LESPÉCIALISTE ACTIVITY-BASED FUNDING: A PANACEA? - FMSQ
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LE SPÉCIALISTE
LE MAGAZINE DE LA FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC
Vol. 15 no. 3 | September 2013
ACTIVITY-BASED
FUNDING:
A PANACEA?
DAY-TO-DAY
MYTHS AND
REALITIES
See text p. 36
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TABLE OF CONTENTS
Le Spécialiste is published 4 times per year by
the Fédération des médecins spécialistes du Québec. 7 PRESIDENT’S EDITORIAL
O Canada, in Canada
EDITORIAL COMMITTEE
Dr Harold Bernatchez ENGLISH VERSION
INTERNET ONLY 9 IN THE NEWS
Dr Karine Tousignant
Maître Sylvain Bellavance
Nicole Pelletier, APR
TO CONTACT US
EDITORIAL CONTENT
10 A WORD FROM THE VICE-PRESIDENT
Patricia Kéroack, c. w.
✆ 514 350-5021 514 350-5175 Unemployed medical specialists,
DELEGATED PUBLISHER ✉ communications@fmsq.org is it possible?
Nicole Pelletier, APR ADVERTISING
Director, Public Affairs
and Communications
✆ 514 350-5274 514 350-5175
✉ fcadieux@fmsq.org
11 FEDERATION AFFAIRS
RESPONSIBLE FOR www.magazinelespecialiste.com
PUBLICATIONS
Patricia Kéroack,
Fédération des médecins 12 DID YOU KNOW...
spécialistes du Québec
Communications Consultant
2, Complexe Desjardins, porte 3000
REVISION C.P. 216, succ. Desjardins 15 LEGAL ISSUES
Angèle L’Heureux Montréal (Québec) H5B 1G8
Priscilla Poirier ✆ 514 350-5000
GRAPHIC DESIGNER PUBLICATIONS MAIL
Dominic Armand Postal Indicia 40063082
ILLUSTRATION LEGAL DEPOSIT DOSSIER 16
(cover) 3nd quarter 2013
Jean Archambault Bibliothèque nationale du Québec ACTIVITY-BASED FUNDING:
L’Artefieor ISSN 1206-2081
A PANACEA?
ADVERTISING
France Cadieux
• T2A: the French Model 18
The mission of the Fédération des médecins spécialistes du Québec is to • Other Experiences Around the Globe 25
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
• Activity-Based Funding in Quebec:
following medical specialties: Adolescent Medicine; Anatomical Pathology; At What Cost? 28
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;
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
diseases; Medical Oncology; Neonatal-Perinatal Medicine; Nephrology; 32 GREAT NAMES IN QUÉBEC MEDICINE
Neurology; Neuropathology; Neurosurgery; Nuclear Medicine; Obstetrics and
Gynecology; Occupational Medicine; Ophtalmology; Orthopedic Surgery; Dr Brian Bexton, psychiatrist
Otolaryngology-Head and Neck Surgery; Pediatric Hematology/Oncology;
34 CONTINUING
Pediatric Emergency Medicine; Pediatric General Surgery; Pediatrics; Physical
Medicine and Rehabilitation; Plastic Surgery; Psychiatry; Radiation Oncology;
Respirology (adult or pediatric); Rheumatology; Thoracic Surgery, Urology and
Vascular Surgery. PROFESSIONAL EDUCATION
All pharmaceutical product advertisements are previously approved by the
Pharmaceutical Advertising Advisory Board (PAAB).
35 PROFESSIONALS’ FINANCIAL
36 SOGEMEC ASSURANCES
The authors of signed articles are solely responsible for the opinions expressed
therein. No reproduction without previous authorization from the publisher.
THIS EDITION’S ADVERTISERS: 38 L’ÉDITORIAL DU PRÉSIDENT
Ô Canada, au Canada
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•
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Groupe Conseil Multi-D
37
40 5
vol. 15
no. 3
LS
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ÉDÉRATION
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PRESIDENT’S EDITORIAL
DR GAÉTAN BARRETTE
O Canada, in Canada
So, why don’t we have a conversation about this big country? In this period of emotional identity
crisis, isn’t this a good idea? Especially since the FMSQ was invited by the Quebec Medical
Association (QMA) to be present at the Annual Meeting of the Canadian Medical Association (CMA)
held in Calgary in August.
F
irst, a few words about the people. Nice, very welcoming, Unfortunately, starting off with an erroneous statement of fact can
very proud of their work, not at all pretentious in spite of their devolve into a very dangerous game. Such an observation leads
wealth. “We worked hard to get to where we are,” we heard directly to proposing a reduction in the number of acceptances
them say. “We” as in “the population of Alberta.” They are right. into medicine. These were exactly the same observations we heard
Especially since we also benefit from it! here at the beginning of the 90s. We know what happened as a
result. We’ve discussed it previously among ourselves. But rational
So much for our hosts. But the CMA covers all of Canada, Quebec planning does exist in Quebec, and we all collaborate. Yes, there
as well as the ROC. Never has this difference seemed so large to us. are a few specialties where full employment seems to be at hand.
Let’s look at two subjects bitterly debated: medical unemployment But not medical unemployment. It’s a shame that the “Canadian
and end-of-life care. national experts” are not bilingual.
First, medical unemployment. In English, the topic was “medical Then, we assisted at another “strategic debate” on end-of-life care.
underemployment” and it was the subject of a strategic debate What we witnessed was an extremely high level of artistic... skating!
session. At the CMA, such a debate leads to a vote on one or more First off, there was the opening speech, which is always given by
resolutions that form the basis of positions that are then defended the federal Minister of Health. This year, the speaker was Madam
by the CMA. To launch the debate, the CMA had invited a speaker Rona Ambrose, herself originally from Alberta. She knew that the
introduced as an expert on the issue. Imagine the scene. In his subject would be addressed later and, before even being asked, she
mid-forties, he declares having been interested by the matter since stated her position clearly: no to assisted suicide! Exit the debate
his residency and, for this meeting, to have surrounded himself with on end-of-life care, focus on assisted suicide! Later on, there was
a multitude of experts to analyze and account for the pan-Canadian the debate itself where everything was done to avoid the subject,
situation on this subject. What a surprise! From the start of his to even say the name out loud. And so, the discussion veered to
presentation, we heard him affirm, with insistence, that nowhere palliative care. As long as they were at it, it was even suggested
in Canada - yes, your eyes haven’t deceived you - nowhere had that a palliative care specialty in family medicine be instituted. One
there been any evaluation or planning for medical manpower of the good doctors from the ROC compared Quebec’s Bill 52 (see
commensurate with the needs of the population and, worse yet, page 9) to supervised injection facilities and stated that medically-
that nowhere in Canada was there any mechanism aimed at assisted dying was just as immoral. You read it here!
ensuring the distribution of physicians throughout the territory!!!
The CMA meetings being very formal, the assistance of the QMA Later on, in a less formal session, Madam Chantal Hébert, a
was required to allow us to address the meeting and inform the media personality had been invited to talk about the subject. Very
so-called “Canadian national expert” that Quebec existed and that, politely, she explained that if they (the physicians) thought they could
in his Canada, there was a province, visible on the radar screen, avoid the debate, then they were wasting their time because, she
where, for more than 10 years, not only was all this being done, reminded them, they were there to serve the people and, on the
but that such projections were extended over the next 25 years!!! subject of end-of-life care, including euthanasia, the choice would
be made by the people.
In spite of everything, this brings up a very real political problem.
The problem surfaces when observations are deliberately biased. I was laughing. If I’d been in their shoes, I would have been
In the ROC, just as in Quebec, resident physicians are worried. In embarrassed to read André Picard’s reporting of these debates
the ROC, there are no PREMs, PEMs, etc. As a result, it’s a free in the Globe and Mail: “With doctors ducking the issue [...] That is
market in which all graduates try to find a position in downtown unsatisfactory, and it’s no way to show physician leadership. We
Toronto, Calgary or Vancouver. It’s even said that it makes for the trust doctors with our lives, and with our deaths. Physicians make
complete happiness of senior physicians in practice who want to tough decisions every day at the bedside. They should be willing
take six months off: candidates fight to determine who will replace and able to do so on the convention floor as well.”
the top guys and they have the competence to do it! However, this
is neither medical underemployment nor unemployment. It’s simply In any case, at the FMSQ, we have never been afraid of debates
refusal, avoidance. Because, one day, the whole territory will have and, when we take part, we say things as they are, whatever the
to be covered… right-thinkers may think! 7
vol. 15
no. 3
In all solidarity ! LS LS
Comparaison Québec – Canada, 2012
LES DIX RAISONS PRINCIPALES POUR LES VISITES AUX MÉDECINS EN 2012
QUÉBEC NOMBRE DE CONSULTATIONS (EN MILLIERS) : 74 992 CANADA NOMBRE DE CONSULTATIONS (EN MILLIERS) : 323 195
Hypertension 4 166 1 Hypertension 19 306
Bilan de santé 2 762 2 Bilan de santé 10 186
Diabète sans complications 2 433 3 Diabète sans complications 9 823
PUBLICITÉ
Dépression 1 739 4 Dépression 8 175
Anxiété 1 671 5 Anxiété 6 425
Hyperlipidémie 1 283 6 Surveillance normale de la grossesse 5 355
Infection aiguë des voies respiratoires 1 161 7 Infection aiguë des voies respiratoires 5 230
Trouble de déficite de l’attention 971 8 Hyperlipidémie 4 195
PLEINE PAGE
Otite moyenne 964 9 Oesophagite 3 866
Oesophagite 959 10 Otite moyenne 3 412
LES VINGT MÉDICAMENTS LES PLUS PRESCRITS EN 2012
TOTAL DES ORDONNANCES % VARIATION TOTAL DES ORDONNANCES % VARIATION
QUÉBEC EN 2012 (000S) 2011 À 2012 CANADA EN 2012 (000S) 2011 À 2012
SYNTHROID 8 303 5,6 1 SYNTHROID 14 788 7
CRESTOR 3 515 -25,2 2 CRESTOR 6 906 -39,1
D-TABS 2 587 44,2 3 APO-ATORVASTATIN 5 473 0,5
NEXIUM
PRO-AAS EC-80
LYRICA
IMS Brogan
2 182
2 154
2 146
-7,9
5,6
19,2
4
5
6
APO-FUROSEMIDE
COVERSYL
CIPRALEX
4 222
3 832
3 243
11,5
15,7
27
ATORVASTATINE 1 900 24,3 7 APO-HYDRO 3 179 -5,7
ATIVAN 1 634 0 8 ELAVIL 3 040 13,7
COUMADIN 1 497 -8,8 9 NEXIUM 3 023 -17,8
RATIO-ATORVASTATINE 1 454 154,7 10 TEVA-AMOXICILLIN 2 920 -16,9
PRO-METFORMINE 1 443 7,1 11 LYRICA 2 911 16,9
APO-ATORVASTATIN 1 431 -0,7 12 TARO-WARFARIN 2 890 5,9
COVERSYL 1 395 14,4 13 ATIVAN 2 849 0,9
SANDOZ-BISOPROLOL 1 283 -18,4 14 TEVA-VENLAFAXINE 2 836 61,7
AMLODIPINE 1 226 15,2 15 ZYLOPRIM 2 710 17,8
PMS-AMLODIPINE 1 159 13,1 16 CELEBREX 2 679 -1,9
CELEBREX 1 126 1,8 17 D-TABS 2 675 47,5
PANTOPRAZOLE 1 116 23,1 18 APO-SALVENT CFC 2 540 15,1
ELAVIL 1 106 47,3 19 VENTOLIN HFA 2 530 -10,8
ALESSE 1 102 5 20 ELTROXIN 2 464 -1,5
Source : IMS Brogan et l’Index canadien des maladies et traitements.
POUR DE PLUS AMPLES RENSEIGNEMENTS : 1-888-400-4672 | www.imsbrogan.com
Une importante source d’information, d’analyse et de consultation pour les secteurs de la santé au Canada
IN THE NEWS
On the Political Front
FROM QUEBEC’S NATIONAL ASSEMBLY FROM THE HOUSE OF
Fall will be quite busy on Quebec’s parliamentary scene. The National COMMONS IN OTTAWA
Assembly will resume work on Tuesday, September 17, and we already know There has been a reversal of the situation with regards
that two important consultations will take place during the fall. To start with, to C-377, the controversial bill piloted by Conservative
the Committee on Health and Social Services will hold public audiences on MP Russ Hiebert, aiming to force union organizations
Bill 52, an Act respecting end-of-life care. The FMSQ was invited to attend in to make public a slew of information on their activi-
view of its interest and implication in the subject, as the Federation was the ties, in particular the names of beneficiaries of any
first physician organization to publicly comment on the question of Dying With transaction of $5,000 or more and any salary paid in
Dignity. It must be recalled that Véronique Hivon, Minister for Social Services excess of $100,000. Tabled on December 5, 2011, the
and Youth Protection, proposed this bill on June 12th. After this first round of bill, having left the House of Commons and already
consultations, the bill will undertake its legislative process. having passed the stage of first reading in the Senate
in December 2012, has finally been substantially
Another consultation to keep an eye on will deal with the white paper on the modified by the adoption of a series of amendments
creation of an autonomy insurance plan which was made public last April 30th on third reading, supported by a majority of Liberal
by the Minister of Health and Social Services, accompanied by the Premier. senators and 16 Conservative ones.
The government intends to submit a bill that it would like to see adopted
before the end of the current year. What remains to be seen is the welcome The bill was thus adopted as modified by the Senate
this white paper, and the legislative bill that would eventually follow, will garner on June 26th and must, de facto, return to the House
from opposition parties, who have the majority. The FMSQ will surely makes of Commons. Two options are then possible: either the
it position known when the time comes. House of Commons adopts the bill as amended by
the Senate or it modifies it again, in which case it will
With each parliamentary session carrying its load of bills, the Federation is have to be returned to the upper chamber. Bill C-377’s
constantly on the alert for any health-related issues. saga will continue when parliamentary work resumes.
S
L
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est dorénavant de 300 $ dans toutes les municipalités. Un candidat pourra en outre verser, pour son bénéfice ou celui de son parti,
une contribution supplémentaire n’excédant pas 700 $ pour l’exercice financier de l’élection.
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Transparence
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du Québec
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vol. 15
LE SPÉCIALISTE no. 3
LS
Demi-page horizontale — 7” x 4,5”
A WORD FROM THE VICE-PRESIDENT
DR DIANE FRANCŒUR
Unemployed medical specialists,
is it possible?
A nitty-gritty subject in the news, fed into from all directions, medical unemployment is on the
program for Canadian medical organizations. The topic was even part of the proposals at the
146th Annual Meeting of the Canadian Medical Association in Calgary. Should we be worried?
Quebec is the only province with rigorous medical manpower plans Should part-time work be allowed? This issue, generating a lot of
(PEMs) which were implemented in cooperation with the medical emotion, will be dealt with calmly in little doses. No one wants us
federations and the department of health and social services to find ourselves with a shortfall from one day to the next, or with
(MSSS). A necessary evil or making managers responsible, the a surplus if all these “part-timers” were to return to work full-time.
opinion varies according to whether one is a citizen of a remote The loss of expertise in specialties with a significant technical
region or a physician at the end of his or her residency who wants component is a reality: one must see patients to retain one’s skills.
to set up in downtown Montreal... Times have changed a lot, but Simulations are not enough to allow us to preserve all our reflexes.
we had to act before finding ourselves in the same situation as At present, the MSSS gives permission much more easily than
our colleagues in the other provinces of Canada where those before, for the pairing of physicians at the end of their careers
who are finishing up their residency take up one fellowship after with newcomers, and this for a period that is much less difficult
another while waiting for a white-haired colleague to give up his to accept than the traditionally obligatory year, which was the
place downtown. rule previously. Evidently, when these files are well prepared and
when population needs justify it, it is a lot easier for us to defend
We don’t have this problem with regard to those who are finishing our members.
up their residency in Quebec. However, the grass is not all that
green in “la belle province”! On the one hand, the deployment of YOUR AFFILIATED MEDICAL ASSOCIATIONS
technical platforms announced for Montreal’s outlying suburbs
(area code 450) did not materialize and, on the other, the issue of MUST KNOW YOUR PRESENT AND FUTURE
extra fees makes newly graduated physicians leery of setting up a NEEDS FOR THE MEDICAL MANPOWER
practice to perform procedures, especially when the current health PLANS FOR 2016-2020 ON WHICH WE
minister seems to be tempted by discounted financing. And yet,
WILL START WORKING IN THE FALL.
recent history has shown (as exemplified by the medically-assisted
procreation issue) that when they are adequately financed, medical
clinics can offer services and procedures without limits, contrary In association with certain other medical associations, we have
to hospitals, thus contributing to shorter waiting times. even reduced the number of positions in residency to avoid
creating unemployed physicians. Residents have been clearly
Another reality that limits access for new graduates: physicians advised to reserve their positions and to start the process early
who put off their retirement thus keeping their PEM and their during training especially in certain regions where their notices
technical platforms. Unfortunately, the economic highs and lows of conformity take an eternity to get there. They have also been
in recent years have also strongly inspired them to keep in shape warned that they can’t take off like kamikaze pilots into fellowships
and continue to work! without having organized their PEM beforehand... otherwise they
might have to learn English upon their return. Exceptions to addi-
So, what are we going to do with all these graduating residents? tional training are far from automatic and an impressive curriculum
The latter have suggested that we reduce the number of students vitae does not open all doors without fail. We are also working on
in medicine. After long discussions with representatives of the a concrete definition of “full-time equivalent”, since the one based
universities and of the MSSS, we cannot support this proposal. on revenue alone is obsolete: certain obligations, like on-call duty
It takes 10 years to train a medical specialist. The feminization of and involvement with hospitals, are included in this package.
the medical profession has brought about changes to the profile
as much for men as for women of all generations. We need more Be assured though: there are no unemployed specialists on the
physicians now to do the same work as before. Young physi- horizon, but we will keep a careful watch! Being without access
cians refuse to settle alone in remote areas. And, by the way, they to technical platforms in spite of long waiting lists is much more
stay longer when on-call schedules are less demanding, which worrisome in this period of reductions and it can represent a form
is reflected in service cut-backs that are much rarer these days. of disguised unemployment.
10
vol. 15 LS
no. 3
LSFEDERATION AFFAIRS
The respite that makes a difference
What would you pay for a restored smile? What is a good night’s sleep worth? For many people,
happiness does not have a price... cannot be bought... can only be given! It’s been more than
a year now since the FMSQ, through its Foundation, has warmed the hearts of thousands of
caregivers and care receivers. The bottom line of medical specialists’ involvement in this cause is
incredibly significant.
On April 23, 2012, the day on which its activities officially started, CAREGIVERS IN QUEBEC
the FMSQ Foundation (FFMSQ) donated an initial amount of More than a million individuals in Quebec dedicate themselves totally
$100,000 to The Brome-Missisquoi Caregivers Support Group to to supporting someone close to them who suffers from temporary
complete the interior and exterior installations of Maison Gilles-Carle, or permanent disability as a result of an illness, a handicap, an
in Cowansville. accident or a degenerative disease. One person out of seven is
likely to be a caregiver to a loved one or a neighbour.
During this first year, the Foundation came
to the aid of respite organizations that had With its Foundation, the FMSQ salutes
qualified in one or the other of the targeted At the time we took this vacation, the important role of those who are,
categories: either to maintain a respite our son […] wasn’t doing well. He in some fashion, the extension of
service or to create new ones; to improve, the professional resources of the
renovate or even procure installations that
had his 17th birthday in August healthcare system. Without them,
were essential to the well-being of their and was in full crisis […]. We were a large section of society would be
users. The Foundation started the year 2013 tired out and at the end of our rope. deprived, even to the point of despair.
with the same energy. “Caregivers act in such complete
selflessness that they forget to take
The Foundation receives requests from all over the Province. For time for themselves, to rest, to the point of neglecting their own
each of these, a complete file was compiled: decisions were made health. We have to realize that without them the public healthcare
based on solid grounds. The Foundation makes sure that each system would not be up to the task of looking after the most vulne-
dollar invested is in fact spent to allow some respite and make a real rable members of our society,” says Dr Barrette.
difference in the lives of caregivers. Each organization receiving aid
from the Foundation undertakes to provide a rendering of accounts We wish to remind you that the FMSQ Foundation is a charitable
until the end of the project. organization, recognized under the Income Tax Act, whose objective
is to support the cause of caregivers in Quebec. It has set aside
Projects varied greatly from one organization to another: relaxation an annual budget of $1 million taken directly from the FMSQ’s
workshops for exhausted caregivers, short-term respites with or regular budget.
without sleepovers, activity days for care receivers or caregivers,
purchase of specialized furniture or equipment for respite centres, Organizations wishing to apply for financial support can look up
drop-in centres for caregivers and care receivers, etc. the section of the FMSQ portal (fmsq.org/fondation) dedicated
to the Foundation. This section contains all the details, eligibility
In total, the Foundation has financially supported some thirty orga- criteria, documents required, terms and conditions for presenting
nizations to make their respite activities a reality. a request as well as the application form.
LAC-MÉGANTIC: A BIT OF RESPITE AFTER THE DISASTER
July 6, 2013 will forever remain a black day in the history of Quebec maintain the pain associated with the loss of loved ones. The
as a whole, but in particular in that of Lac-Mégantic, because of the signers asked instead that a dignified and pacifying memorial be
train accident that caused considerable and irreversible damage. built in memory of those who disappeared.
Hand-in-hand with their colleagues in general practice, the medical
As for the FMSQ, right from the start, the FMSQ Foundation took
specialists working in the region all signed a letter asking municipal
steps to come to the aid of relief organizations in the immediate
authorities not to authorize the reconstruction of train lines within
region so as to identify their needs. Responding to the Foundation’s
the perimeter of the city and to prevent the construction of housing
invitation, the organization Les Soupapes de la Bonne Humeur
near any future train tracks that would bypass the urban area. The
proposed two respite projects within the scope of their organi-
medical specialists who were signers include Denys Breton and
zational capacity in the circumstances. Some thirty families were
Paul E. Paradis, general surgeons; Yves Marmen, radiologist;
thus able to take advantage of moments of respite thanks to the
Adrian Pusca and Wadith Pierre Saad, internists.
Foundation’s contribution.
Their letter was submitted to the municipal council meeting on
Moreover, medical specialists were invited, in particular by their
July 17th from the perspective of social and preventive medicine
respective medical associations, to give generously to the fund
11
– the signers wanting to avoid other accidents, but also invoking
raising organized by the Red Cross.
the opinion that the presence of train tracks would awaken and
vol. 15
no. 3
LS LSDID YOU KNOW...
PRIZES, AWARDS AND NOMINATION
AMPQ AWARD DOUBLE RECOGNITION FROM THE AMERICAN
Dr Pierre Vincent, who works at the Institut SOCIETY OF HYPERTENSION
universitaire en santé mentale de Québec, The American Society of Hypertension has honoured one of its
received the Heinz E. Lehmann Prize for oldest members, Dr Ernesto L. Schiffrin, Physician-in-Chief
Excellence in Psychiatry from the Association of the Jewish General Hospital in Montreal, by naming him the
des médecins psychiatres du Québec. This 2013 ASH Distinguished Scientist and conferring on him the
prize was presented to him to highlight his Robert Tigerstedt Award, in remembrance of the physiologist-
exceptional contribution to the advancement researcher known for his discovery of the renin-angiotensin
and reputation of psychiatry. system. Dr Ernesto L. Schiffrin has dedicated a great portion
of his career to research on the renin-angiotensin-aldosterone
AMEQ AWARD system and hypertension.
Dr Jana Havrankova, an endocrinologist in
practice in Saint-Lambert has been named CHU SAINTE-JUSTINE AWARD
endocrinologist emeritus in 2013 by the On the occasion of the Gala reconnaissance, the Prix Sainte-
Association des médecins endocrinolo- Justine was presented to Dr Normand Lapointe, a pediatrician,
gues du Québec. She received this award in recognition of the work he has done with women and children
in recognition of her commitment throughout affected by HIV. Since 1988, Dr Lapointe has dedicated a large
her career. part of his professional activities to the development of the Unité
hospitalière de recherche, d’enseignement et de soins sur le
HEART RHYTHM SOCIETY AWARD SIDA (UHRESS) at the CHU Sainte-Justine of which he is still
Dr Stanley Nattel, a cardiologist and the co-director.
director of electrophysiological research at
the Montreal Heart Institute Research Centre In addition, Doctors Arielle Lévy, a pediatrician; Andrée
has received the 2013 Founders Lectureship Sansregret, a gynecologist and obstetrician; France Gauvin,
Award from the Heart Rhythm Society. The a pediatrician; Sandra Lesage, an anesthesiologist; Nancy
distinction honours the scientist who has Robitaille, a pediatric hematologist and Géraldine Pettersen,
contributed in a unique and significant a pediatric intensive care specialist, received the Prix Excellence
fashion to the field of heart rhythm. Innovation. This prize recognizes the excellence and innovative
nature of care given to mothers and children. The group not only
evaluated the application of a protocol for massive hemorrhaging
920 boul. Maisonneuve Est via a simulation in an interdisciplinary team, but was also able to
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En choisissant un hôtel Jet-Set de Vacances TMR, vous bénéficiez DOCTORS WITHOUT BORDERS
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Dr Joanne Liu, a pediatrician at Sainte-
• Stationnement à l’aéroport au Valet • Transferts privés à destination Justine University Hospital Centre has
Parking de Park N’ Fly (Montréal) et • Meilleure localisation à l’hôtel accepted the position of President of the
au Self Park (Ottawa) sélectionné
• Accès au salon VIP à l’aéroport de • Excursion gratuite à destination humanitarian aid organization known as
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vol. 15
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no. 3
LSDID YOU KNOW...
8TH EDITION OF
ARMAND-FRAPPIER FOUNDATION OF INRS THE MEDICAL FEDERATIONS’ GOLF
UNIVERSITY AWARD TOURNAMENT
Dr Jacques Montplaisir, IN AID OF THE QUEBEC PHYSICIANS’ HEALTH PROGRAM
a psychiatrist and the
founding director of the
C e n te r f o r A d v a n c e d This annual edition of the Medical Federations’ Golf Tournament, the 8th one,
Research in Sleep in aid of the Quebec Physicians’ Health Program which took place at Le Mirage
Medicine ( CARSM ) at Golf Club, amassed a total of $117,000. Close to 125 participants took advantage
Hôpital Sacré-Cœur in of a beautiful day to meet their colleagues in this magnificent environment and
Montreal was awarded the 2013 Bell Award to compare their golfing talents.
of Excellence in Health for the CARSM. This The organizers wish to thank sponsors, participants, donors as well as everyone
state-of-the-art research centre was created who made this day such a great success.
in 1977 by Dr Montplaisir. The date for the 2014 edition will be decided upon shortly.
WOMAN OF MERIT AWARD FROM THE YWCA
IN QUEBEC CITY
Dr Marie Plante, an onco-
logical gynecologist at the
Photo: Édith Prudhomme
CHU de Québec is the
Photo: Judith Gauthier
winner in the Women of
Merit contest, in the Health
categor y. This contest
seeks to promote women
who transform their environment and distinguish From left to right: Mr Christopher Lemieux from the Fédération médicale étudiante du Québec;
themselves through their commitment, leader- Dr Louis Godin, President of the Fédération des médecins omnipraticiens du Québec; Dr William
Barakett, President of the Quebec Physicians’ Health Program; Dr Charles Dussault, President
ship, creativity and determination. Dr Plante of the Fédération des médecins résidents du Québec, and Dr Gaétan Barrette, President of the
took an active part in the development of the Fédération des médecins spécialistes du Québec.
radical trachelectomy.
SOCIÉTÉ QUÉBÉCOISE DE RHUMATOLOGIE
AWARD
Dr Jean-Pierre Pelletier,
a rheumatologist, and
Johanne Martel-Pelletier,
P h . D., b o t h r e s e a r-
Photo: Judith Gauthier
chers at the Centre de
recherche du CHUM, have
jointly received the 2013
Roger Demers Prize at the 44th Laurentian This year, it was the FMSQ foursome who won the Tournament honours. The trophy was presented
Conference of Rheumatology. This award by Dr William Barakett to the foursome: Dr Roger Grégoire, Dr Raynald Ferland, Me Sylvain
seeks to highlight their exceptional contribu- Bellavance and Dr Serge Legault.
tion to their area of research.
THANKS TO OUR SPONSORS
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13
vol. 15
the disease, from symptoms to treatment by
way of diagnosis, prevention and research.
S
L no. 3
LSVendredi AU PROGRAMME CETTE ANNÉE
15 novembre 2013 • Chirurgiens et anesthésiologistes : • Tumeurs de la base du crâne : controverses
ACTIVITÉS CONJOINTES
plus que des partenaires obligés et nouveautés
PALAIS DES CONGRÈS Session associative : chirurgie générale et Session associative : endocrinologie,
DE MONTRÉAL anesthésiologie neurochirurgie, ORL, pathologie,
radio-oncologie et radiologie
• Altérations de la flore intestinale et
• Le plus gros congrès annuel de de l’immunité : C. difficile, mais pas • Comment gérer les complications chez
médecins spécialistes au Québec impossible ! les enfants munis de sondes alimentaires
Session associative : gastro-entérologie, entérales, de trachéostomies et de cathéters
• Créée par la FMSQ en 2008 microbiologie et infectiologie veineux centraux
Session associative : chirurgie générale,
• Ouvert à tous • Les troubles du sommeil : quand Morphée pédiatrie et pneumologie
relâche son étreinte
• Une occasion unique d’échanger Session associative : cardiologie, neurologie, • La maladie d’Alzheimer : mieux la comprendre
dans un cadre de DPC ORL, pneumologie et psychiatrie Session associative : gériatrie et neurologie
• Plus de 27 ateliers et sessions • Thérapies endovasculaires • Cessation tabagique : comment passer
associatives au programme Session associative : chirurgie vasculaire et à l’action
radiologie Session associative : pneumologie, psychiatrie,
• Récipiendaire du prix 2013 santé communautaire
• Les complications ophtalmologiques de
d’innovation des prestataires pathologies endocriniennes • Anaphylaxis and drug allergies : diagnosis,
de DPC (CRMCC) Session associative : endocrinologie et treatment algorithms, post-interventions
ophtalmologie studies and referral for work-up
after screening
EN PLUS : Session associative : allergologie et
immunologie clinique et anesthésiologie
• Allocution de Dr Gaétan Barrette (Présentation en anglais, diapositives bilingues)
pendant le lunch
• Cocktail de réseautage en
• L’expertise et le médecin spécialiste : • Les dix situations médico-légales les plus
présence du président
SESSIONS GÉNÉRALES
une longue carrière fait-elle de vous fréquentes de la pratique du médecin
• Remises de prix un expert ? spécialiste au Québec
• Pour éviter de faire la une du journal : • La planification de la retraite, à court
gestes de base en réanimation et à long terme - les aspects financiers
(tarification spéciale pour les conjoints)
• La polymédication ou l’optimisation de
INSCRIVEZ-VOUS DÈS la pharmacothérapie chez le patient • La planification de la retraite, à court et à
MAINTENANT EN LIGNE gériatrique long terme - les assurances, les aspects
fmsq.org/jfi • La lecture critique d’une étude
juridiques et les aspects psychosociaux
(tarification spéciale pour les conjoints)
randomisée contrôlée
• L’AVC et la fibrillation en 2013 : gestion
• Enhancing learning, advancing care :
pratique des nouveaux anticoagulants,
TARIF SPÉCIAL POUR INSCRIPTION the Royal College’s MOC Program
accent sur les situations urgentes
AVANT LE 15 OCTOBRE and Mainport Web Application
(English Workshop) • Suivre un médecin et rester zen…
Cette journée a été rendue possible grâce suivi de : un avant-goût du mieux-être
• Maximiser la section 3 du programme
à une subvention à visée éducative de : Maincert (3 crédits/heure) : comment • Les habiletés de gestion d’un chef de
autogérer et autoévaluer mon DPC département, suivi de : Leadership
médical : par son implication, le médecin
• La gestion du temps
hospitalier peut améliorer sa situation et
• iPad, iPhone et autres gadgets au service celle de ses patients
de notre pratique quotidienne
• Comment débuter sa pratique (Session
• La gestion du stress : pour le médecin, le conçue pour les médecins spécialistes en
stress est à la fois le mal et la potion début de carrière)LEGAL ISSUES
A major investment
BY MAÎTRE SYLVAIN BELLAVANCE
Director, Legal Affairs and
Negotiations – FMSQ
A survey was sent out to all medical specialists in 2012 in order to The next two activities are also covered for all medical
collect more information on the extent of physician participation specialists participating:
in the organization of hospitals. This information was used to • Academic meetings during which a medical subject is
negotiate three new agreements on remuneration representing discussed within the framework of a formal presentation;
a total investment of $140 million annually. • Reading clubs during which an article published on a
medical subject of interest is discussed.
We wish to provide you with certain details on these agreements
which will take effect starting on January 1, 2014. The full text These activities must be announced via a formal invitation and be
of these agreements will be sent to you during the fall, along the subject of an agenda. A record of attendance is also required.
with additional information on the conditions of their application.
3. MULTIDISCIPLINARY CLINICAL MEETINGS
1. MEDICAL ADMINISTRATIVE ACTIVITIES Meetings called to discuss clinical cases and in which at least
A first Memorandum of Agreement deals with the remuneration two other healthcare professionals from another specialty take
of medical specialists who take part in the following meetings part are included.
in their institution:
• Unit, department or client-program meetings; Participation in these meetings must be in person and in the
• Meetings of various committees set up in the institution. institution. Again, a certain level of formality is required since an
A complete list of more than 70 committees has been invitation and an agenda for the meeting must be sent out and
identified (such as morbidity, pharmacology, discipline, discussion notes must be compiled and included in the patient’s file.
operating suite, etc.).
This measure is not available for psychiatrists nor for anatomical
In order to qualify for remuneration, the following conditions must pathologists who already benefit from similar measures. It is also
be met: not possible to benefit from it for tumour clinics nor for certain other
1- Only participation in the meeting is remunerated, not types of meetings listed in the Memorandum.
preparing for it;
2- Presence must be in person, not via telephone conferencing; REMUNERATION FOR THESE ACTIVITIES
3- Only specific unit, department, or committee members All of these activities will be remunerated at an hourly rate or
can be remunerated along with physicians who have been according to an equivalent act code. The rate is $150 per hour
invited to attend; starting on January 1st, increasing to $175 per hour on April 1,
4- The meeting must take place within an institution, be 2014 and to $200 per hour on April 1, 2015. Any activity must
announced via a formal invitation and be the subject of a last for at least sixty continuous minutes, otherwise it is
written agenda; not remunerated.
5- Attendances must be recorded and minutes must
be consigned. Specific conditions apply to physicians who benefit from lump-sum
remuneration, including physicians receiving mixed remuneration
This Memorandum does not, however, apply to physicians who as well as physicians working in medical biochemistry or in
are acting as heads of units, departments or client-programs microbiology and infectious diseases. These receive – in addition
as they will be remunerated by way of another Memorandum of to the payment, if applicable, of their per diem or share –, a
Agreement which is presently being negotiated and which we remuneration that is equivalent to 50% of the hourly rate applicable
expect to finalize during the fall. for activities taking place between 7 a.m. and 5 p.m., from Monday
to Friday. Outside of this period, the full hourly rate applies.
2. TEACHING ACTIVITIES
The current Memorandum of Agreement remunerating clinical In order to take into account the overall budget allocated to the
supervision activities will be modified to include the following remuneration of these new measures, the following maximum
academic activities: annual number of hours, per medical specialist, is payable
• Dispensing courses or presentations, other than courses on according to the activity involved:
the university curriculum; • Unit (20), department (20) or client-program (25) meetings;
• Teaching students by way of apprenticeships in • Meetings of a pharmacology committee (20), a CMDP board
clinical reasoning; meeting (45) or any other type of committee involved (10);
• Teaching via simulation; • Academic meetings (25);
• Evaluations based on the OSCE method. • Reading clubs (15);
• Multidisciplinary clinical meetings (40).
With the exception of teaching via simulation and OSCE, these
activities must take place within a healthcare institution. These measures seek to recognize the role of medical specialists
in hospital organization and in teaching and to remunerate them
appropriately. It’s up to you to take advantage of them.
15
vol. 15
no. 3
LS LSDOSSIER
ACTIVITY-BASEDFUNDING:
A PANACEA?
16
vol. 15
no. 3
LSACTIVITY-BASED
FUNDING:
A PANACEA?
In its 2012-2013 budget speech, the Charest government
announced its intention of improving the organization of
health services and to distribute resources more equitably
by implementing activity-based funding (ABF) in the
Quebec health and social services network, a model
already in use in various countries, including France.
An Expert Panel on Activity-Based Funding was set up in
order to provide some thoughts on the matter. The group
began working at the end of the month of April 2012. The
Marois government reviewed the name and mandate of the
panel, which became the Expert Panel for Patient-Based
Funding, during the budget speech in April 2013. The panel
of experts’ report is expected at the end of 2013.
The possible adoption of such a mode of funding would
in essence affect activities that take place in a hospital
centre. Physicians - mainly medical specialists – would
be directly involved, at several levels. The implementation
would require that physicians, who are at the heart of the
delivery of care and services, be a party to a possible
implementation process, both before and after.
In this dossier, we are presenting an overview of the various
forms of activity-based funding repertoried around the
world. We are also providing extracts of the white paper
submitted by the FMSQ to the group of experts who are
mandated by the government.
SEVERAL NAMES, SAME PRINCIPLE
Whether it’s called Tarification à l’activité (T2A) in France,
Prospective Payment System (PPS) in the United States,
Payment by Results (PbR) in Great Britain, Activity-Based
Funding (ABF) in Canada, the principle behind the funding
of activities consists essentially of granting health care
institutions the same lump-sum payment for a given
type of stay. Each patient is classified according to his
or her pathology and type of stay which are inventoried
in an overall classification. To each category of stay
corresponds a pre-determined fee.
Editor’s Note: This dossier includes extracts of a report on research and of a
white paper prepared by the FMSQ. The latter were prepared on the basis of a
large volume of documentation. Because of their pertinence and the quality of
the information they contain, complete passages of certain works are reproduced
or adapted for editorial reasons. We thus wish to ensure that the comments and
observations made by these authors are as true as possible to the originals. We
offer our thanks to them.
17
vol. 15
no. 3
LSBY RICHARD-PIERRE CARON
Senior Consultant
Public Affairs and Communications – FMSQ
T2A: the French Model
Of all the activity-based funding models implemented in various countries, that of France is of
particular interest, as it has relatively recently come into effect and its implementation is not
yet complete. The transition between the old and the new model of budgetary allocation was
put into effect some four years ago and this was not done without a few stumbles, since it
generated its load of problems and pernicious effects, and is still doing so.
In December 2011, close to eight years after the introduction THE MECHANICS
of activity-based funding for a few sectors, the Assessment T2A only applies to and covers 3 types of activities: medicine
and Monitoring Mission for the Laws Governing Social Security (M), surgery (C for chirurgie) and obstetrics-gynecology
(Mission d’évaluation et de contrôle de la sécurité sociale (O) (giving rise to the acronym MCO).
or MECSS), an emanation of the French Senate’s Social Affairs
Committee, decided to launch a reflection on the subject Hospital stays considered sufficiently similar from a medical
because of the numerous irritants generated by this funding and economic point of view are grouped together into homoge-
model. On July 25, 2012, the MECSS published its report.1 nous groups of patients (groupes homogènes de malades
or GHMs).
AT THE BEGINNING
Up to 1984, public and private non-profit healthcare institutions Based on analytic accounting data collected in volunteer
were funded by daily rates. Starting in 1984, these amounts institutions – a sampling involving only 9% of MCO stays in
were replaced by a global allocation that almost automatically hospital centres and 5% in clinics – the Technical agency for
renewed budgets year after year. If such a system allowed hospital information (Agence technique de l’information
a control of expenses, it still presented some major inconve- sur l’hospitalisation or ATIH) calculates the average cost
niences: failure to act and hospital activities not adapted to the per stay for each of these GHMs. On the basis of this costing
needs of healthcare. scale, taking into account public health
objectives and the orientation of case
Starting in 1991, a first reform (in search of transparency, management methods, the Department
equity and efficiency) implemented an analysis tool to study of Health developed a fee grid for the
medical activity and medical processes within institutions: homogenous groups of stays (groupes
the Program for the Medicalization of Information Systems homogènes de séjour or GHSs) as
(Programme de médicalisation des systèmes d’informa- the financial counterpart of the GHMs.
tion or PMSI). Institutions had to deploy information systems Normally, each GHS corresponds to
taking into account pathologies and case management methods a GHM.
to improve knowledge, evaluate activities and their costs to
improve the optimization of their offer of care. The number of patient groups varies a
great deal from one country to another.
The T2A architecture was developed There are 355 in Belgium, 698 in Ireland,
based on the PMSI, the informa- 983 in Sweden, 1020 in Finland, 1182 in
Credit: rubensoft.com
tion infrastructure. Germany, 1389 in England and 2318 in
France. Almost all the GHMs in France
Although it was announced in 2002, T2A have four levels of severity. Taken apart,
was introduced in public institutions and the French GHMs could be regrouped
in non-profit private institutions in 2004, into 600 roots, each divided into various
then in institutions for profit in 2005. degrees of severity.
France has joined the majority of Western countries who
have adopted the principle of fees, each corresponding to a
lump-sum payment per type of stay.
A BIT OF USEFUL INFORMATION
In 2010, France had 2,751 hospital facilities offering 427,000 beds for
complete hospitalization and 60,500 places for one-day hospitalization.
To be more specific, the public sector included 966 institutions; the private
non-profit sector had 1051 and the private for-profit sector, 734.
18
vol. 15
1
Le Menn J and Milon A, Senators. Rapport d’information au nom de la mission
d’évaluation et de contrôle de la sécurité sociale de la Commission des affaires Source: Le panorama des établissements de santé - édition 2011. Direction de la
recherche, des études, de l’évaluation et des statistiques (DREES)
sociales sur le financement des établissements de santé. Paris: Senate,
no. 3
LS July 25, 2012.Vous pouvez aussi lire
