RQDMSS demands decentralization of Québec health care system


J-D Potié

The Regroupement Québecois de Médecins pour la Décentralisation du Système de Santé (RQDMSS) held a virtual press conference demanding the return of power to local healthcare professionals on August 27. Represented by over 800 doctors from around 50 facilities in the province, the RQDMSS is a non-profit collective dedicated to combating the hyper-centralization of Québec’s health care system.
Attracting around 50 participants, RQDMSS members and community leaders from across the province voiced their opinions on the state of Québec’s health system, explained particular problems in
certain regions, and discussed solutions to a poorly organized administrative framework.
RQDMSS’s President Dr. Daniel Kaud said the state of Québec’s system drastically regressed after Bill 10 – an Act modifying its organization and governance by removing regional agencies – and the Barrette Reform in 2015. He said the province needs to be more flexible and adaptable.
“Bringing back local management, [close] to patients…would help solve a lot of problems,” Kaud said. “Proximity services would give us the agility, efficiency, quality, and extent of services [we need].”
What the RQDMSSS wants
The group has demanded the reinstatement of local administrators in all hospitals to improve productivity and quality of services.
Currently, workers must contact the Centre intégré de la santé et des services sociaux (CISSS) or University Integrated Health and Social Services Centres (CIUSSS) to file administrative requests.
The RQDMSSS also wants to reinstate a Director of Professional Services (DSP) who would oversee employee recruitment in each hospital. Currently, DSPs work within the CISSS, recruiting personnel and managing complaints, often far from where their decisions impact.
The organization also wants to re-establish local councils of physicians, dentists, and pharmacists in all facilities. Currently, there is one such committee per regional health center, which RQDMSSS members claim struggles to fulfill its responsibilities due to lack of resources.
A local perspective
MRC Pontiac Warden Jane Toller said the region supports the RQDMSS’ mission, emphasizing the severity of the health system’s deficiencies over the last several years and the difficulty of recruiting employees at the Pontiac Community Hospital (PCH) due to higher salaries available in nearby Ontario.
She said the hospital is now undergoing undeniable staff shortages, which has closed its obstetrics unit for the last year and half.
Toller said hiring new employees isn’t easy since the Pontiac borders Ontario where nurses earn roughly $10 per hour more.
While the PCH boasts a highly-certified team of doctors, Toller said it still requires a wider diversity of specialists which have been hard to find. “For our most vulnerable patients, it’s not fair and right that they have to go all the way to Gatineau,” Toller said.
She said it’s important to pressure politicians to fulfill promises of improving working conditions for health workers and the efficiency of services in the region.
Dr. Ruth Vander Stelt, RQDMSS Vice-President and doctor at the Pontiac Community Hospital, told the Journal the last several years have become increasingly difficult due to the lack of connectivity between decision-makers and patients.
“Issues aren’t the same for different areas of Québec,” Vander Stelt said, adding that Bill 10 also resulted in a significant shortage of family doctors in the province and decline in local innovation. “The needs are different and the population is different…we want to be able to serve people where they are, how they are, and who they are.”
She added that, before Bill-10, the PCH always met its budgetary requirements, but its operational costs have exploded – notably in terms of transportation and overtime – since then.
Estimating that many registered
nurses living in the Pontiac don’t work at the hospital, she added that the PCH needs an urologist, gynecologist and more employees to reopen its obstetrics unit and operate its medical home-care program.
“If you can make $10 per hour more, can concentrate on a certain ratio of patients, and not have to run an entire emergency room on your own, why wouldn’t you?” Vander Stelt said, adding that health professionals in Ontario typically have less arduous working conditions than ones at the PCH.
To solve the conundrum, Vander Stelt believes Pontiac needs a multi-year initiative dedicated to giving decision-making duties back to local PCH managers, with reasonable working conditions, equal salaries to nurses in Ontario, and autonomy of recruitment.
“We don’t think the law should change, we should implement it differently,” she added, noting there are positive administrative aspects of centralizing healthcare services. “Everybody working together is a good thing. However, you need local autonomy in order to have everyone working properly.”
Pontiac MNA André Fortin supports RQDMSSS’ demands for local autonomy and agrees with Toller’s demands for equal pay for Ontario and Québec nurses. He said he’s brought up both topics in parliamentary discussions and will continue pressing the issue.
“If there’s something that can be done quickly, with maximum impact, it certainly would be to increase the salary of nurses,” Fortin said, stating the government promised to augment salaries in the last electoral
campaign. “Everybody knows this would work. It’s a head scratcher as to why they haven’t moved on this already. Sure, it costs money, but at the end of the day, the government is there to provide service…
it needs to be addressed yesterday.”