Alain Jodoin, M.D., FRCSC
COA 2nd President Elect
Montréal, QC

Introduction
The COA Bulletin is happy to publish a report that was put together by the Quebec Orthopaedic Association (QOA). This report was discussed in great detail among the QOA membership at its last annual meeting in September 2002. QOA President, Dr. Raymond Hould, then forwarded a copy to Drs. William Rennie, COA President, and Victor de Korompay, Chairperson of the COA's COPEF Committee; for discussion at the recent Mid Winter Meeting that was held in Toronto last November.  

As mentioned in the report, this document has been produced in order to assess the present and future needs in orthopaedic surgery for the Quebec population over the next 10 years.

Significantly lower fees, higher tax rates and poorer working conditions easily explain why 25% of the new orthopods leave the province shortly after training to work in other Canadian provinces or in the USA. This situation will certainly not improve in the coming years.

The conflict between Quebec specialists, including orthopaedic surgeons, and the provincial government has only just been resolved by negotiations after three study days that have taken place since November 2002. The difficult manpower situation described in this report is only one of the many problems that require improvement in "La Belle province".

At the present time, 222 orthopaedists are considered to be working full time in the Province of Quebec.

In the spring of 2001, the Ministry of Health and Social Services (MHSS) asked the provincial associations to anticipate our medical staffing for the next three years. We did so by undertaking an exhaustive review of the existing staffing in all Quebec hospitals and by conducting a survey to assess the number of staff currently in these centres, and the number of orthopaedists according to our members' requirements and according to resources allocated by the community. In addition, we inquired about foreseeable departures over the next three years.

At the time of this study, the immediate addition of 40 new orthopaedists was identified as a requirement to meet the needs as assessed by our members. This number certainly does not equal the much greater number of orthopaedists required to meet the current and future needs of the population. Many QOA members limited their estimates of need for new orthopaedists, taking into consideration the lack of available resources in their hospitals, especially operating room availability.

Furthermore, we tried to anticipate the number of additional orthopaedists that would be needed in 10 years. We therefore took several factors into consideration, i.e., the average age of Quebec orthopaedists, the number of surgeons over 55 years old, the annualized historical attrition rate, feminization of the profession, population aging and the increase in service demands due to the aging population.

We therefore anticipate that, in 10 years, it will be necessary to again add 40 more orthopaedists.

Hence, to meet the expectations of our members and the estimated needs of our population, we estimate that 80 new orthopaedic surgeons will be needed (40 now and another 40 in 10 years).

As it happens, there are fewer orthopaedic surgeons in 2001 than there were in 1991.

In 1991, 298 orthopaedists submitted fee claims to the Régie de l'assurance maladie du Québec [Quebec Health Insurance Plan] (only one consultation charged to the Plan meant that the surgeon was counted as practising).

Of these 298 doctors, 58% are no longer active: 22 are deceased, 48 are retired and 55 are no longer practising in the province of Quebec.
Those who remain in the count cannot all be considered as full-time hospital equivalents since a number of them have turned to medico-administrative activities as a means of getting away from a system that they no longer find satisfying.

We were not able to assess the impact of these changes in practice on the reduced medical care offered to our clientele.

Since 1991, 114 new members have joined the Quebec Orthopaedic Association, i.e., 107 residents who graduated from Quebec training centres and seven immigrants.

However, nearly 25% of fourth-year residents in Quebec will leave us to practice orthopaedics outside of Quebec.

There are many reasons for this exodus of fellowship residents and practising orthopaedists: lack of available operating rooms, obsolete technology, meagre incomes and the special type of taxation. We should point out that, overall, orthopaedists' incomes are "42% less" than the national average. Quebec also has the highest rates of taxation in Canada.

In our opinion, this shortage is not likely to diminish over the coming years. In 1992 or 1993, our civil servants predicted a surplus of approximately 1,000 doctors in Quebec in the early 2000s. The government therefore quickly reduced the number of medical school admissions. However, the specialist/general practitioner ratio has been maintained: i.e., 60-40. As a result, the number of resident positions allocated to orthopaedics each year decreased significantly, dropping from 10-12 in recent years to eight last year - a year that saw the smallest number of medical school graduates in Quebec in decades.

In July 2002, eight first-year residents were therefore spread out among the Province's four medical schools. The effects on the educational community will be disastrous in the short-term.

Now that this medical shortage has been at last recognized by our government these past two years, medical school admissions have increased by 55 per year.

It is therefore heartening to note that, over the next 10 years, a net of 0.88 new orthopaedists, instead of the desired 80, will help reduce the shortage that is already established in Quebec.