THE GREAT LOSS OF A HEALTH GAMBLE
Some physicians renounce lucrative pay, call for broken system to be fixed
At first glance it may seem surprising that the latest voices to join the chorus decrying the failure of the Quebec government’s health reforms are those of doctors.
Doctors are at the top of the food chain in the medical system, many might think. They are handsomely paid — even more so thanks to lucrative new compensation agreements reached recently with the federations representing specialists and general practitioners.
They would seem to have very little to complain about. Yet in recent days, more than 200 doctors have signed an open letter renouncing these new pay schemes and asking instead that the money be reinvested in Quebec’s ailing health system.
The manifesto on the website of the group Médecins Québécois pour le régime public obviously does not speak for all of the province’s 10,000 specialists or 9,500 GPs, but it does tap into a growing sense that, for many doctors, a proper-functioning system is more valuable than any raise.
The announcement comes as Quebec nurses sound the alarm over the toll all these changes have taken on their own health.
Nurses have been speaking out about exhaustion and burnout from constantly being asked to work mandatory overtime and patient volumes that are so heavy they are having difficulty fulfilling all their work during a shift. They are warning that care is being compromised as a result of this untenable situation, with some even going so far as to take the unprecedented step of reporting themselves to their own professional orders for dereliction of duty, so grave are their concerns.
There could be a certain amount of shame in the move by some doctors to rebuff the pay increases. To have the hikes announced when the suffering of nurses is front and centre certainly risks feeding into stereotypes, often perpetuated by Health Minister Gaétan Barrette himself in trying to discredit opposition to his policy changes, that doctors are just greedy and self-interested.
But for the most part, that rap is grossly unfair. Family doctors and cardiologists, pediatricians and orthopedic surgeons, are also on the front lines of delivering services. Their own work conditions are undermined when other parts of the health system are squeezed or cut. They see firsthand how the reforms enacted by this government affect their patients.
Barrette’s overhaul of health care during the last four years had the stated goals of reducing waste and refocusing scarce resources on patient care. Taking an axe to useless bureaucracy might have seemed like a painless approach to slashing costs — until it turned out some of those so-called middlemen were pretty crucial to service delivery.
Without managers to organize staff, medical secretaries to schedule surgeries or enough nurses to monitor vital signs properly, patients start falling through the cracks. For doctors, this can mean patients coming to them in worse condition than they should be in or unable to abide by their follow-up care instructions. Or it means having to pick up the slack, type out reports, give out their email addresses and phone numbers because there’s no other way for their critically ill patients to reach them.
Doctors, who study for years to develop badly needed expertise to diagnose, treat and cure disease, shouldn’t be saddled with administrivia any more than airline pilots should be put in charge of baggage checks. It’s not a good use of their skills or good value for the money they are paid. And it takes long enough to get in to see a specialist or have a needed operation take place without physicians getting bogged down with additional distractions.
Doctors’ jobs get that much harder if nurses are pushed to the brink of burnout, patients can’t reach anyone when they need to book an appointment, there aren’t enough orderlies to respond to a Code White, or there are no cleaning staff on hand to reduce the chances of infection. They know that each actor has an important role to play and, when the balance is compromised, the system is as wobbly as an old table.
Perhaps the government was banking on doctors’ concerns being allayed by their latest pay package as much as they were counting on nurses to suffer in silence. Maybe Quebec’s radiologist health minister and brain surgeon premier thought they could effectively pit physicians against all other actors by creating a winner-takes-all health system.
But doctors didn’t sign up to work in a broken network plagued by plummeting morale and declining quality. In recent years, there has been a sharp uptick in the number who are throwing in the towel on the public system, moving over to practise in the less-hassle private sector.
A well-functioning public health system is as important to those who work in it, from obstetricians to orderlies, as it is to the patients it serves.