.

With a ratio of 2.43 doctors per 1,000 people — slightly above the Canadian average — Quebec ranks well below Australia (3.5), Germany (4.1) and Austria (5.1)

By increasing the number of doctors, Dery said, “the public system would have a larger workforce from which to fill vacant positions — which currently number in the hundreds.”

“Access and patient choice would increase correspondingly,” he said.

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Additionally, more doctors would allow the private system to develop “without any risk of them cannibalizing the public system,” he added.

The Quebec Liberals have posted a series of balanced budgets and the province has consistently been among the leaders in the country in job creation in recent years.

But as the Oct. 1 vote nears, the Parti Québécois (PQ) and Coalition Avenir Québec (CAQ) want to talk about health care, which is seen as one of the Liberals’ main weak spots.

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Coalition Leader François Legault regularly lambastes the Liberals by claiming they overpaid medical specialists during the last round of contract negotiations.

Hundreds of doctors in Quebec have signed a petition rejecting the recently negotiated salary increases, saying the money should be redistributed back into the system.

PQ Leader Jean-François Lisée consistently talks about Quebec nurses, who for the past few weeks have been demanding the government improve their working conditions by lowering nurse-patient ratios.

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Moreover, Le Journal de Montreal published a report on Tuesday indicating Quebecers — despite major reforms in the health network by Barrette over the past several years — are waiting longer to obtain a family doctor.

For those with chronic illnesses, the wait time increased from 219 days in January 2017 to 285 by December. For other Quebecers, wait times increased from 224 days to 321 during the same period.

But Roxane Borges Da Silva, a professor at Université de Montréal who researches public health, believes Quebec has enough doctors and sufficient money to provide better care.

Doctors, she said, need to delegate more responsibilities to lesser-paid professionals such as nurses, psychologists, nutritionists and medical attendants.

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“We need to encourage collaboration,” Borges Da Silva said.

“I am against increasing the number of doctors and in favour of delegating more work to other medical professionals in the health-care system.”

Eric Maldoff, former chair of the Montreal Children’s Hospital and a lawyer and adviser in health-care matters, said both sides are partially right with regard to whether the province has enough doctors.

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The government decides how many are allowed to work in specific regions across the province in order to ensure a rationing of resources, he said.

Across Quebec, “the distribution of doctors is uneven,” Maldoff explained.

He said Quebec could potentially benefit from developing the private health system more. For example, he said, in some other countries, doctors are required to work a minimum number of hours in the public sector, per week, and can spend the rest of their time as they wish.

“Do I think by having a measure of private medicine we might be able to improve access? I would say only if it’s not a free-for-all,” Maldoff said.

Catherine Audet, a spokeswoman for Barrette, said in an email that one million more Quebecers have obtained a family doctor since the minister took over in 2014 and that emergency wait times across the province have diminished by an average of three hours.


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