Québec doctors push for decentralization

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Allyson Beauregard

QUÉBEC – About 700 doctors from more than 50 hospitals across the province are calling on the government to decentralize health services in Québec, including some from the Pontiac. Under of the umbrella of the Regroupement québécois des médecins pour la décentralisation des soins de santé (RQMDSS), the members of the collective are family doctors, general practitioners, specialist physicians, psychiatrists, radiologists and dentists.
Although the group has been “working in the background for several years,” it was officially established on November 11. According to RQMDSS’ website,
the group was created after several Montreal-based physicians observed that centralization was having a significant impact on quality of care, an observation
they discovered was unanimous across the province.
“For a long time, the hyper-centralization of our healthcare system has harmed our healthcare services and as a result of COVID-19, the situation has become worse…In ordinary times, hyper centralization has made our healthcare system slow and rigid, but the pandemic has made it dangerous for patients…In order to combat the current health crisis, we need a flexible healthcare system that can adapt quickly. Agility and speed in our decision-making processes are essential now more than ever,” says the RQMDSS website.
The group lays out four demands for the government: re-establish a local administrator in each healthcare facility; a local Professional Services Director
position for each hospital (responsible for medical recruitment and complaint management); a local Council of Doctors, Dentists and Pharmacists (CMDP) for each hospital center; and a local Directors Table bringing together the heads
of all departments of a hospital.
These changes would allow local people with knowledge of the facility and surrounding community to make decisions, which would improve both quality of care and efficiency. “It’s illogical for someone who does not know the reality of a healthcare facility and who may be over one hour’s drive from the hospital to be responsible for important decisions,” says the RQMDSS.
Dr. Ruth Vander Stelt, a Shawville doctor, is a firm supporter of giving back hospitals control over decision making. She gave several examples to illustrate the toll centralization has taken on local healthcare services.
“Doctors in outlying areas benefit from increased tariffs: 130,135, and 140% for 0-4, 4-7, and 7+ years of service in the Pontiac respectively. This was built as an incentive for doctors to come and (hopefully) live in the Pontiac, but especially to serve the population’s needs across the board: hospitalization, family practice, procedural sedation, obstetrics, emergency, home care, etc. We were doing fairly well up until 2015 (centralization). With centralization, we have an increasing amount of doctors in the ER who simply come up from the city because of the increased fees, but do nothing else for the patients. Our ERs are “sold” as being lower volume, lower acuity and higher pay….so the city docs come up,” she explained.
Meanwhile, Vander Stelt said the Pontiac’s doctors are aging and many are pre-retired or retired. “Pontiac is no longer in charge of recruiting. Whether or not this is the cause, I can’t say for sure, but recruiting is virtually nil, except for the low-commitment ER docs. Our hospital services are very precarious. If any of us physicians get sick or can no longer serve the population in the hospital, CISSSO will have to find city docs to come up here too. Roughly four times as many patients are on wait lists for family doctors as before centralization. We’ve lost obstetrics. It’s so paradoxical: the docs come up the highway following financial incentives; Pontiacers go down the highway to deliver their babies,” Vander Stelt told the Journal, noting she took the fee issue up with the Ministry of Health a year or two ago and was told there was nothing they could do – it had to be managed by the CISSSO.
The Centre intégré de santé et des services sociaux de l’Outaouais would not comment on the movement.