LETTER

Healthcare issues continue

In the October 1 election, an important issue is whether the parties will respect a previously signed contract with specialists. Premier Couillard and his designated new health minister Gertrude Bourdon are committed to do so. The other three parties regard the specialists as overpaid. Who is right, and what are the consequences of rolling back their fees?

First, consider that it is false to compare the current incomes of Quebec MDs with the most recent statistics from Ontario. These may well change. Ontario physicians have been without a contract for over four years, and under the previous government suffered the cancellation of several fees, and fee cuts of 30-50%, plus monthly billing clawbacks of 3.15%. The Ontario Medical Association is currently in negotiations with the new Doug Ford government and if they fail, will then go to binding arbitration. Among the demands of the OMA are restoration of previous fee cuts and return of money that was clawed back, plus a cost of living adjustment of fees. If many of these demands are met, the incomes of Ontario physicians will hardly be below the most recent ones of their counterparts in Quebec.

It is most difficult to compare gross incomes, when take-home pay and living costs vary so much within each of these two provinces. Rent for a one-bedroom apartment is $916 in Montreal, $731 in Quebec City, $925 in Hamilton, $1,189 in Ottawa, and $1,423 in Toronto. A detached house costs $325,900 in Montreal, $240,000 in Quebec City, $500,183 in Hamilton, $383,793 in Ottawa, and $1,200,000 in Toronto. All of these are much lower in smaller towns in both provinces. Yet in Ontario, the fee schedule is uniform in every locality. 

Income taxes are much higher in Quebec, but daycare and drugs are better subsidized. What counts is after-tax, net disposable income. Thus, it is most complex to decide the income that would make an average physician in Quebec equally well-off compared with one in Ontario.

Recall that in 2003, when Quebec MDs earned 30% less than did those in Ontario, it was François Legault, acting as Health Minister for the PQ, who agreed that the pay disparity needed to be corrected.

If the CAQ wins the election and implements income cuts to Quebec specialists, several adverse consequences will likely occur: The province will experience difficulty attracting and retaining MDs unless they are not sufficiently bilingual to also work in English. This is at a time when Quebec needs more MDs;  the population is aging and developing more chronic disorders such as diabetes mellitus, cardiac disease, and malignancies.

The situation will be particularly grim for West Quebec, which has had a chronic shortage of specialists and family physicians.

These cuts would also greatly lessen the chances of Quebec ever signing the Reciprocal Medical Billing Agreement. All Quebecers would hence remain second-class citizens when seeking medical treatment in the rest of Canada, or for the first three months after permanently moving to another province or territory.

Premier Couillard should promise that - if he is re-elected - he will sign the RMB agreement and leave as his legacy fully portable healthcare throughout Canada for all his fellow Quebecers. 

Charles S. Shaver, MD

Ottawa