Working Conditions for Medical Specialists in Quebec Imposed by Special Law

Pierre Lavalle, M.D., FRCSC
President, Quebec Orthopaedic Association
Quebec City, Quebec

The Quebec Government hastily adopted Bill 37 at the end of the parliamentary session on June 13, 2006. This special bill not only establishes the working conditions of medical specialists in Quebec until 2010 but also imposes hefty penalties for organized efforts that impede the continuity of care.

This bill prevents doctors from participating in actions that would stop, decrease, slow down, or change their professional actitivites. Doctors are not allowed to resign, disengage or organize to leave the public medicare system. Offenses are punishable by a $1,000-$5,000 fine per day for doctors, a $7,000-$35,000 fine for senior administrators of associations, and a $25,000-$125,000 fine per day for medical associations. It should be noted that in most cases, the presumption of innocence is rejected and it is up to the doctor, association or the Fdration to prove that an infringement of the law has not occurred.

Reaction to this bill among orthopaedists fluctuates between bitterness and anger. We were ready to negotiate and had just requested a mediator to assist us. This bill was passed despite the absence of pressure tactics and despite the fact that the government had already committed to compensating for the salary gap in the other provinces of Canada in 2003. Although the government and the Fdration des mdecins specialists du Qubec (FMSQ) are not in agreement on the size of this gap, it has been assessed at 34%-36% by an independent expert. The government says that it cannot keep its word due to the financial framework of Quebec

This special bill is even more difficult to swallow since the approved [salary] increase is lower by nearly 100 million compared to the proposal that the FMSQ rejected just a few days prior.

The imposed salary increases are 0%, 0%, 2%, 2%, 2%, 2% respectively for 2004 to 2010. There is also 119 million dollars allocated for targeted measures to be determined by the Minister. This 119 million, which includes partial reimbursement for professional liability insurance, represents at the most 5.5% over the renewal period. Throughout this timeframe, professional expenses will increase at the rate of inflation.

It is clear that along with this imposed agreement, the salary gap between medical specialists in Quebec and the rest of Canada will most likely widen from now until 2010. The government seems to be counting on the reluctance of Quebec doctors to move.

The official position of the FMSQ and the Quebec Orthopaedic Association is to recommend that doctors abide by this bill. The FMSQ has called upon its attorneys to look into any legal recourse that can be pursued. We are also reviewing all collaboration that the Quebec Orthopaedic Association provides to the government. In future, we will focus on the application of our standards of practice by also ensuring that compensation is received for all tasks we perform. The tone of our relationship with the government has changed our trust has been betrayed.

We will remember June 13, 2006 as a somber day.