Paid more, doctors in Quebec work less

Patrick Bellerose

Wednesday, 7 march, 2018 00:00

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Wednesday, 7 march, 2018 00:00

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The increase in compensation fast-paced médecins du Québec for the past 10 years has led to a significant decline in productivity, reveals a devastating report.

“We managed, between 2006 and 2015, to double the money we have invested in the remuneration of the doctors, without an increase in the volume of services,” says one of the researchers who led the study, Damien Contandriopoulos, in an interview with The Newspaper.

During this period, the expenditure related to the remuneration of doctors rose from $ 3.3 billion to nearly 6.6 billion $, representing an average annual increase of 8.1 %. In addition, the number of physicians increased by 17 %.

However, the number of visits per family doctor has fallen by 17% during the years studied ; for specialists, the reduction is 12 %. The number of days worked follows the same downward trend : 4.5% among general practitioners, and 3.1 % among their colleagues.

In some categories, the performance of doctors has simply stagnated, without back, says Dr. Contandriopoulos, also a professor at the University of Victoria.

Payment to the act

For researchers, the mode of remuneration of physicians is at the heart of the problem. “The compensation act, it should give us more for our money, stresses Damien Contandriopoulos. But, when you look at 2006 to 2015, clearly, it has not delivered the goods. “

The latter does not go so far as to say that the payment to the act harms the productivity of doctors. “But if it has an effect on productivity, it is clearly much too modest,” he says.

On the contrary, the increase in payments made to physicians may have had a perverse effect on their productivity. “In a system where it is paid to the deed and where it increases a lot the value of the acts, it is sure that you can afford to work less and earn more “, stresses Damien Contandriopoulos.

In addition, the new generation of physicians, values more the work-family balance, which may also have an impact on the delivery of services.

Salaried

For Damien Contandriopoulos, physicians who work primarily within a single establishment should be of the employees. “We didn’t have to call it wages,” he said. It could be the time blocks : for each block of three and a half hours worked, the doctor receives a fee. “In the case of the work in the clinic, the payment to the act remains necessary, since no handler is present to ensure that the physician is present during the hours paid for.

And to those who claim that wage labour could lead to a reduction in productivity, Damien Contandriopoulos responds : “It is difficult to see how one could do worse than between 2006 and 2015, with the payment to the act. “

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The “errors” of the minister Barrette

As a majority of Quebecers, Damien Contandriopoulos judge severely the work of the minister of Health, Gaétan Barrette, since the beginning of its mandate.

According to the results of a survey by Léger published in The Journal last Saturday, 66 % of respondents disapprove of the work of the minister.

“Dr. Barrette has made mistakes is extremely important in the reforms that it has undertaken “, says the researcher, who has often criticized the work of the minister in the public square.

Cuts

The researcher blames particularly the project of act 10, which abolished the regional agencies of health to create integrated centres for health and social services (CISSS). “It rolled the ability steering system,” says Damien Contandriopoulos.

“And when we do it at the same time as imposing cuts brutal institutions, it makes the system really dysfunctional “, he adds, specifying that the cuts were a decision of the government as a whole, not only of the minister Barrette.

Long-term effects

For Mr. Contandriopoulos, the cry of the heart initiated by the nurses in recent weeks that sick leave increases are ” an effect of bad initial decisions “. “You start to see the effects, because it takes time, it is a big ocean liner,” he says.

However, the researcher does not share the opinion of 44 % of Quebecers who believe that the presence of a doctor to the post of minister at night to the health network. “There were all kinds of doctors and, when we look at our ministers of Health, they were very different from each other “, lance-t-il.

“If one takes the doctors Rochon, Hébert or Bar, there are three personalities are very different, with ways to act different,” adds the researcher.