A Quebec government under the Coalition Avenir Québec party would use the long-dormant notwithstanding clause in the Charter of Rights and Freedoms to try to keep doctors who get trained in the province from leaving, leader François Legault says.
Legault, who recent polls suggest is in a three-way race to become the province's next premier in Tuesday's election, said med students from McGill University are especially guilty of exiting Quebec once they've finished their education.
He told the editorial board of Le Devoir newspaper that the situation is "unacceptable."
"I won't rule out, if necessary, using the notwithstanding clause to be able to keep more doctors who are studying at McGill," Legault told the Montreal-based daily.
"It doesn't make sense that from McGill, after five years, half the doctors have left Quebec."
Just over 55 per cent of McGill MDs who finished their residency in 2009 were practising in Quebec as of July 2011, according to figures from the Canadian Medical Association. That compares with 91 per cent of Laval University medical grads who were still in province, 90 per cent from the University of Montreal and 76 per cent of Sherbrooke University trainees.
The largest portion of departing McGill MDs — nearly half of those who left Quebec — went to Ontario.
Tuition is heavily subsidized at the province's universities, with the Quebec Education Ministry estimating it costs taxpayers upward of $160,000 to train each doctor.
Legault said a CAQ government would be ready to invoke Section 33 of the Charter of Rights, the so-called notwithstanding clause, to force medical graduates to repay that amount.
He didn't specify to Le Devoir's editorial board how he would do that, or why he would need the notwithstanding clause, which allows a government to exempt a law from being struck down on certain charter grounds for a renewable five-year period. A possible obstacle that might require the notwithstanding clause is Section 15 of the Charter of Rights, which protects against discrimination.
'Not a formal position'
Legault's own lead candidate on health matters, Gaétan Barrette, cautioned not to read too much into his party leader's words because they aren't official CAQ policy.
"Mr. Legault expressed his opinion on that. This is not to me a formal position by the party, but it something that is clearly on the table," Barrette told the CBC Montreal radio show Daybreak.
Barrette himself, a physician and the former head of the Quebec federation of medical specialists, said he doesn't support Legault's views.
"Personally — and I'm not involving the party itself — if you're asking me, personally I think we have to train our people, and our people are free to go, as others are free to come to Quebec," he said.
"We need to be competitive with the rest of the world so that in a balanced society and within a balanced world, those coming in should equal those going out."
Research from the early 2000s, when Quebec-trained MDs were leaving the province in higher numbers, found one of the primary motivations for the exodus was pay.
Fewer Quebec-trained doctors emigrate to other provinces or the U.S. now, however. Quebec lost a net total of just eight doctors to other provinces in 2010, but gained an aggregate of 10 from those returning from abroad, figures from the Canadian Institute for Health Information show.
'We don't offer them jobs'
The head of the province's association of medical residents said those who leave can't really be faulted, and certainly shouldn't be made to repay the cost of their degree.
"The question we need to ask is why they leave Quebec. And the reason is not because they don't want to serve the population here," said Charles Dussault, president of the Fédération des médecins résidents du Québec.
"It's because we don't offer them jobs or we don't offer them of sufficient quality, and that's the problem. And by forcing them to pay their training, we don’t address the problem."
The only real uses of the notwithstanding clause since the advent of the Charter of Rights in 1982 have been by Quebec governments. The Parti Québécois invoked Section 33 to re-pass every law on the books, and on every law from then until 1985, as a form of protest in the wake of the charter. The Liberals used it in 1989 to safeguard Bill 101, the French Language Charter, from constitutional challenge.
Alberta, Saskatchewan and Yukon have also used the notwithstanding clause in legislation, but in those cases the laws were either never brought into force, inoperative for other reasons, or didn't need Section 33 to be valid.