LESPÉCIALISTE Is an Aging Population More Costly to Our System? - 2010, FMSQ
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LE SPÉCIALISTE
LE MAGAZINE DE LA FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC
Vol. 13 no. 1 March 2011
Is an Aging
Population
More Costly
… to Our System?
2010,
une autre
bonne année…
grâce à vous !
voir texte p. 37
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Summary
LE SPÉCIALISTE IS PUBLISHED 4 TIMES PER YEAR BY THE 7 WORD FROM THE PRESIDENT
FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC
Conceit, Disinformation in a Snow Job
8 LEGAL ISSUES
EDITORIAL COMMITTEE PRINTING
Dr. Bernard Bissonnette Impart Litho
Dr. Raynald Ferland
Dr. Diane Francœur CIRCULATION The FMSQ Appeals CPM Decision
10 IN THE NEWS
Maître Sylvain Bellavance 13,200 copies
Nicole Pelletier, APR, director
TO JOIN US
Patricia Kéroack,
EDITION
12 DID YOU KNOW...
communications consultant
Telephone: 514 350-5021
DELEGATED PUBLISHER Fax: 514 350-5175
Nicole Pelletier, APR E-Mail: communications@fmsq.org
16 FOLLOWING DECEMBER’S EDITION
PUBLICITY
RESPONSIBLE FOR Telephone: 514 350-5274
PUBLICATIONS Fax: 514 350-5175
Patricia Kéroack E-Mail: fcadieux@fmsq.org
www.magazinelespecialiste.com Haïti: The 1st Year
DOSSIER
REVISION Fédération des médecins
Angèle L’Heureux spécialistes du Québec
2, Complexe Desjardins, porte 3000 17
PRODUCTION ASSISTANT
Véronique Clément
C.P. 216, succ. Desjardins,
Montréal QC H5B 1G8
LE SPÉCIALISTE
LE MAGAZINE DE LA FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC
Telephone: 514-350-5000 IS AN AGING POPULATION MORE
Vol. 13 no 1 Mars 2011
GRAPHIC DESIGNER
Dominic Armand PUBLICATIONS MAIL COSTLY … TO OUR SYSTEM?
Mailing Indicia 40063082 Vieillir coûte-t-il
plus cher...
TRANSLATION • The Cost of an Aging Population 18
au système ?
Anne Trindall Legal Deposit
Annette Grimaïla 1st quarter 2011 • Your Opinion Please, Doctors 27
Bibliothèque nationale du Québec 2010,
une autre
bonne année…
grâce à vous !
PUBLICITY ISSN 1206-2081 voir texte p. 37
France Cadieux
29 GREAT NAMES IN QUEBEC
MEDICINE
All pharmaceutical product advertisement's have been approved by the
Pharmaceutical Advertising Advisory Board (PAAB).
CCAB audits the medical specialists and residents database
(11,219 copies audited for December 2010) The FMSQ also Dr. Michel Roy, Obstetrician-Gynecologist
30 CONTINUING PROFESSIONAL
distributes around 1,000 copies to Researchers and
Professors of the 4 Medical Faculties in Quebec, as well as managers and leaders
EDUCATION
of the Québec healthcare system.
The authors of signed articles are sole responsible for the opinions
expressed therein.
The Fédération des médecins spécialistes du Québec represents the following
Department Head - A Challenge for which Physicians are
specialties: Allergy and Clinical Immunology, Anesthesiology, Cardiac Surgery, Rarely Prepared
32 IN THE WORLD OF MEDICINE
Cardiology, Community Health, Dermatology, Diagnostic Radiology, Emergency
Medicine, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology
and Medical Oncology, Internal Medicine, Medical Biochemistry, Medical Genetics,
Medical Microbiology and Infectious Diseases, Nephrology, Neurology, Neurology,
Nuclear Medicine, Obstetrics and Gynecology, Ophthalmology, Orthopedics, Three-dimensional Navigation in Endoscopic
Otorhinolaryngology, Pathology, Pediatrics, Physiatry, Plastic Surgery, Pneumology,
Psychiatry, Radiation Oncology, Rheumatology and Urology. Endonasal Surgery
35 FINANCIÈRE DES
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40 MEMBERS SERVICES
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LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011 5
FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC
WORD FROM THE PRESIDENT
Dr. Gaétan Barrette
Conceit, Disinformation in a Snow Job
T
he worst thing that can happen to someone, especially a So, in three minutes, this delegate to the FMOQ board of
columnist or a broadcast moderator, is to realize that they directors confirmed that there are enough doctors in Quebec
have been duped for a long time. And, if it does happen, and that there is a problem with organization, he also managed
the person’s conceit will instantly push them to adopt a policy to denigrate family physicians’ office practice by describing it as
of “Omertà”, rarely to set things straight. easy work. He also confirmed that all this discussion was only
for negotiating purposes, since the other governments had
All of you will have understood that the campaign waged by the understood how to use income incentives.
FMOQ over the past several months was intended – and is still
intended – to manipulate public opinion. It worked very well until On Friday, February 11, I was invited to take part in Christiane
we intervened before Christmas, stating what the FMOQ failed Charette’s radio program reviewing the week’s news (hyperlink
to mention following the gains achieved during the last to this interview at www.fmsq.org). There was nothing special,
negotiations. We also commented on the fact that there is no denigration, but a reminder of facts. The FMOQ, outraged,
indeed a gap in the remuneration received by our two groups, asked for and obtained the right to respond on the following
but that there were obvious reasons for this. Monday. In line with the FMOQ’s new strategy, Dr. Godin did not
talk about gaps in remuneration but insinuated that the FMSQ
Since the beginning of this year, it seems that the FMOQ’s denigrated family physicians. Specialists and generalists agree
strategy has changed and that its representatives have now in the field; it is the leaders of the FMSQ – and me, primarily –
decided to attack me personally! When you don’t like the who do not understand. That’s it! Then, François-Pierre Gladu
message …. This doesn’t pose any problem as far as I am yet again (who was also present at the interview), went so far as
concerned! If you need convincing, however, just read the to say that I am against the specialty of family medicine (untrue).
words of François-Pierre Gladu, president of the Association He explained that medical specialists have only 2 or 3 years
des jeunes médecins du Québec, and a family physician more training than family physicians (untrue). They then said
himself, in certain print media renowned for their unstinting that feminization is the same everywhere (untrue) and that, in
loyalty to general practitioners. Quebec, family physicians work more hours providing direct
care to patients than specialists do (untrue).
Dr. Gladu is clearly off on a crusade. On January 6, the subject
of the “Maisonneuve en direct” radio program was the In this same interview, Dr. Godin explained that compulsory
umpteenth emergency room crisis. François-Pierre Gladu got hospital time is 12 hours … without being contradicted by his
on the program’s open line and made some particularly startling colleague Gladu. But, if the compulsory hospital time of 80%
statements. First of all, he insinuated that family physicians’ (according to Gladu) equals 12 hours per week (according to
problems are due to the fact (and I quote) “that for the past Godin), does that mean that a GP’s total work week is
17 years, all new family physician graduates are sent to 15 hours? This is a blatant manipulation of the public and
hospitals for 20 years … and spend 80% of their time journalists alike. A perfect snow job!
there”. That’s it! No full office practice before age 50. Stunned,
the program host asked him three times to repeat the Finally, reluctantly, Dr. Godin admitted that younger practitioners
statement “to make sure he had understood correctly”. And do not view medicine in the same way as their elders. That is
Gladu obliged! And, at the 29 minute 50 second mark, he went euphemistic, at the very least. During that time, the FMOQ
even further: “… and that is the main reason why, despite completely avoided mentioning time worked!
having enough doctors, Quebec has two million people with
no family doctor …”, continuing “…the situation is the same Truly Shakespearean! A rose by any other name…
throughout Canada, except that they have fewer doctors
than us and yet they manage to have well-staffed hospitals Faced with so much disinformation, and other even more
because of the simple fact that when work is more difficult devious tactics, we have no choice but to refute, correct, and
government pays a higher rate of income, but when the work reposition, even if it shocks the FMOQ and perhaps some of
is easier, they pay a lower amount. So, using incentives, they our own troops. The public health system will never function
succeed in staffing a thousand hospitals and also provide properly if all problems are swept under the rug or, even worse,
office services to the population …” Then, he lets one fly at taboo. And all physicians will suffer! If we take part in the
nurses, stating that specialized nurse practitioners (SNP) are debate today, we will have nothing to reproach ourselves with
just a hobby-horse of the Ordre des infirmières. if, in a few years’ time, the system is totally screwed up!
Yours in solidarity!
LS
7 LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011
LEGAL I SSUES
By Maître Sylvain Bellavance
The FMSQ Appeals CPM Decision
DIRECTOR, LEGAL AFFAIRS
In 2003, the Council for the Protection of Patients (Conseil pour upon the measures to be taken to meet the repeated attacks of
la protection des malades – CPM) instituted class action the Minister of Health at that time. It should be remembered
proceedings against the FMSQ because of the study days held that the Minister of Health had had a special Act passed during
in November and December 2002 and January 2003. The CPM the summer which assigned physicians to emergency room
asked the Court to “condemn the Federation to pay moral and duty using bailiffs. During the fall, the Minister tabled another
exemplary damages for each patient who, on one of these Act that, this time, attacked physicians’ professional
study days, should have received a therapeutic surgical independence and was likely to be prejudicial to patient care.
operation or presurgery examination related to such surgery, Supported by various medical associations in Quebec and the
and which was cancelled by the physicians because of the rest of Canada, as well as various members of the public, the
study days”. FMSQ deplored the Minister’s attacks and insisted that it was
instead important to attack the real problems undermining the
It was only in June 2010 that this case was finally heard by health system, including lack of accessibility for patients and
Justice Clément Trudel of the Montreal Superior Court. After the constant postponement of surgery.
deliberating for nearly six months, Justice Trudel finally handed
down his decision on December 9, 2010. As reported by the The Federation also provided evidence that the study days had
media, he rendered judgment against the Federation and been organized following consultation with the Collège des
condemned it to pay $4.5 million in damages, plus interest. On médecins du Québec in order to ensure that essential patient
January 10, 2011 the Federation appealed this judgment to the care was maintained, and that notice of the study days was
Quebec Court of Appeal. provided sufficiently in advance – i.e., before patients received
confirmation of surgery on these dates – in order to avoid
Let us take a look at the broad reasons for Justice Trudel’s cancellation by the hospitals insofar as was possible.
decision and also the various errors of law and of fact that the
Federation found he committed and which provide the reason The Federation pleaded that physicians had the fundamental
for the intervention of the Court of Appeal. As the case is still right to take part in these study days and did so in a
before the Courts, you will understand that I am unable to make responsible manner.
any comment for the time being and will limit myself to giving a
general summary of the judgment and the reasons for
appealing it. More specific information on both the decision and
Justice Trudel’s analysis of the situation
the Federation’s appeal can be found at www.fmsq.org. Following is my summary of the main conclusions reached by
Justice Trudel as part of his analysis of the facts and
circumstances surrounding the organization of the study days:
The position of the parties
In its action, the CPM claimed that the Federation had 1) Physicians must be diligent and be readily and reasonably
available to their patients. These two duties include an implicit
organized three days which were similar to a disguised strike reference to the obligation to keep their appointments and to be
and had deliberately encouraged its members to take part in punctual. In this context, physicians cannot absent themselves
them, resulting in the postponement of various surgeries. The as and when they neither wish, nor can they do so without a
CPM alleged that physicians had an obligation to keep valid reason. Since physicians provide hospitals with advance
appointments with their patients and that the Federation had, notice of their availability, once this process is under way
instead, induced them to disregard such obligations without physicians cannot cancel their commitments without a
valid reason.
any valid reason and had used various forms of pressure that
were not authorized by law. For these reasons, the Federation 2) Participation in the study days does not constitute a valid
should be responsible for the moral damages caused patients, reason for physicians not to keep appointments made by
plus interest. The CPM also asked that the Federation be hospitals on their behalf. The judge concluded that it was a
condemned to pay punitive damages, because it considered movement equivalent to a strike or work stoppage. Physicians
that patients’ right to dignity had been infringed. were certainly entitled to take part in the study days, but only to
the extent that they had no prior commitment to treat patients
whose appointments had already been arranged.
The Federation, for its part, provided evidence that the
organization of the study days fell within the framework of its 3) The study days were nothing other than concerted and massive
constituent powers and objects and complied with physicians’ work stoppages forming part of physicians’ strategy and union
ethical obligations – i.e., not to harm patients’ health and safety. tactics, a group violation of their duty to be assiduous and to
The Federation emphasized the fact that the days were honour commitments given. By taking part and cancelling
intended to inform medical specialists and agree with them patients’ appointments, physicians had committed a fault
under civil law for which they could be held responsible.
8 LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011
LEGAL I SSUES C SUIT ED
4) By inducing and encouraging physicians to take part in the 3) As to the Federation’s fault, the judge erred in deciding that the
study days, despite their professional commitments, the Federation had induced medical specialists to fail in their
Federation itself had committed a fault and must be held professional obligations since these had been observed in full
responsible for the damages resulting from its faulty action. and the physicians had not violated any contract or undertaking
Regardless of whether the Federation had consulted the contracted with their patients.
Collège des médecins or ensured essential services were
maintained, without the action taken Federation physicians 4) The judge also erred in failing to take into account the overall
would certainly not have absented themselves and that is the measures taken by the Federation in order to ensure, in
reason why the Federation must be held responsible. particular, that essential care was available, that the days were
notified in advance and that they complied with the
5) According to the judge, 10,000 patients had had their surgery requirements of the medical code of ethics.
or presurgery examinations cancelled and he awarded them
$250 each as moral damages, for a total of $2.5 million. 5) The judge ignored evidence submitted that the study days had,
in general, been called before patients’ operations were
6) The judge considered that physicians dealt with users of the confirmed, leading him to inflate without foundation the number
health system in an abusive manner, employing them as a of patients who had been subject to a cancellation of
means of pressure and as hostages in physicians’ confrontation their surgery.
with the government, and that the number of surgeries
cancelled or postponed demonstrated a deliberate infrin- 6) The judge also erred in his evaluation of the evidence regarding
gement of patients’ dignity. The judge therefore also awarded the number of presurgical examinations that had
an amount of $200 per patient as exemplary damages, for an been cancelled.
additional total amount of $2 million.
7) The judge erred in allowing the CPM to subsequently amend its
7) Lastly, the judge concluded that the Federation should pay claim in order to request an overall condemnation of
these amounts with regard to the class action. $7.5 million against the Federation, whereas the authorized
claim instead concerned an award of $1,000 per patient.
As you can see, it would be harder to find a more caustic
judgment against medical specialists and the Federation. 8) The judge also erred in concluding that all patients had suffered
an equal prejudice, whereas the evidence produced before the
Court demonstrated that, on the contrary, the situations
Filing of appeal experienced by the patients called as witnesses differed from
each other.
On January 10, 2011, the Federation appealed Justice Trudel’s
decision to the Quebec Court of Appeal. Both the Federation 9) The judge also erred in condemning the Federation to pay
and its legal counsel consider that the judgment is vitiated by exemplary damages on the basis that it had acted with the
numerous errors of fact and of law and the premises on which intent to violate the dignity of Quebec patients, whereas the
evidence instead shows that the Federation had put numerous
they are based are themselves erroneous.
measures in place to limit the impact of the study days on
Quebec patients.
Within its appeal, the Federation also points out that Justice
Trudel had, during the coordination of the action and 10) The judge also erred in granting the payment of legal interest for
throughout the proceedings, shown an unfavourable bias a period of seven years, whereas the Federation is not
towards it, resulting in him not considering the evidence responsible for the time that had elapsed between the filing of
presented by the Federation as a whole and not taking into the action and the hearing of the case.
account the representations made by Federation legal counsel,
11) The judge also erred in awarding damages with regard to the
the which contributed to the various errors committed. class action, since the evidence submitted does not establish
the total amount claimed by members of the group in a
A summary of the main reasons for the Federation’s appeal sufficiently accurate manner.
follows:
For all these reasons, the Federation asks the Court of Appeal
1) The judge erred on the scope of physicians’ duty to provide
to reverse the judgment handed down by Justice Trudel in first
care and their obligation to observe appointments already
set unless there were an emergency or any other reason instance and disallow the action brought by the CPM.
for exemption.
The appeal process means that the Federation must file a more
2) The judge spurned medical specialists’ fundamental rights of detailed brief setting out its reasons for appeal by the beginning
association and expression, and erred in deciding that of May 2011. The CPM will then have a period of 90 days to do
physicians had absented themselves without valid reason. The the same thing. The hearing before the Appeal Court can then
exercise of such rights by physicians, such as assembly and
be set; there is every indication that it will not occur before the
being heard, when employed in a reasonable manner and when
taking measures to ensure that emergency care is available, end of 2012 or during 2013.
cannot constitute a fault under civil law. L S
LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011 9
IN THE NEWS
The FMSQ Continues Its Offensive
PR Campaign
In 2010, the Federation hit a home run by launching a bold Les Docteurs
public relations campaign. This campaign had two distinct Since last fall, the Federation has agreed to sponsor a
goals: the first was to demonstrate that our government had Société Radio-Canada show called “Les Docteurs”, a
the means to exploit new ways to refill its coffers if it only had Quebec version of the American show “The Doctors”.
the political will; the second was to provide the public with a
better understanding of medical specialties. During its first season, advertising spots were shown with
the President of the Federation asking people to tell him
The first goal, “Expertise Has a Price”, ended in the spring whether the work of medical specialists had had a positive
of 2010. The results were conclusive: not only did the FMSQ impact on their lives. The Federation received dozens of
make a place for itself in the public debate, but some of the replies from patients and some were published on its Internet
measures it put forward were included in the Quebec Budget site (www.fmsq.org/lesdocteurs).
of March 2010 (royalties on water used in industrial
processes including water bottlers, a review of mining rights The second season has been on the air since the start
and generic drugs). of the year and patients tell, on screen, how their lives
have changed because of the intervention of a medical
The second goal, “Passionnés specialist. Apart from the 30-second message
pour la vie” (“A Passion for Life”), broadcast during the “Les Docteurs”, each complete
will continue until mid-March story can be seen via a microsite, developed to support
2011. This part of the campaign the campaign. This microsite (www.MonHistoireSante.com)
portrays 35 physicians from the reminds the public about the work performed by
35 medical specialties practised medical specialists and provides a link to all the
in Quebec. information available from the FMSQ on its Internet site.
S
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10 LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011IN THE NEWS CSUITED
General Internal Medicine is
Royal College
recognizes as a Subspecialty
After more than 30 years of discussion, work and be working with the proposers to set up a working group
deliberations within the Internal Medicine community, the responsible for finalizing standards documents, creating a
Council of the Royal College of Physicians and Surgeons of master plan for examinations and approving Canadian
Canada has unanimously decided to approve General programs. The discipline of Internal Medicine (four years) will
Internal Medicine (GIM) as an Internal Medicine subspecialty; continue to exist and we do not plan to remove it as a path
it will now require two years’ training. The resolution was leading to medical practice.”
adopted at a meeting held at the end of December 2010.
The President of the Association des spécialistes de The new face of internal medicine
médecine interne du Québec (ASMIQ), Dr. Patrick Chagnon, In line with many medical specialties, Internal Medicine has
said that this was excellent news for both Quebec and the become much more complex over the years: managing
rest of Canada. “Quebec was a pioneer in this field by adding multiple pathologies and medications and the need for more
an extra year of training some time ago; the advanced training with regard to technical
rest of Canada has finally decided to follow platforms speak for themselves. In Quebec,
its example.” the faculties of medicine and the MSSS have
considered for the past several years that a
Discussions mainly concerned how to fifth year of training was needed before
harmonize training in Internal Medicine certification. This situation has also been
between the various Canadian provinces and experienced in cardiology, where there has
the United States. Each province had its own been a veritable explosion of knowledge over
specific circumstances in the field of Internal the last 20 years. In agreement with the
Medicine. In some cases, dual certification was faculties of medicine, cardiology training was
required, but not in others like Quebec, where revised upwards to now include a sixth year
internists were already heading towards of training.
Dr Patrick Chagnon,
subspecialties such as cardiology, pneumo- ASMIQ President
logy, etc. In Ontario, harmonization with U.S. All current residents have already received a
training was a priority because the shorter notice from the Collège des médecins du
training time there only too often attracted Canadian Québec. Only a few administrative formalities remain to be
candidates to move south of the border. settled. Certification in Internal Medicine will be awarded to
residents after they have completed four years of residency
In a press release, following the meeting, the Chief Executive and passed the fourth-year examinations.
Officer of the Royal College stated, “GIM will gradually
become a separate two-year training program leading to Ontario is still deliberating on how to deal with this
certification in the subspecialty. The Office of Education will new certification.
S
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LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011 11D I D YO U K N O W. . .
Prizes and Awards Family honours
Dr. Marie-Jeanne Kergoat, a geriatrician,
Order of Canada and her sister, Dr. Hélène Kergoat, an
On December 30, the new Governor General of Canada, the optometrist, who are both researchers at
Honourable David Johnston, named a number of personalities the Institut universitaire de gériatrie de
to the Order of Canada. Among these, were four medical Montréal, were presented with an Award of
specialists from Quebec: Excellence at the 9th International French-
Speaking Congress of Gerontology and
Dr. Sylvia Cruess, Geriatrics for a poster presentation of their
endocrinologist research entitled Évaluation de la fonction
(Officer) visuelle chez la personne âgée en santé et chez la personne âgée
vivant en institution (Evaluation of visual functions in healthy
seniors and in the elderly living in institutions). The prize was
awarded in Nice during the most important event of its kind that
brings together, every four years, some one thousand
Dr. Maurice McGregor,
cardiologist (Officer) professionals and scientists from the fields of geriatrics
and gerontology.
Dr. Gilles Julien,
pediatrician (Member)
2010 Robert Volpé Prize
The 2010 Robert Volpé Prize was awarded
Crédit : Production multimédia CHUM
to Dr. André Lacroix of the University of
Montreal Hospital Centre by The Canadian
Dr. Pierre Fréchette, Society of Endocrinology and Metabolism to
emergency medicine
specialist (Member) highlight his exceptional contribution to
endocrinology in Canada. The prize was
presented at the annual scientific meeting
The recipients will be given their insignia in a special ceremony held in Edmonton last October.
to be held later.
CONGRÈS CANADIEN SUR
L A S A N T É R E S P I R ATO I R E 2 0 1 1
28 – 30 avril 2011
Sheraton on the Falls Hotel
Présenté par
& Conference Centre
Niagara Falls (Ontario)
En collaboration avec
Pour tous les détails du programme et pour s’inscrire, visitez le site www.poumon.ca/crc
12 LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011D I D YO U K N O W. . . C S U I T E D
The Pashby Award for an emergency medicine
specialist
TOURNOI
Dr. Scott Delaney has won the 2010 Pashby
Sports Safety Award. This prize is given DE GOLF 2011
each year to a Canadian who has
contributed to the prevention of serious WINTER IS COMING TO AN END!
injury in sports and recreational activities.
IT’S TIME TO THINK ABOUT GOLF!
Dr. Delaney has been rewarded for his work
on concussions and neck injuries in soccer, Following tradition, this is our first invitation to take part in the 6th
hockey and football, as well as for his efforts Annual Medical Federation Golf Tournament for the benefit of the
to raise awareness of this type of injury. Quebec Physicians’ Health Program (QPHP) Foundation. Please
mark your calendar now: July 25, 2011. The QPHP provides help and
James IV Association of Surgeons
support to all physicians, residents and students who are experiencing
Dr. Pascuale Ferraro, a general surgeon, has
Crédit : Production multimédia CHUM
various situations that may affect their quality of life (addiction,
been named Canadian Ambassador to the psychosocial problems, etc.) or that may have repercussions on their
James IV Association of Surgeons for the work, health or personal equilibrium. Year after year, the QPHP sees
year 2012. Doctor Ferraro will visit several
the number of requests for intervention increase significantly.
Commonwealth countries to present the
fruit of his experience in research and Registration forms are already available at www.fmsq.org. As each
teaching at the Université de Montréal. A tournament is more popular than the previous one, register without delay.
hundred or so surgeons from the British
Isles, New Zealand, Australia, the United Several sponsoring opportunities are still available. For full details as
States and Canada are members of this association, created to to availability and rates, please contact Ms. Hoda Sayegh at
honour the memory of Scottish king James IV, who was greatly 514-350-5000, extension 279 or e-mail her at hsayegh@fmsq.org.
interested in medicine and surgery.
Merci à :
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René MaRtel téléphone : 450 839-3616 pédiatrie,
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LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011 13DID YOU KNOW... CSUITED
New Publications Organ and tissue donations: Quebec now
Des réseaux responsables de leur population
in step
Almost five years after William Cusano, then MNA for Viau and
Dr. Denis A. Roy, a public health medical
a heart transplant recipient, presented a Bill to facilitate organ
specialist and Vice President for
donations, Quebec finally passed such legislation in December
Scientific Affairs at the Institut national de
2010 (Bill 125: An Act to facilitate organ and tissue donation)
la santé publique du Québec; Dr. Éric
and, since February 28, a national consent registry to donate
Litvak, a public health medical specialist
organs and tissue after death. According to Québec-
and medical consultant for the Agence
Transplant, “These measures will also encourage the donation
de la santé et des services sociaux de la
of organs between living people, both through Québec’s
Montérégie, and Dr. Fred Paccaud, a
participation in the Canadian registry of living donors combined
colleague from Belgium, have published
with an exchange of beneficiaries and through the preservation
Des réseaux responsables de leur
of an employment relationship and the reimbursement program
population; moderniser la gestion et la
for living donors”.
gouvernance en santé (Networks responsible for their population:
modernizing management and governance in the health sector).
2011 Accreditation Visit
This reference work is intended for anyone involved in the
The Federation recently hosted visiting physicians from the
planning, managing or governing of health systems and for
Collège des médecins du Québec and the Royal College of
members of the public wishing to follow the direction taken by
Physicians and Surgeons of Canada during their five-year
the organizations designatd to serve them. The book seeks to
Continuing Medical Education/Continuing Professional
offer innovative proposals and approaches, because today’s
Development (CME/CPD) accreditation visit. Thirty-six groups
needs are very different from those that prevailed in the past.
(the FMSQ’s Office of Continuing Professional Development,
Traditional approaches have to be reexamined and replaced by
the 34 affiliated associations and the Société des experts en
more suitable approaches that are better adapted, simpler, less
évaluation médico-légale du Québec) presented their
costly and more efficient.
accomplishments over the past five years and their future
projects. Each association had previously supplied a
New edition of Transœsophageal Echocardiography comprehensive presentation document, which had been
Multimedia Manual reviewed by the two colleges.
Doctors Pierre Couture, André Denault
The purpose of an accreditation visit is not to impose sanctions,
and Jean-Claude Tardif from the Montreal
but rather to take stock of past actions and to orient and
Heart Institute (MHI), in cooperation with
prioritize future action. These days allowed us to show the
Dr. Annette Vegas of Toronto General
increasing involvement of our affiliated associations in
Hospital and Dr. Jean Buithieu of the
professional development, and they presented their high-quality
McGill University Health Centre, have co-
accomplishments to the visiting physicians with great pride.
authored the second edition of the work
The associations as a group seek to obtain the maximum five-
that has become a reference manual for all
year accreditation. Continuing professional development is not
specialists wishing to develop expertise in
limited to educational activities or to an annual conference. It
this area.
encompasses any intervention or action that associations
undertake to improve the quality of care, such as the
development or application of practice guides, the improved
Conseil québécois de développement
professionnel continu des médecins delivery and safety of care in our hospital centres, or the
therapeutic instruction of patients.
Explorons, innovons et partageons !
Prix de la recherche, Prix de l’innovation pédagogique
et Bourses de recherche en développement
professionnel continu 2011
Date limite : 1er mai 2011
Pour participer, consultez le site Internet au www.cqdpcm.ca
For your calendar
Friday, November 11, 2011
Palais des congrès de Montréal
Details to follow.
14 LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011DID YOU KNOW... CSUITED
On the political scene A Journalist’s true rigour…
On February 10, journali
st Madeleine Roy of the
Enquête show declare
d the FMSQ was resp
At the Federal level: Bill C-510 defeated the MSSS decisions con onsible for
cerning the Bill 34 enfo
measures on SMC’s. rcement
On December 15, 2010 private member’s Bill C-510 Here’s her motivation…
presented by Manitoba MP Rod Bruinooge was defeated
by 178 votes to 97. Quebec MPs from all parties opposed
the Bill which sought to criminalize any action aimed at
exerting pressure on a woman to convince her to have an
abortion. The Bill was tabled following the death of
Roxanne Fernando, a Winnipeg woman who, according
to various sources, was murdered by her ex-boyfriend
because she refused to have an abortion.
At the Provincial level: two Bills being closely
watched by the Federation
Two Bills that could have an impact on the work of
medical specialists or affect how health care services are
organized in Quebec were tabled during the fall 2010
session of the National Assembly, and are being closely
watched by the Federation.
• Bill 127: An Act to improve the management of
the health and social services network
The aim of this Bill is to introduce new rules to improve
the management of the health and social service
network. Among other things, it revises the
composition of institutions’ and agencies’ boards of
directors, and provides for the creation of a L S
governance/ethics committee and an audit committee.
The Bill provides that institutions’ boards of directors
will have to perform their duties in conformity with
national and regional policies and draw up a multi-
annual strategic plan in this regard; agencies are ÉTOILE DU VIETNAM
already required to do this. 13 jours / 27 repas / Départs garantis
Départs 15 mars, 12 et 19 avril 2011*
• Bill 133: An Act respecting the governance and À partir de 2899 $ départ du 15 mars 2011
management of the information resources of
public bodies and government enterprises AVENTURE SUD-AFRICAINE
This Bill establishes a framework for the governance 12 jours / 25 repas / Départs garantis
Départs 13 et 27 avril, 11 et 18 mai
and management of information resources applicable
À partir de 3989 $ départ du 13 avril 2011
to government departments and most public bodies,
including those in the educational system and those in
VILLES D’ART ET BOHÊME
the health and social services network. The Bill also DU SUD
makes provision for the appointment of administrators 12 jours / 23 repas
of the information network and regional administrators Départs 23 mai, 13 juin et 11 juillet 2011*
of information, setting out their duties. It identifies the À partir de 2389 $ départ du 13 juin 2011
management tools that public bodies must use with
respect to the governance and management of their Consultez les spécialistes en voyages de votre agence partenaire.
information resources. In addition, the Bill requires
public bodies to have their annual programming Appelez-nous pour tous les détails ! BERRI-UQAM
approved and to obtain authorization for their
information resource projects. 920, boul. de Maisonneuve E.
1 888 732-8688
Départs de Montréal. Prix par personne en occupation double basés sur les tarifs les plus bas, incluant les taxes et toutes les promotions calculées,
ainsi que la prime de fidélité. Prix en vigueur au moment de l’impression et valables pour les nouvelles réservations individuelles, sous réserve de
disponibilité. Prix inclus réserve-tôt jusqu’à 200$, client fidele de 60$ et paiement comptant de 60$. *Autres dates disponibles, informez-vous. Pour les
détails et conditions générales, veuillez vous référer à la brochure Circuits Trafalgar 2011 de Rêvatours. Rêvatours est une division de Transat Tours Canada
inc. et est titulaire d’un permis du Québec (no 825121). Club Voyages est une division de Transat Distribution Canada Inc. Permis No 753141 au Québec.
Prix excluant le 3,50$/1000$ de services touristiques achetés qui représente la contribu-
tion des clients au Fonds d’indemnisation des clients des agents de voyages.
LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011 15FOLLOWING DECEMBER’S EDITION
Haïti: The 1st Year
Our special report on Haiti generated a great deal of feedback, all positive. It is always difficult to
stand back sufficiently to appreciate or to provide an update on a situation, especially when it is a
question of the human catastrophe created by the earthquake in Haiti on January 12, 2010.
Of all comments received, one has touched us. Doctor Jean-Marc Ouellet, an anesthesiologist at
the CHUQ, is a literary columnist for the blog Le chat qui louche. He published the following* in
response to the special report in Le Spécialiste (translated from French*):
It’s 4:50 p.m. Day-to-day living supplies its own misery. Everyone fights to survive, like every
member of the family, like everyone else, like everywhere else. But there are places where these
words mean something. We smile, we cry. We are afraid of tomorrow because tomorrow likes to
surprise us. And not always happily. Disasters don’t always wait. A span of three minutes. A fault
fractures, tectonic plates move closer together or further apart. The earth shakes. Slum dwellings
and palaces, all crumble in the dust. With their occupants still inside. More than two hundred
thousand voices are silenced. Forever. Life stops. Haiti becomes rubble. A fragile country – a
country that makes the transition from little to nothing. No. Not nothing. Because misery is
something. And sometimes, sadly, nothing is better than almost nothing.
Help has come. The world has been generous. Money, food, medical supplies. Men and women.
People from all over the place, strangers. To help, to save, to learn. Yes, to learn. Because misery
teaches. About how others live, their needs, their smiles in the face of disaster. Misery teaches us
to understand. To understand... ourselves, to start with.
* Short extract; unofficial English translation.
Read the rest of the text on: http://maykan.wordpress.com/ (in French)
Doctors of the World – Canada and Doctors Without Borders visit the FMSQ
Dr. Nicolas Bergeron, a psychiatrist and the President of Doctors of the World – Canada, along with Mr. André Bertrand, the
Director General, wanted to present the FMSQ with a memento, a gift in appreciation of the help given by medical specialists
following the devastating earthquake. Entitled Mèsi ampil, this work combines a number if photographs of Haitians and a message
of hope for the future of Haiti.
Last April, a delegation from Doctors Without Borders also visited the FMSQ offices to deliver a report on their most recent
activities following the earthquake. The organization’s representatives had a long discussion with Dr. Barrette, mainly about the
operation and rapid commissioning of the inflatable hospital.
Mr. André Bertrand and Dr. Nicolas Bergeron, both from Doctors of the Mr. Gregory Vandendaelen, DWB Press officer, Dr. Gaétan Barrette,
World Canada, presented a souvenir-frame to Dr. Gaétan Barrette. Ms. Rebecca Davies, Fundraising Director and Mr. Arias, for a quick
The artwork is installed within the FMSQ offices. photo-op last April taken during the DWB Activity report presentation.
16 LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011
LSDossier
Is an Aging Population
More Costly
… to Our System?
Quebec’s population is aging. Aside from
the mini baby-boom Quebec has been
experiencing in recent years, the general
population is getting older. Many are
concerned about this fact and are
wondering about its impact on the public
health care system.
Population aging can be analyzed from
various standpoints and questions asked
as to whether human, physical and financial
resources will be available to meet future
demands. Many experts agree that a crisis
is underway in the public health network.
Will Quebec have the human, financial and
physical resources needed to meet the
increased demand for health care and
services? Le Spécialiste has explored this
subject and the results are contained in
this issue.
The report summarizes research begun
over a year ago into the economic and
financial consequences of an aging
population. Several physicians also share
their thoughts with us.
LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011 17By Richard-Pierre Caron
SENIOR CONSULTANT
PUBLIC AFFAIRS AND COMMUNICATIONS
The Cost of an Aging Population:
A Catastrophe in Waiting or
Simply Fiction?
For many years, we have been witnessing a vast campaign designed to shape
public opinion on the presumed effects that aging and a population decline will
have on our economy and public finances.
The government of Quebec theorizes The concept of population aging is now interesting to investigate further. You
that the first consequence of this cast in stone and is used to explain will then be able to draw your own
“anticipated aging” would result in a everything: from our precarious public conclusions.
monumental increase in the health and finances to the explosion in health care
social services budget, placing a costs over the last decade. Within the
constantly growing strain on the gover- past ten years, the health and social
Analyzing an inflated view
nment’s overall budget. This would lead services budget has increased by of reality…
Quebec directly to a financial impasse in nearly 91%, rising from $14.8 billion On November 17, 2009, Quebec’s
the next ten or twenty years. In simple in 2000-2001 to $28.2 billion in Finance Minister announced with much
terms, population aging – and, as a 2010-2011. fanfare the creation of a committee of
corollary, population decline – would “independent experts”, made up of
threaten our future productivity and, in Numerous studies here and elsewhere economists and a tax expert, which
turn, our collective financial future and have attacked this belief, but it still would work with him during the pre-
our capacity to shoulder the cost. refuses to die. The question is not a budget consultation process. Quebec’s
recent one, nor is it only recently that financial situation was so worrisome
conclusions have converged and that it required exceptional action. The
This article refers to a whole range of supplementary become known. Some work under- government wanted to make its position
information that would have been too unwieldy to taken by and for the government of clear. The advisory committee on the
reproduce in this issue: various tables showing the Quebec dates back to 1998... Since eco nomy and public finances was
growth of health care costs since 1975, numerous
information issued by the government charged with identifying and proposing
extracts from the many sources used in researching
should be accurate and completely several solutions. It would also have
this report, further documentary sources, and links to
the main web sites. All this additional information can objective, so that decisions are made an educational mission: to prepare
be found at www.fmsq.org. on a sound basis and for the correct public opinion.
reasons, we thought it would be
Evolving Birth Rates in
150 000
140 000
Nombre de naissances
130 000
120 000
110 000
100 000
90 000
80 000
70 000
60 000
50 000
1900
1910
1920
1930
1940
1950
18 LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011Is an Aging Population More Costly
… to Our System?
In the first part of the third instalment of “A decline in the Quebec population is evolved to such an extent that the most
its report, Le Québec face à ses défis, forecast for 2031 if the various demo- recent demographic forecasts no
une voie durable, pour rester maître de graphic trends are maintained. […] longer foresee a decline in Quebec’s
nos choix (Quebec facing its chal- Population aging appears inevitable. population by 2050 […] The number of
lenges, a sustainable path, to remain […] The basic scenario sets the break births has increased by more than 20%
master of our choices), committee point at around 2021, but it could be as in Quebec over the last decade. Nearly
members drew a sombre and alarming early as 2009, or towards the end of the 89,000 children were born in 2009
portrait of Quebec’s future against the 2020s, according to other scenarios.” versus 72,000 in 2000. Total fertility
background of an aging population and has also increased, from 1.45 children
its presumed impact on the economy In the 2009 edition, Perspectives per woman in 2000 to 1.73 in 2009.
and public finances. démographiques du Québec et des […] The increase is not unique to
régions, 2006-2056 (Demographic Quebec. All Canadian provinces are
In particular, the advisory committee forecasts for Quebec and its regions, following the same trend. It also applies
used demographic forecasts from the 2006-2056), the ISQ completely to Sweden, the United Kingdom, and
Institut de la statistique du Québec revised its forecasts to take into several countries with very low fertility
(ISQ) to support its reports and as account a new element: the baby rates in Southern and Eastern Europe…”
grounds for its own projections. One boom that started in 2004. Birth rates
point requires clarification, however: rose from 74,068 per year in 2004 (9.8 It is clear that population decline no
did the committee use the ISQ births per 1,000) to more than 88,600 longer forms part of the equation.
publication dated 2004 or 2009? The in 2009 (11.3 per 1,000). This trend Population aging will still affect Quebec,
answer is important since, on July 15, has been maintained through 2010. as it will industrialize nations in general.
2009, four months before the The ISQ also had to revise other Some (Germany, France, Switzerland)
committee received its mandate, the variables (mortality and net migration), already have population structures
ISQ published a new demographic to take increased life expectancy and older than ours. Given this fact, what
forecast for Quebec covering 2009 – higher immigration limits into account. will be the effect of aging on health care
2056. There is a substantial difference expenditures and public finances?
between the two forecasts, compiled “If recent trends are maintained,
four years apart: two reports, with Quebec will not see any population To start with, what about the premise
diametrically opposed projections decline between now and 2056[…]. that increasing health care expen -
regarding population. Following are a Quebec’s natural growth will remain ditures (because of an aging popula-
few extracts from the 2004 document: positive until 2029.” tion) will represent a constantly growing
Si la tendance se maintient… strain on the government budget until it
Perspectives démographiques, Québec On December 7, 2010 the ISQ issued a reaches the breaking point? The
et régions, 2001-2051 (If the trend press release confirming that “Quebec subject has been extensively studied
holds... Demographic Forecast, has experienced its highest demo- here and abroad and numerous studies
Quebec and Regions, 2001-2051). graphic growth since 1990.” In its most have been published. We will touch on
recent publication in December 2010, some of them in this article. However,
Portrait social du Québec (Portrait of let us begin by looking at some of the
Quebec Society), the ISQ adds: data that place matters in perspective.
“Fertility, mortality, and migration have
Quebec from 1900 to 2009
1960
1970
1980
1990
2000
Année
LE SPÉCIALISTE VOL. 13 NO. 1 MARCH 2011 19Vous pouvez aussi lire
