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Quebec grants health minister power to impose duties on doctors

Quebec’s health minister can now unilaterally impose new duties on physicians when granting or renewing their hospital privileges

Lauren Vogel | CMAJ | November 15, 2017

A new law that gives Quebec’s health minister unprecedented power over physicians and health institutions will undercut patient care and penalize young doctors, warn medical specialists and trainees.

Bill 130 empowers the minister to decide the obligations that doctors must meet in order to work in health institutions. It also gives the minister the final say on institutions’ organizational plans and requires doctors to reapply for hospital privileges formally every one to three years.

“The bill marks the end of independent decision-making in institutions, and sanctions the complete hold by political powers over the organizational, medical and clinical management of the network,” stated Dr. Diane Francoeur, president of the Fédération des médecins spécialistes du Québec.

Although Bill 130 came into force this month, doctors still don’t know the nature of the duties that will be imposed on them. “One thing is certain, the additional powers the minister has granted himself, with the support of the parliamentary majority, are once again excessive, even dangerous,” Francoeur said.

The situation is particularly worrisome for medical students, who are unsure how the law will affect their career prospects if they stay in the province. “One of the big problems is lack of transparency,” said Philippe Simard, vice president of the Fédération médicale étudiante du Québec. “We don’t know what to expect.”

The law requires that “the obligations must be intended to meet primary care family medicine needs.” But doctors and trainees fear that the minister may impose changes based on personal or political whim. “He might think budget before patient care,” Simard said. “To be honest, if it had been another minister, we wouldn’t be this worried.”

Health Minister Dr. Gaétan Barrette has acknowledged he is “putting a dent in professional autonomy,” but argued that operating rooms sit empty when doctors organize their own schedules. “It is a privilege to have the opportunity to work in a hospital,” he told Quebec legislators. “It comes with bonds. It comes with obligations of result.”

There’s some concern that Barrette intends to introduce performance evaluations based on patient outcomes, Simard explained. “The danger is that doctors will start doing only easy procedures, things they know they can do, and all of the higher risk, more complicated patients might be left out.”

Young physicians also worry they will be expected to perform on par with older, more experienced professionals. “We’d like assurance that young doctors will not be penalized,” Simard said.

The requirement to reapply for hospital privileges every one to three years will be a burden, he added. Previously, “you didn’t have to formally apply every time.”

The government has promised the new process won’t increase administrative costs or burden, “but let’s be honest here, we’re looking at 20 000 physicians having to renew, possibly every year,” Simard said.

Photo credit: sudok1/iStock


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