The Coalition Avenir Québec government is proposing restrictions for physicians who want to go from the public to the private health system, but an opposition MNA says the proposal lacks substance.
Late last year, the CAQ tabled a bill to force physicians to practise in the public system for at least five years after graduating.
Now, it’s proposing amendments that would apply to all physicians — not just new ones.
With the current rules, Health Minister Christian Dubé says it’s too easy for physicians to go “back and forth” between the public and private system. A physician just needs to give the Régie de l’assurance maladie du Québec (RAMQ), the province’s health insurance board, a 30-day notice to go from the public to private sector.
On Tuesday, Dubé proposed amendments to Bill 83, the proposed legislation he tabled in December that focused on new doctors.
Those amendments would require doctors to get formal approval from Santé Québec, the newest provincial Crown corporation that now oversees the health system, before switching from the public to private sector.
Santé Québec will either approve or reject a doctor’s request based on the following criteria:
- The number of available doctors in a region.
- The doctor’s departure from the public system cannot lead to negative consequences for patients in that region.
- The inability of the public network to use this doctor in the establishments in that region.
For decades, Quebec’s public health system has been criticized for not meeting the population’s needs. The province allowed the private sector to fill some of those gaps, but that hasn’t lifted much of the burden off of the public system.
The province’s College of Physicians has said that it prefers an outright ban on doctors leaving the public system.
The minister’s amendments fall well short of that.
“We want to make sure that we give flexibility, because I always said that the private sector is complementary to the public,” Dubé said when asked whether the proposed rules are tough enough.
Vincent Marissal, an MNA with Québec Solidaire, was quick to point out Tuesday that the province’s Heath Insurance Act already gives the minister power to limit doctors’ movements between the public and private system if they think it’s in the best interest of a patient in a given region.
As far as Marissal is concerned, Dubé is using the amendments to transfer that responsibility to Santé Québec.
“It’s a lack of courage on his part,” the MNA said.
He added that the minister should simply forbid doctors from breaking away from the public system.
“We can’t be speaking from both sides of our mouths,” Marissal said. “We can’t be saying that we want to bring people back to the public system while continuing to develop the private system.”
Fines for new doctors
In its news release announcing these changes, Dubé’s office points to data that shows that 820 doctors are practising in the private sector.
Although there are about 22,000 physicians in Quebec, Dubé’s office said the number of doctors who chose to opt for the private system represents an 80-per-cent increase compared to 2020.
It also says that there 150 other physicians, mostly specialists, who alternated regularly between the private and public sector in the last year.
As for new doctors, Bill 83 calls for fines ranging from $20,000 to $100,000 per day, with repeat offences incurring fines of $40,000 to $200,000, for physicians who leave the public system in the first five years after graduating.
The bill, and its amendments, were scheduled to be studied extensively by lawmakers at the National Assembly on Tuesday.
