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LE SPÉCIALISTE 15TH YEAR
The Fédération des médecins spécialistes du Québec Magazine
Vol. 16 No. 1 | March 2014
Autonomy Insurance:
Social Duty or
Marketing Strategy?
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106018 (02/2014)
TABLE OF CONTENTS
Le Spécialiste is published 4 times per year by
the Fédération des médecins spécialistes du Québec. 7 PRESIDENT’S EDITORIAL
Encore!
EDITORIAL COMMITTEE
Dr Harold Bernatchez ENGLISH VERSION
INTERNET ONLY
8 FEDERATION AFFAIRS
Dr Karine Tousignant
Maître Sylvain Bellavance
Nicole Pelletier, APR
TO CONTACT US 11 A WORD FROM THE VICE-PRESIDENT
EDITORIAL CONTENT
Patricia Kéroack, c. w.
✆ 514 350-5021 514 350-5175
The PEM Obsession is Not Limited to
DELEGATED PUBLISHER ✉ communications@fmsq.org a Single Generation
Nicole Pelletier, APR ADVERTISING
12
Director, Public Affairs
and Communications
✆ 514 350-5274 514 350-5175
✉ fcadieux@fmsq.org
IN THE NEWS
RESPONSIBLE FOR www.magazinelespecialiste.com
PUBLICATIONS
Patricia Kéroack,
Fédération des médecins 13 DID YOU KNOW...
spécialistes du Québec
Communications Consultant
2, Complexe Desjardins, porte 3000
REVISION C.P. 216, succ. Desjardins 15 LEGAL ISSUES
Annie Dallaire Montréal (Québec) H5B 1G8
Angèle L’Heureux ✆ 514 350-5000
GRAPHIC DESIGNER
Dominic Armand
PUBLICATIONS MAIL
Postal Indicia 40063082 DOSSIER 17
ADVERTISING LEGAL DEPOSIT
1st quarter 2014
AUTONOMY INSURANCE:
France Cadieux
Bibliothèque nationale du Québec SOCIAL DUTY OR
ISSN 1206-2081
MARKETING STRATEGY?
• What “Society” Should Know 18
The mission of the Fédération des médecins spécialistes du Québec is to
defend and promote the economic, professional, scientific and social interests
of the medical specialists who are members of its affiliated associations.
The Fédération des médecins spécialistes du Québec represents the
following medical specialties: Adolescent Medicine; Anatomical Pathology;
32 GREAT NAMES IN QUÉBEC MEDICINE
Anesthesiology; Cardiac Surgery; Cardiology (adult or pediatric); Clinical
Immunology and Allergy; Colorectal Surgery; Community Medicine; Critical
Care Medicine (adult or pediatric); Dermatology; Diagnostic Radiology;
Emergency Medicine; Endocrinology and Metabolism; Forensic Pathology; Dr André Carpentier, Endocrinologist
Gastroenterology; General Pathology; General Surgery; General Surgical
Oncology; Geriatric Medicine; Gynecologic Oncology; Hematological Pathology;
Hematology; Infectious Diseases; Internal Medicine; Maternal-Fetal Medicine;
Medical Biochemistry; Medical Genetics; Medical microbiology and infectious 34 CONTINUING
diseases; Medical Oncology; Neonatal-Perinatal Medicine; Nephrology;
Neurology; Neuropathology; Neurosurgery; Nuclear Medicine; Obstetrics and PROFESSIONAL EDUCATION
Gynecology; Occupational Medicine; Ophtalmology; Orthopedic Surgery;
Otolaryngology-Head and Neck Surgery; Pediatric Hematology/Oncology;
Pediatric Emergency Medicine; Pediatric General Surgery; Pediatrics; Physical
Medicine and Rehabilitation; Plastic Surgery; Psychiatry; Radiation Oncology;
35 PROFESSIONALS’ FINANCIAL
Respirology (adult or pediatric); Rheumatology; Thoracic Surgery, Urology and
Vascular Surgery.
36 SOGEMEC ASSURANCES
All pharmaceutical product advertisements are previously approved by the
Pharmaceutical Advertising Advisory Board (PAAB).
38 L’ÉDITORIAL DU PRÉSIDENT
The authors of signed articles are solely responsible for the opinions expressed
therein. No reproduction without previous authorization from the publisher. Encore !
39 MEMBER SERVICES
THIS EDITION’S ADVERTISERS: Commercial Benefits
• Desjardins 2
• Telus 3
• RBC Banque Royale 4
• Financière des professionnels 6 Doctor,
• La Personnelle 10
• Congrès santé respiratoire 12
Your practice’s best friend:
• Club voyages Berri 13
the FMSQ portal
• Evenko 14 Keep your profile up to date to make sure you receive
•
•
Sogemec Assurances
Multi-D/FIDL
36
40
all the communications that concern you by email
(messages from the President, job openings, etc.). 5
vol. 16
fmsq.org No. 1
LS
Recommandé par la
Fédération des médecins
spécialistes du Québec.
Le service
d’accompagnement à
l’incorporation
de la Financière des
professionnels
..
PUBLICITÉ
PLEINE PAGE
Permet le fractionnement de revenu
. Optimise le report d’impôt
Favorise plusieurs stratégies fiscales avantageuses
En tant que professionnel en pratique privée, vous pourriez
obtenir de réels avantages en vous incorporant. Et si vous êtes
déjà incorporé, savez-vous que plusieurs aspects ont évolué
avec le temps ?
Financière des professionnels
Votre fédération est le principal actionnaire de la Financière des
professionnels depuis plus de 35 ans. Nos conseillers sont vos
partenaires privilégiés pour constituer votre société par actions
ou vous aider à l’optimiser. Ils connaissent précisément votre
réalité professionnelle.
Appelez l’un de nos conseillers pour en profiter.
www.fprofessionnels.com
Montréal 1 888 377-7337
Actionnaire de la Financière Québec 1 800 720-4244
des professionnels depuis 1978 Sherbrooke 1 866 564-0909
Financière des professionnels inc. détient la propriété exclusive de Financière des professionnels – Fonds d’investissement inc. et de Financière des professionnels – Gestion privée inc. Financière
des professionnels – Fonds d’investissement inc. est un gestionnaire de portefeuille ainsi qu’un courtier en épargne collective inscrits auprès de l’Autorité des marchés financiers (AMF) qui gère et
distribue les fonds de sa gamme de Fonds, et qui offre des services-conseils en fonds d’investissement et en planification financière. Financière des professionnels – Gestion privée inc. est un courtier
en placement membre de l’Organisme canadien de réglementation du commerce des valeurs mobilières (OCRCVM) et du Fonds canadien de protection des épargnants (FCPE) qui offre des services
de gestion de portefeuille.
PRESIDENT’S EDITORIAL
DR GAÉTAN BARRETTE
Encore!
In French, it means a repetition, something that’s done again. In English,
it’s used to call for an encore performance. That’s the term that best
describes the social and political situation in which we find ourselves
today: an encore presentation. The same thing. Again.
A
budget deficit, again. Were you expecting
Physicians’ compensation, again. Oh, yes! Again and
something else? The budget does include, in
again. But, dear colleagues, remember this: in 2006,
the area of health, the concept of activity-based
your remuneration was on average 55% below that of
funding, which must make you laugh since we’ve lost
your Canadian colleagues. Two consecutive governments
track of the number of times the FMSQ has promoted the
admitted it and agreed to make up the difference over a
notion in its various communications. In fact, the politicians
period of 10 years, which should bring you to approximately
have appropriated another one of the FMSQ’s ideas
10% less than the Canadian average by March 31, 2015. The
for themselves! same gap on average as other Quebeckers. You have
not received preferential treatment compared to
the rest of the population in Québec, but you will
BUT, DEAR COLLEAGUES, REMEMBER THIS: IN 2006, continue to be the object of envious comments
YOUR REMUNERATION WAS ON AVERAGE 55% BELOW by the right-thinkers who monopolize the public
THAT OF YOUR CANADIAN COLLEAGUES. TWO CONSECUTIVE arena and who, in many cases, have revenues
GOVERNMENTS ADMITTED IT AND AGREED TO MAKE UP comparable to yours which they keep well
THE DIFFERENCE OVER A PERIOD OF 10 YEARS, hidden, of course.
WHICH SHOULD BRING YOU TO APPROXIMATELY 10% LESS
And incorporation, again. The target is always
THAN THE CANADIAN AVERAGE BY MARCH 31, 2015. the same in the current climate. We, physicians,
THE SAME GAP ON AVERAGE AS OTHER QUEBECKERS. are deafened by the silence of the political elite
when faced with such a generalized discourse,
but we are not surprised. Are we not witness to
Elections, again. Well, yes, we have to have them sooner how these opinion leaders stir up suspicion, even hatred, in
or later. But, do we also need the flood of pre-election our society? Don’t they encourage division and agitate the
announcements? Can we afford them? How can the population solely for their electoral objectives? It’s called
government make so many announcements when its playing with fire.
coffers are so empty?
Again and finally, if the government wants to attack the
Once again, indecent partisan interventions remotely- notorious one-percenters, let the attack be global and
controlled by the governing party. Is there anyone in without discrimination. Their weapon is called income tax.
Quebec who believes that Diane Lavallée’s comments And, stop targeting a single group, the one made up of
on behalf of the AQESSS were NOT the result of a physicians, a group whose role is still and again considered
request to this former deputy minister and PQ candidate? essential and of immense value by society. But, if it is to
Haven’t we all noticed the lack of questions regarding this be, this battle will be fought on equal terms, because the
government’s choices? How cheap can one get? one-percenters will react.
And again, lacking in subtlety, the interventions of the Once again, the time is near for you to use all the means
Contandriopoulos family. Do they really think their biases necessary to defend yourselves.
are invisible? It wouldn’t be so bad if they did not constantly
drape the veil of “science” over themselves. Bah! As it Once again, you’ll be right to do so.
is, I was just reading that the number of cheaters in our
universities is constantly on the rise and that they’re In all solidarity!
seldom caught... S
L 7
vol. 16
No. 1
LS
FEDERATION AFFAIRS
This is Also Part of Being a Medical Specialist
On December 31st, while all Quebec homes were getting ready to welcome in the New Year,
the FMSQ was launching its new publicity campaign.
In the works for the last few months, this new media offensive WHO ARE THEY?
seeks to illustrate, under various guises, the commit- The ad campaign
ment, passion and achievements of medical specialists in calls only upon “real
several fields. p e o p l e .” T h i s i s
true for the medical
Some medical specialists actively get involved in causes close specialists, who relate
to their hearts, while others have achieved innovative projects how they “did more”
aimed at improving how the health system works. Some are alongside their daily
recognized on the international stage in their specialty, while practice. The same
others are pushing back the limits of current knowledge, is true for natural
perfecting new techniques that are less invasive, finding new caregivers : people
treatments to improve their patients’ living conditions. As who work within an
Dr Barrette emphasized: “We are proud to show this little-known association coming to the aid of natural caregivers and who
side of the work performed by medical specialists, in addition to received financial support from the FMSQ Foundation. They are
treating their patients. What we will be presenting to the public the best spokespersons for this important cause!
over the next few months will captivate audiences.”
The regular capsules (already being broadcast) star medical
The first capsules paid tribute to caregivers. You will recall that specialists who talk about dermatology (Dr Dominique Hanna),
the Federation, in April 2012, created its Foundation to finan- cardiology (Dr Gilles O’Hara) and pediatrics (Dr Pascale Hamel).
cially support various respite projects for the benefit of natural A series of special capsules has been produced for the Olympic
caregivers. These ads had a double objective: to publicize the Games period: three medical specialists speak of their work
commitment of medical specialists to caregivers and to pay with high-level athletes (Dr Paul Poirier, a cardiologist; Dr Louis-
homage to these men and women whose dedication is inade- Philippe Boulet, a pneumologist; and Dr François Marquis, an
quately measured. This period of the year seemed particularly orthopedist). Incidentally, Dr Marquis is the father of Philippe
appropriate for this exercise. Marquis, a member of the Canadian acrobatic ski team.
Look up all the publicity capsules on the FMSQ portal at fmsq.org.
Dr Dominique Hanna Dr Gilles O’Hara Dr François Marquis Dr Paul Poirier Dr Louis-Philippe Boulet Dr Pascale Hamel and Vincent
AFTER THE DEEP FREEZE, A HEAT WAVE
The summer season is approaching... get your Registration forms are available on the FMSQ portal
clubs ready. The next Medical Federations’ Golf at fmsq.org. Since the tournament sells out rapidly,
Tournament in aid of the Quebec Physicians’ register without delay.
Health Program will take place on July 28, 2014.
This ninth edition will be perfect day to network There are also several sponsorship options. For more
with your colleagues! information, please contact Madame Hoda Sayegh
8
vol. 16
at 514 350-5000, extension 279 or by email at
hsayegh@fmsq.org.
No. 1
LS
FEDERATION AFFAIRS
Psychiatry Lac-Mégantic
In Favour of a Framework for Additional Respite Thanks
Medical Expert Witnesses to the FFMSQ
During a press conference held on Februar y 6th, the The FMSQ Foundation (FFMSQ) contributed to the magic of
Association des médecins psychiatres du Québec (AMPQ) Christmas by offering some respite to more than 220 families
asked for a framework for medical expert witnesses while in Lac-Mégantic who were affected by the July 6th tragedy.
revealing the results of a survey performed on the subject The Foundation gave financial support totalling $45,000
among its members. which provided for the addition of one night’s accommodation
and one day’s activities to the stay already organized by the
Aimed at recognizing the quality of medical-legal expert Fondation Pierre Gagné and the Patronage Saint-Vincent-de-
witnesses, the AMPQ had seven recommendations geared Paul in Jonquière.
to tightening up the rules and the standard of care. Lamenting
the lack of markers to delimit the work of experts today, the “The tragedy which occurred in Lac-Mégantic is certainly the
Association is suggesting a review of criteria, a clarification event that preyed the most upon the minds of Quebeckers
and documentation of the quality of the expertise. On the during 2013. When we heard of what the Fondation Pierre
one hand, it is asking that physicians document their ability Gagné was planning (an initiative for which we wish to congra-
to act as experts and, on the other, it wants the Collège des tulate them), we immediately set out to learn more about it and,
médecins du Québec to create a bank of recognized experts. eventually, added our contribution. During this period of sharing,
we are happy to have been able to make a concrete gesture
Invoking the fact that medical practice is circumscribed and to bring some respite, some comfort, to these sorely afflicted
that the medical act’s quality is controlled, the Association families,” said the President of the FFMSQ, Dr Gaétan Barrette.
is asking for the setting up of professional inspections of the
practice of providing expert testimony. Thus, any expert report LS
should contain a Declaration by the expert. “Our thinking is
an integral part of the normal evolution of medical practice.
Over the years, medicine has become greatly more complex,
giving rise to various subspecialties. Calling upon a medical
expert is making sure there is a guarantee of competence and
experience,” explained from the outset the President of the
AMPQ, Dr Karine Igartua.
QUALITY EXPERTISE ABOVE ALL
The AMPQ deplores the practice of a directed expertise.
“Unfortunately, we often find cases where the work of the expert
is directed for the benefit of one or the other of the parties,”
added Dr Igartua. The Association therefore proposes that
expertise mandates be awarded by the courts rather than by the
interested parties. The courts could call upon a bench of three
experts for the more complex cases. Finally, the Association
considers that if the expertise mandate is not awarded by the
courts, then the solicitors should be obligated to divulge all the
expert opinions they requested for the case (written or verbal,
preliminary or complete).
The AMPQ’s reflection parallels the process undertaken by
the Collège des médecins du Québec. The latter set up, in
July 2013, a working group on the subject of medical expertise
whose mandate is, among others, to update the practice guide
on medical expertises, to propose identification criteria for a
medical expert, to propose a method of evaluating the quality
of an expertise and to define the framework delimiting a medical
expertise. The group’s final report is expected in May 2014.
9
vol. 16
No. 1
LS
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Aucun achat requis. La promotion se termine le 31 décembre 2014.A WORD FROM THE VICE-PRESIDENT
DR DIANE FRANCŒUR
The PEM Obsession is Not Limited
to a Single Generation
Residents are not the only ones to obsess, justifiably, over the question of medical manpower. In the
field, we are faced with attempts to improvise the rules for managing medical manpower plans (PEMs).
What a surprise! Suddenly, colleagues nearing the end of their This means having a full-time practice and covering his or her
careers are becoming the prey of predators: heads of departments on-duty obligations. How then does one calculate teaching obli-
are worried they will not be able to recruit and they add pressure to gations (there are students everywhere!), and those of research
incite departures. Residents are stressing out over their future postal or medical administration? And how does one calculate the
codes. Between these two generations, we find physicians from numerous hours on duty either on site or on call?
generation-X along with the youngest boomers dreaming of part-time
work... with questionable arguments. It is difficult to maintain one’s
TIMES HAVE CHANGED. CANDIDATES ARE JOSTLING
competence when working part-time in surgical disciplines.
ONE ANOTHER TO REMAIN AROUND THE MAJOR
How did we reach this point? Several related situations are URBAN AREAS AND TWO PART-TIME POSTINGS DO
responsible for this possible loss of control that could lead to medical NOT EQUAL A FULL-TIME ONE!
unemployment if we don’t wake up soon! Physicians have habi-
tually covered for one another; there was always one or more than
one colleague to catch the ball and to do a little more, until the How does one manage colleagues’ absence of enthusiasm due
situation could be redressed. And absences for illness or maternity to a lack of sensitivity to group spirit? What will the chief’s powers
are not new. However, the latter were shorter and requests less hare- be in the management of his or her obligations? There is the smell
brained, because the day would come for the table to be turned. of contracts in the air... We are living in a time of turbulence after
all the years of shortcomings when we accepted candidates, no
The practice of specialized medicine is more than ever a case of matter what our particular needs were, by telling ourselves that
working in a silo, even with groups. Modifying the profile of the part time was acceptable since our own physicians were reaching
practice, without taking into consideration the needs of the group, the end of their rope.
has always been a problem. And what of requests from colleagues
who want to retain the privilege of keeping their “goodies” such Times have changed. Candidates are jostling one another to remain
as surgical priorities or technical platforms in external clinics, while around the major urban areas and two part-time postings do not
generously leaving the on-call duty to be covered, especially when equal a full-time one! We’re at the point where expectations must
one’s beeper goes off all the time...? be mutually negotiated, divulged and accepted by the teams. A
“real job” for a chief! Part-time PEMs are not on the schedule.
According to the rules of management,
a PEM is accounted for as follows (translated): This does not mean that it is impossible for all that, but it is more
4. ACCOUNTING FOR A PHYSICIAN IN THE PEM
complicated and under the responsibility of the physician who
wants to leave the beaten track. He or she will need to find one
4.1. General Rule or more partners to share the tasks. This is not easy. In fact, the
A physician is accounted for in the PEM of a single establish- definition is a subject of controversy and discussion with our friends
ment, the one where he or she performs the major part of his in the ROC: a two-day colloquium on medical manpower was
clinical practice organized by the Royal College in February.
4.2. Physician with a practice in several establishments
Finally, should we worry about the end of our careers? Some
A medical practice with privileges in more than one establish- subjects which are presently being considered, such as end-of-
ment is, barring exceptions, accounted for in the PEM of the
career twinning, the number of end of career PEMs if we move
main practice establishment or the one where the proportion of
earnings in an establishment is the highest. away from Appendix 38, changes in mixed remuneration and the
obligation of seeing patients to be able to bill a per diem, are already
Before implementing a change in the main location of his or her an incentive to a real retirement. The financing of offices, if it ever
practice, a physician must make sure he or she obtains a PEM
happens, will allow for an increase in the offer of services and for
in the establishment where he or she will have his or her main
practice from now on. the management of specific needs. But, all of this will not change
our main obligation which is that on-call duty must be covered.
Source: Règles de gestion : plan d’effectifs médicaux en spécialité,
MSSS, 2011. Available in French only from msss.gouv.qc.ca .
These are possible solutions that are more elegant than just
pushing our elders towards the exit.
11
vol. 16
LS No. 1
LS IN THE NEWS
Encourage Your Patients: Health or Profits?
breastsobservation.org With the aim of protecting
the health of individuals,
One woman out of nine will be stricken with breast cancer Dr David Mulder, a senior
during her lifetime. The Quebec Breast Cancer Foundation thoracic surgeon at the MUHC
launched a far-reaching educational campaign at the end of – Montreal General Hospital,
February dealing with the three breast health practices. The along with Dr Dick Menzies,
FMSQ supports this important campaign. Chef of the Thoracic Surgery
Division and Director of the
Dr David Mulder Dr Dick Menzies
Within the context of your work, you no doubt meet a lot of Respiratory Care Division at
women who are worried about their health. Nevertheless, the MUHC – Montreal Chest Institute, in cooperation with the
78% of women do not often observe their breasts; several of Coalition québécoise pour le contrôle du tabac, have launched
them are afraid, lack knowledge, or are convinced, wrongly, that a campaign entitled La santé avant leurs profits.
it is a complicated practice. By making appropriate resources
available to them, the Foundation aims to show women that they Along with denouncing the use of tobacco and its effects on
are capable of doing so themselves. You have the power to have the health of the population, the campaign asks the Minister
a positive impact on the health of your patients: you can help to of Health and Social services to take action in order to forbid
better inform them, or even to convince them! tobacco products, the most important cause of avoidable illness
and death in our society.
The two physicians, in addition, call on all their physician collea-
The Foundation makes available to gues to do the same. In fact, they quote Section 3 (Chapter
you, as healthcare professionals, II) of the Code of Ethics which stipulates that: “A physician’s
posters and flyers that you can give to paramount duty is to protect and promote the health and
your patients. well-being of the persons he attends to, both individually
Visit rubanrose.org/educationalmaterial to get more of them free and collectively.”
of charge. When it’s a question of breast cancer, women are
well-advised to put all the chances on their side! You too can support this campaign, by visiting the site
lasanteavantleursprofits.com to download a template of a letter
to send to Health Minister, Réjean Hébert.
LS
Congrès canadien
sur la santé respiratoire
PUBLICITÉ
1/2 DE PAGE HORIZONTALE
2014
À inscrire à votre agenda!
Congrès santé respiratoire
Telus Convention Centre, Calgary (Alberta)
24-26 avril, 2014
Pour tous les détails du programme et pour s’inscrire,
visitez le site www.poumon.ca/crc
Présenté par : En collaboration avec:
12
vol. 16
No. 1
LS DID YOU KNOW...
PRIZES AND AWARDS NEW RELEASES
TRANSPLANT QUÉBEC PRIZE PHYSIOPATHOLOGIE RESPIRATOIRE APPLIQUÉE
During the Société québécoise de trans- (APPLIED RESPIRATORY PHYSIOPATHOLOGY)
plantation congress, Dr Michel R. Pâquet, Dr Louis-Philippe Boulet, a pneumologist
Production multimédia CHUM
a nephrologist specialized in kidney trans- at the Institut universitaire de cardiologie
plants at the CHUM – Hôpital Notre-Dame, et de pneumologie de Québec, published
was awarded the Transplant Québec 2013 Physiopathologie respiratoire appliquée at
Grand Prix. Dr Pâquet is recognized for his the Presses de l’Université Laval. This book
unrelenting commitment to the cause of assembles the knowledge essential to
organ donation, in particular the adoption of an act to facilitate understanding the physiopathology of respi-
organ and tissue donations. ratory system ailments. It mainly addresses
medical students, researchers in respiratory
CRCHUM AWARD health as well as general practitioners and
T he Ce ntre de re c he rc he du CHUM specialists who wish to review the most recent discoveries
(CRCHUM) presented its Excellence Award concerning the mechanisms of respiratory diseases.
Production multimédia CHUM
to Dr Fred Saad in recognition of his excep-
tional scientific contribution throughout GUIDE POUR LES PATIENTS ATTEINTS DE DIABÈTE
his career. Dr Saad is a researcher in the (A GUIDE FOR PATIENTS WITH DIABETES)
CRCHUM Cancer Theme, a urologist and Under the direction of Dr Claude Garceau,
the head of the Urology Department at an internist at the Institut universitaire de
the CHUM. cardiologie et de pneumologie de Québec,
several Quebec specialists in diabetes
RCPSC AWARD collaborated on the Guide pour les patients
he Royal College of Physicians
T atteints de diabète : comment devenir expert
a nd Surg e ons of Ca nada ( RCPSC ) dans la prise en charge de sa maladie,
presented the 2014 James H. Graham published by the Presses de l’Université
Award of Merit to Dr David Mulder, a Laval. This guide is intended for patients who want to be active
senior thoracic surgeon at the MUHC – partners in the management of their health.
Montreal General Hospital. Dr Mulder has
dedicated his career to the advancement
of medical science. He is also the Montreal
Canadiens’ physician-in-chief.
AMBASSADORS CIRCLE AWARD
D r Fr a n ç o i s R o u s s e a u, a m e d i c a l
biochemist at the CHUQ – Saint-François
d’Assise, received the 2013 Event of the
Year award from the Ambassadors Circle
for the International Cochrane Colloquium.
Dr Rousseau co-chaired this international
gathering which generated tourist spending
of approximately $1.9 million throughout the region.
Marseille, France
NATIONAL GEOGRAPHIC MAGAZINE
The February 2014 issue of the famous
maga zine is dedicated to the brain.
Describing scientific advances and the
magic of medical imagery, the magazine
devotes a few pages to the work of
Dr David Fortin, a neurosurgeon at the
CHUS – Hôpital Fleurimont. The magazine
presents certain 3D imaging tools used during oncolo-
gical neurosurgery.
Contactez votre conseiller
RECOGNIZED BY THE CITY OF BORDEAUX Club Voyages Berri
514 288-8688
Dr Michel Gagner, a general surgeon at
920 Boulevard de Maisonneuve Est
the Hôpital du Sacré-Cœur de Montréal www.berri.clubvoyages.com
was awarded the City of Bordeaux medal
Azamara Club Cruises® est un fier membre de la famille de croisiéristes Royal Caribbean Cruises Ltd. ©2014 Azamara Club Cruises.
to highlight his contribution to the advance-
ment of digestive surgery via laparoscopy
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Permis N° 753141 au Québec. Siège Social : 300, rue Léo-Pariseau, bureau 1601, Montréal, Québec H2X 4B3. 13
vol. 16
during the 24-hour Coelio World Congress No. 1
of which he was Honorary President. LS DID YOU KNOW...
NEW RELEASES (CONT’D)
LE GLAUCOME (GLAUCOMA)
Dr Pierre Blondeau, an ophthalmologist
at the Centre hospitalier universitaire de
présente plus de 1 000 événements Sherbrooke and Dr Paul Harasymowycz,
an ophthalmologist at Hôpital Maisonneuve-
musicaux, familiaux, sportifs partout au Québec Rosemont and the medical director of the
Institut du glaucome de Montréal have
published Le glaucome with Annika Parance
Une référence en divertissement corporatif Éditeur. The book covers the various aspects
à l'échelle locale et internationale ainsi que of the disease and provides all the necessary
plusieurs sites événementiels information for patients and their relatives.
pour la tenue de vos événements spéciaux LES MALADIES DE LA PROSTATE (PROSTATE DISEASES)
Still with Annika Parance Éditeur, Dr Michael
McCormack and Dr Fred Saad, both
urologists at the CHUM have published Les
maladies de la prostate, a complete guide
for health professionals, researchers and
medical students. This guide takes stock of
the most recent knowledge in the field and
UNE
inventories current practices.
EXPÉRIENCE PRÉCIS DE CARDIOLOGIE – CARDIOMEDIK
(CARDIOMEDIK – A CARDIOLOGY HANDBOOK)
D r David Laflamme, a cardiologist at the
VIP CSSS Champlain-Hôpital Charles-LeMoyne,
has published the Précis de cardiologie
– Cardiomedik, a reference document
Traitement rapide de for clinicians. Dr Laflamme synthesized
thousands of pages in order to create this
toute demande spéciale comprehensive tool to help with clinical
decisions. Cardiomedik is published in
Obtention de billets d'événements pocket book format by Éditions Frison Roche.
culturels à la dernière minute LE SUICIDE, L’AFFAIRE DE TOUS
(SUICIDE, EVERYONE’S BUSINESS)
Organisation de soirées privées Dr Suzanne Lamarre, a psychiatrist at
St. Mary’s Hospital Center, published Le
Salles et sites en location suicide, l’affaire de tous, a guidebook which
presents a new perspective on the problem
of suicide. She provides proof that we
Réservation de loges should no longer limit ourselves to treating
suicidal behaviour as a symptom of mental
Rabais corporatif sur illness, but as a key moment to reorganize
certains spectacles one’s life with others. The book is published
by Éditions de l’Homme.
Artistes et divertissement UNE RETRAITE ÉPANOUIE
(A SATISFYING RETIREMENT)
Are you thinking of retiring soon? You
could benefit from all the advice offered by
Dr Yves Lamontagne, a psychiatrist who
retired in 2010 and for whom it is possible
LE TOUT SOUS UNE SEULE ADRESSE ! to grow old both happy and healthy. The
book Une retraire épanouie, published by
Valérie White | 514 925-2124 | vwhite@evenko.ca Québec Amérique, deals with physical and
Chargée de projets, événements corporatifs psychological health, living with a spouse
14 and finances.
vol. 16
No. 1 LS
LS LEGAL ISSUES
BY MAÎTRE SYLVAIN BELLAVANCE
Director, Legal Affairs and
Negotiations – FMSQ Nearing the End of our Agreement
By the time you read this article, we will find ourselves at the beginning of the last year of
the FMSQ-MSSS Framework Agreement, which ends on March 31, 2015. Various measures
remain to be implemented by that date, but we nevertheless have to prepare ourselves for a
meeting shortly dealing with the renewal of the Agreement.
As you are aware, recent agreements reached with the Quebec HAVE PHYSICIANS RECEIVED SIGNIFICANT
government in 2007 and in 2011 will have allowed us to adjust INCREASES OVER THE LAST FEW YEARS?
the remuneration of medical specialists and to implement Yes, of course! These were the fruit of negotiations which took
various measures to improve the quality and accessibility place over a long period with more than one government,
of specialized medical care. At this moment in time, there is who each recognized that the remuneration gap between
only one last fee increase to be introduced. Insofar as quality Quebec medical specialists and their colleagues in other
and accessibility measures are concerned, there is a balance provinces was not only disproportionate, but unfair and that
of approximately $120 million to be implemented during the it was important to make a special effort to reduce this gap.
coming year, and this is what the Federation is concentrating This conclusion was reached not only by the previous Liberal
on at present. government, but as well by the PQ government which, at the
start of 2003, was the first to
Current efforts aimed at completing recognize the need to correct
the implementation of the last invest- IT IS PERFECTLY NORMAL AND remuneration gaps in order
ments provided for in the 2007 and to ensure a competitive level
HEALTHY, IN A DEMOCRATIC
2011 Agreements are taking place at of remuneration compared to
a time when various reactions and SOCIETY, TO RECONSIDER physicians in other provinces.
emotions are being expressed in public CERTAIN GOVERNMENT POLICIES
concerning the validity of the increases AND DECISIONS. HOWEVER, IT AREN’T THESE
granted to Quebec physicians. Some INCREASES INDECENT?
attack the increases granted over
IS IMPORTANT TO DENOUNCE In no way. Rather what was
the last few years, labelling them as THE COOKIE-CUTTER FORMULAS, indecent was the remune-
indecent or not justified. Others say that THE DISTORTION OF FACTS AND ration gap that had existed
physicians are egotistical or argue that THE HASTY CONCLUSIONS OF for many years, reaching up
the increases did not serve to improve to more than 50%. We must
the problem of access to the healthcare CERTAIN STAKEHOLDERS. insist on the fact that the level
network nor contribute to an increase of adjustment granted to physi-
in services. cians was established not only
because of the situation with colleagues in other provinces,
It is perfectly normal and healthy, in a democratic society, but also according to the economic reality of Quebec workers
to reconsider certain government policies and decisions. overall and the State’s capacity to pay.
However, it is important to denounce the cookie-cutter
formulas, the distortion of facts and the hasty conclusions of In fact, the increases granted to physicians will not result in
certain stakeholders. their being remunerated at the level of the Canadian average.
Despite these increases, Quebec medical specialists will
It is important to respond to these attacks. continue to lag behind the Canadian average by more than
10% and will therefore continue to be among the least paid
It is perfectly normal and healthy, in a democratic society, to physicians in Canada. However, this is also the situation for
reconsider certain government policies and decisions. However, Quebec workers overall, who, according to various studies,
it is important to denounce the cookie-cutter formulas, the have an average revenue that is between 10 and 12% lower
distortion of facts and the hasty conclusions of certain stakehol- than the Canadian average. Thus, the increases granted to
ders. To illustrate the excesses and shortcuts we see too often physicians will have had the effect of correcting an indecent
in numerous debates, let’s look at the current one surrounding gap, which previously stood at more than 50% to bring it
the Secularism Charter or even the one concerning the famous back to a fairer level more in line with the one that applies to
group made up of the richest 1% of taxpayers, who are being Quebec workers overall.
blamed for all our ills. I am trying here to control myself and not
expand on the subject of these latest issues, but it still seems
essential to me to reset the clocks on the debates surrounding
the remuneration of physicians. I thus propose a few succinct
answers to certain statements being conveyed. 15
vol. 16
No. 1
LSLEGAL ISSUES
ARE PHYSICIANS BEING SELFISH BY It is important, however, to mention that physicians have
ACCEPTING SUCH AN INCREASE? offered a compensation. In fact, physicians offered to link
Once again, the reality of our negotiations allows us to easily a portion of the adjustment they have been granted to the
refute these ridiculous, even insulting, allegations. While physi- implementation of measures aimed at improving the quality of
cians had been asking since 2002 for an important immediate healthcare and its accessibility for the population. They have
correction to their remuneration in order to make up the unfair thus accepted to do what few other groups have done. Insofar
gap that had existed for far too many years, we had agreed as medical specialists are concerned, investments in certain
with the Treasury Board and the government to spread the measures were effected in order to promote an increase in
amount of the correction over several years in order to respect the number of surgical interventions in hospital settings, an
the Province of Quebec’s capacity to pay. Physicians proved increase in access to services for patients referred by general
themselves to be very patient. The main increases were thus practitioners and a better contribution to the management of
put off until the years 2008 to 2014. So, of course, these years the healthcare network. As for general practitioners, we know
finally arrived! And the corrections so long awaited were imple- that a part of the adjustment granted was introduced with
mented. Today, the efforts to show up physicians as egotistical, measures seeking to increase the number of patients and
when in fact they acted in a responsible fashion by putting off improve access to a family physician.
the increases to later, is a bit odd to say the least.
Physicians have thus acted in a responsible
fashion by offering certain concessions.
Preliminary results have shown an increase
PHYSICIANS OFFERED TO LINK A PORTION OF THE
in the number of surgical interventions in
ADJUSTMENT THEY HAD BEEN GRANTED TO THE hospital settings. As for other measures,
IMPLEMENTATION OF MEASURES AIMED AT IMPROVING it is probably too soon to see their impact
THE QUALITY OF HEALTHCARE AND ITS ACCESSIBILITY since many of them have only recently been
introduced. There is no reason to believe
FOR THE POPULATION. THEY HAVE THUS ACCEPTED that wished-for results will not be realized.
TO DO WHAT FEW OTHER GROUPS HAVE DONE. However, conclusions in this regard cannot
put into doubt the fact that physicians chose
to act in a responsible fashion by using a
IS THERE NO COMPENSATION FOR THESE portion of the increases that were owed them in a way that
INCREASES IN REMUNERATION? would improve the healthcare system.
Some argue that increases in remuneration do not result in
an improvement in the healthcare system nor in an increase Many other questions can be asked and answers supplied to
in services to patients. There are two answers to this. Firstly, show that the treatment granted to physicians over the last
an increase in remuneration is not usually granted in return few years was justified and fair and that physicians have acted
for an additional service. If one looks at the pay scales in the in a responsible fashion. Pretending it is not so is always easy
public service and the increases that are granted with each when one uses impressions and half-truths, something we
new agreement, the latter are granted more as a response can blame on various stakeholders. Nevertheless, I persist
to cost of living increases and as recognition of the expe- in remaining optimistic regarding the overall capacity of
rience acquired by salaried employees than as an incentive Quebeckers as a whole to see the difference between facts
to provide new services. When the hourly remuneration of and unfounded judgments. The results of a Cyberpresse
hundreds of thousands of State workers is increased by survey last January 14th have proven to be reassuring on
2% next April 1st, we can already predict that all those who this point. In the aftermath of the reflection launched by the
will want to analyze the number of hours paid to by these Health and Welfare Commissioner on the remuneration of
workers over the following year will not find an increase in Quebec physicians, a question was asked about whether
the number of hours actually worked! In the same way, when physicians were overpaid, paid enough or not paid enough.
the government prioritized the issue of salary equality in the That physicians were overpaid was the answer of only 29%
middle of the 2000 decade, the aim was to correct an inequity of respondents, the great majority being of the opinion that
imposed on numerous State employees and the increases such was not the case.
that were granted did not result in more services to the popu-
lation, despite the hundreds of millions of dollars invested. The We will shortly be starting the last year of our Agreement with
situation with physicians is similar. How can one justify that the government. It is important to finish the implementation
physicians should need to offer more services to obtain their of all the investments that were provided for, including the
increases when such a condition is not required from any sums that were allocated to the implementation of measures
other group of workers? aimed at improving the quality and accessibility of care. It
is also important to prepare ourselves for the next round of
negotiations. Let’s be ready.
16
vol. 16
S
L
No. 1
LSAutonomy Insurance:
SocialDOSSIER
Duty or
Marketing Strategy?
Autonomy Insurance:
Social Duty or
Marketing Strategy?
On May 30, 2013, the Minister of health and social services made public
a consultation document entitled: L’autonomie pour tous : livre blanc
sur la création d’une assurance autonomie. After private consultations
and public audiences regarding the White Paper, the Minister of
health proposed Bill 67, Autonomy Insurance Act, on December 6th.
The government, who wanted to implement this program starting in
April 2014, decided instead to delay its effective date to 2015, with the
avowed aim of having it come into effect at the start of a new fiscal year.
Does this autonomy insurance project meet the needs of society? Will
it make a difference in the healthcare services available? At what cost?
What do you know about this project? In this dossier, Le Spécialiste
draws up a balance sheet of the situation by providing you with a
multitude of data issued by, among others, the Institut de la statistique
du Québec, the Institut national de santé publique du Québec, the
Quebec Auditor General and the Quebec Ombudsperson... data that
merits some thought.
17
vol. 16
No. 1
LSBY RICHARD-PIERRE CARON
Senior Consultant
Public Affairs and Communications – FMSQ
Autonomy Insurance
What “Society” Should Know
This is a project that is of vital concern to our society as a whole, if only from the point of
view of public finances and of the choices that will have to be made in terms of access to
care and services. It also concerns the actors in the healthcare network since it implicitly
involves the functional health of our population and the various pathologies that generate
different types of disabilities. This project is being presented to us as something new and
yet, all the service programs already exist, even if they suffer from chronic dysfunction. Or
are we witnesses to a marketing strategy?
For these reasons, it seemed to us the time was right to reset HOME CARE SERVICES – 2011-2012
the clocks on this nth attempt by the government to modify the
Interventions/
healthcare system. We undertook a sizeable research project,
Users Interventions Users
reviewing reports, studies and data from various sources likely
to help us dig deeper in aid of this analysis. Intellectual Deficiency
16,069 181,475 11.3
or PDD
We must emphasize that we had already dealt with the Physical Deficiency 1,362,821 33.3
question of population aging as related to the costs of Addiction 80 247 3.1
healthcare. That particular dossier, which is worth rereading,
Youth in Difficulty 785 3,377 4.3
was published in the March 2011 issue of the magazine
Le Spécialiste. Today’s dossier is therefore a logical follow-up. Loss of Autonomy
186,576 5,910,881 31.7
Associated with Aging
WHAT DO WE MEAN BY A LOSS OF AUTONOMY? Mental Health 4,433 68,661 15.5
According to the definition used during the Canadian Physical Health 67,535 862,271 12.8
Community Health Survey (CCHS), conducted by Statistics Public Health 19,289 1.1
Canada in 2001, 2003 and 2005, a portion of which was used
General Services 869,658 7.7
by the INSPQ in its projects, “The health problems or diseases
identified (in the CCHS) are problems which last or should Others 4 6 1.5
last six months or more and which have been diagnosed by Total 447,959 9,278,686 12.2
a health professional.” Source: Ministère de la Santé et des Services sociaux1
Disabilities resulting from health problems cover a much larger
spectrum and people of all ages are likely to be incapacitated, WHITE PAPER AND BILL 67
to one degree or another, over time. The table opposite shows A quote from the White Paper2 quite clearly summarizes the
the different types of clients with a loss of autonomy and government’s view which, all in all, is identical to the one
the number of home care service users for the year 2011- the former government used in 2006. In the background:
2012,1 the last year available. The province of Québec had population loss, aging and the sustainability of public finances.
447,959 users.
“L’augmentation anticipée des coûts en raison du
vieillissement de la population québécoise oblige à
DISABILITIES RESULTING FROM HEALTH une réflexion en profondeur afin de trouver les sources
PROBLEMS COVER A MUCH LARGER SPECTRUM additionnelles de financement requises pour répondre
à la croissance de la demande tout en maintenant un
AND PEOPLE OF ALL AGES ARE
niveau de services acceptable et pour éviter de reporter
LIKELY TO BE INCAPACITATED, les coûts sur les générations futures.”
TO ONE DEGREE OR ANOTHER, OVER TIME.
For the benefit of readers, general references are indicated in the magazine; complete references are available in the elec-
18
vol. 16
tronic version of the magazine on the FMSQ’s portal (fmsq.org). Also, within the context of this dossier, certain passages
have been emphasized to attract readers’ attention. Please note that most of these references are NOT available in English.
No. 1
LSAutonomy Insurance:
Social Duty or
Marketing Strategy?
To start with, there is a statement affirming that, within a few Here is what the White Paper states concerning the
years, the sums that we collectively inject into the health and EQLAV: “Cette enquête à autodéclaration indique que
social services network will not be sufficient to meet demand. 12,8 % des Québécoises et 8,7 % des Québécois de
15 ans et plus vivant à domicile et hors institution
The White Paper, like the Bill, invokes the fact that we have to présentent une incapacité modérée ou grave, c’est-à-
respond adequately to the needs of all persons stricken with dire un niveau fonctionnel restreint et qui limite ou empêche
a disability. It targets people aged 18 years and over who l’accomplissement de certaines ou de nombreuses activités.
“have a significant and persistent disability caused by
a chronic disease, a physical or mental impairment or “On considère que le taux d’incapacité, qu’il s’agisse du
a pervasive developmental disorder”. This is thus a policy nombre de personnes qui sont atteintes d’une incapacité
whose principal aim is to dam up the potentially devastating ou de l’intensité de l’incapacité, s’accroît avec l’âge. Ainsi,
effects that, we presume, the large cohort of baby-boomers 7,3 % des personnes de 15 à 64 ans ont une incapacité
will have as they age on the costs of health care. qualifiée de modérée et grave, un taux qui se situe à
26,1 % chez les 65 ans et plus. Selon l’EQLAV, le taux
The government wants to allow the elderly of the future atteint même 59,1 % chez les 85 ans et plus. Ce sont
to preserve their autonomy and stay as long as possible environ 480 000 personnes de 15 ans et plus vivant à domicile
in their own living accommodations. It hopes to thus qui ont une incapacité modérée limitant l’accomplissement de
reduce the costs to the system, presumably because it certaines activités et environ 230 000 personnes qui ont une
costs less to deliver care and services to homes than to incapacité grave, c’est-à-dire empêchant l’accomplissement
call upon public facilities. To do so, the offer of services d’un grand nombre d’activités.
from the health system must be reviewed and adapted.
“On peut estimer à environ 725 0 0 0
le nombre de personnes ayant une
FOR THE GOVERNMENT, THE SOLUTION PASSES incapacité qui présentent des besoins
pouvant nécessiter des soins et des
THROUGH THE CREATION OF AN AUTONOMY FUND, services professionnels, de l’aide et de
SIMILAR TO AN INSURANCE, WHICH WILL BE USED TO l’assistance dispensés à domicile et hors
PAY THE COSTS OF CARE AND PROFESSIONAL SERVICES institution. Compte tenu du vieillissement de
la population, il faut prévoir une augmentation
(NURSING CARE, NUTRITIONISTS, REHABILITATION,
relativement importante de ce groupe de
PSYCHOSOCIAL SERVICES), HELP WITH DAY-TO-DAY population et accorder une attention tout à
ACTIVITIES (SUCH AS WASHING, DRESSING, EATING) fait particulière aux services de longue durée
AND HELP WITH THE DAILY ACTIVITIES OF HOME LIFE à leur intention.”
(HOUSE CLEANING, PREPARING MEALS, SHOPPING, ETC.). The White Paper draws a summary of the
ex p e n s e s c o m m i t t e d to f i n a n c i n g
long-term programs, which were of
From the start, the White Paper uses a series of projections the order of $4.3 billion in 2011-2012, the last year for
to illustrate the urgency of the situation. It states that by which data is available. This envelope is divided as follows:
2031 the number of people aged 65 and over will have $2.9 billion allocated to the S outien à l’autonomie des
increased by more than 80%. More specifically, starting personnes âgées program (CHSLD, interim resources,
in 2026, people aged 85 and over will number 16,000 more home care services and other services), $869 million for the
people per year. It should be noted that the current annual Déficience intellectuelle et troubles envahissants du
average growth of this group is of 6,000 people. développement program, and $555 million for the Déficience
Physique program.
The problem evoked by the prevalence of disabilities is
illustrated with data extracted from the Québec Survey
on Activity Limitations, Chronic Diseases and Aging By the way, is it a fund or insurance?
(EQLAV), 3 conducted by the Institut de la statistique
Which is the right term? It’s difficult to choose since the
du Québec (ISQ) in 2010-2011 (see details on page 22). two terms are used concomitantly by the government. And
This data is used to evaluate the future needs of the population yet, it’s neither a fund, nor insurance.
insofar as long-term services are concerned.
In France, the term chosen is Caisse nationale de solidarité
pour l’autonomie ( CNSA) . Visit the FMSQ por tal at
fmsq.org for more information.
19
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No. 1
LSVous pouvez aussi lire
