$ 41 Million to be punctual

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Jean-François Cloutier and
Eric Yvan Lemay

Friday, December 8, 2017 01:00

UPDATE
Friday, December 8, 2017 01:00

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The government Couillard has paid for three years $ 41 million in premiums only to that of the doctors arrive and end on time in the operating rooms of hospitals.

Physicians who do surgical interventions have indeed the right to a “bonus for attendance” so that the operation rooms of the hospitals to be in operation between 8 a.m. and 16 p.m. in the afternoon, Monday to Friday.

This premium, that many canadians would like to probably have, is unknown to the general public and not well known even in the world of health… except for those who work in the operating room, was able to observe our Bureau of investigation in the last two months.

For surgeons, this premium is $ 105 if there is contact of the anaesthetist with the patient to operate between 7 a.m. and 8 a.m. in the morning.

It is then of $ 21 per 15 minutes for work performed after 15 h in the afternoon.

These bonuses attendance represent approximately 7500 $ by doctor who operates, according to the data obtained from the Régie de l’assurance maladie du Québec. It took three weeks to our Office of investigation for more details on these premiums that have benefited over 1900 physicians, only last year.

Improve access ?

The objective of these bonuses is to allow “better access of patients to operating theatres and diagnostic testing,” according to a spokesperson for the ministry of Health, Noémie Vanheuverzwijn.

But according to figures obtained from the ministry, the number of operations carried out since the introduction of this premium attendance has increased by only 1 % between 2012 and 2017.

“It is a gift [bonus]. Is this change something about the productivity ? It remains to be seen, ” said a doctor who requested anonymity and who takes advantage itself of the premium.

For his part, Dr. Mario, Come, of the quebec Association of surgery, acknowledges that no study has measured the impact of rewards on productivity. According to him, she aimed to begin operations sooner in order to use the operating theatre as soon as it opened at 8 h.

“This is an incentive as anything. If you want to do more more more, this is an incentive to encourage surgeons to do more, ” he says.

Some of the interviewees, who are also working in the health system, to denounce abuses in the payment of the premiums. The surgeon was right as soon as the anesthesiologist takes contact with the patient.

False hours

“It is beyond stretching the elastic,” explains the specialist, who requested anonymity in speaking for his colleagues who abuse it.

“Nobody checks to see if the doctor really entitled to the bonus,” he continued.

“In some cases, it takes 1: 30 or 2 hours to prepare the patient as in open heart surgery. At this time, the surgeon may enter at 8: 30 a.m. or even 9 a.m. and receive the bonus $ 105. “

“It happened several times that I have seen that time [the beginning of the operation] was 7: 59 in [the computer system], even if it was entered after,” says a surgeon in another hospital.

“Sometimes, the anaesthetist comes in the room [of the hospital] and it is over 8 pm,” says a surgeon.

Unlike the doctors, the support staff and nurses did not receive any bonus to arrive before 8 o’clock in the morning, we confirmed the Federation interprofessional of the health (FIQ).

►In addition to the surgeons, other specialists have the right to a premium when they operate. This is the case of specialists in urology, obstetrics and gynecology, oto-rhino-laryngology, neurosurgery and ophthalmology.

►The average income net of medical specialists was 443 161 $ 2016-2017.

The premiums to be on time to

2016-2017

• Anesthesiologists : $15.1 million (average of 19 891 $ by anaesthetist)
• Surgeons : $14.1 million (average of 7610 $ by surgeon)

2015-2016

• Anesthesiologists : $14.9 million (average of 19 875 $ by anaesthetist)
• Surgeons : $14.3 million (average of 7648 $ by surgeon)

2014-2015

• Anesthesiologists : $14.4 million (average of 19 448 $ by anaesthetist)
• Surgeons : $13.3 million (an average of 7148 $ by surgeon)

►Total : 86.1 million $

How it works

• The premium $ 105 is paid to the surgeon as soon as the anaesthetist has made contact with the patient.
• To be eligible for the premium, this contact must have occurred between 7 and 8 o’clock in the morning, either 7: 5 or 7: 59.
• A bonus of $ 21 is paid for every 15 minutes that the surgeon goes to the operating theatre after a 15-h. This premium, which totals $ 84 per hour is valid for all operations up to 19-h.

A premium negotiated by Module

Photo Agence QMI, Simon Clark

On the above document dated 21 December 2010, a few days before Christmas, and initialled by Gaétan Barrette (then president of the Fédération des médecins spécialistes du Québec) and Yves Bolduc (the then minister of Health ), a premium of $ 100 is given to the surgeons if there is contact with the patient before 8 h. The premium for attendance has been increased to $ 105 in 2015.

Photo Simon Clark

Anesthesiologists have been entitled in the first on October 1, 2008. The premium has been paid then to the surgeons in march 2011. It has been enhanced for anesthesiologists in 2013. It corresponds to an increase of 29 % of their compensation.

Photo courtesy

19 891 $ per year per anesthesiologist

Photo archive

Jean-François Courval

Association anesthesiologists

Anesthesiologists have affected on average $ 20,000 per year for the past three years to present before 8 a.m. and continue their work after a 15-h.

For the anaesthetists (or anesthesiologists), there is an increase of 29 % of their compensation. Anesthesiologists of Quebec, on average, earn 490 000 $ per year, according to the Régie de l’assurance maladie du Québec.

For Dr. Jean-François Courval, the premium is justified. According to the president of the Association of anaesthesiologists, the number of patients has jumped by 22 % from 2006 to 2016.

True or false ? One thing is certain, the ministry refuses to confirm the figures put forward by the anesthesiologists on the rise in the number of operations.

“Before 2011, a different system was used and the data are not comparable to those of the current system,” explains the spokesperson of the ministry, Noémie Vanheuverzwijn.

Premium doubled in 2013

According to a report by the ministry of Health of 2014, the majority of the increase of productivity in anaesthesia is explained by the increase in the number of anaesthetists and the fact that they work with patients eight days more per year.

In 2013, the premium has doubled for the anesthesiologist. The increase of their fees increased from 15% to 29%. “This is not a large dollar increase,” says Dr. Courval.

Increase surgery 1 %

The ministry of Health has told us not to have specific means of measuring the effectiveness of the premium. We did, however, follow the indicators “overall” on the surgeries. According to these data, the number of surgical procedures performed each year in Quebec increased 1 % in five years, from 458 162 in 2012 to 463 661 last year.

Over the past three years, the number of doctors has also risen. In total, 1913 doctors have affected the award last year against 1860 a year earlier, an increase of 2.8 %.

“Before, there were sometimes staff who complained of does not start on time. However, it is a bonus for people who were already [start time], ” says a source.