By: Samir Shaheen-Hussain and Nazila Bettache
"The first task of the doctor is [...] political: the struggle against disease must begin with a war against bad government."
- Michel Foucault, The Birth of the Clinic
On May 13 the Federation of Medical Specialists of Quebec (FMSQ) held a special general assembly, Operation "Code Red," at the Montreal Olympic Stadium. The imagery is evocative: the Quebec health-care system is going down in flames, and the FMSQ wants to rush to its rescue.
Dr. Diane Francoeur, president of the Federation des Medecins Spécialistes du Quebec (FQMS). (Photo: Radio-Canada)
The FMSQ, which includes over 10,000 medical specialists from across the province, is completely justified in its opposition to the major overhaul of the health-care system imposed by Minister Gaétan Barrette that has been denounced from all sectors of society. Physicians across the province have already expressed their concerns about, and/or rejection of, Laws 10, 20 and 92, as well as Bill 118. However, it is Bill 130, and its threat to physicians' professional autonomy, that ultimately compelled the FMSQ to escalate its tactics by mobilizing for the May 13 assembly (over 3,000 members reportedly registered), in a context where the agreement between the FMSQ and the Ministry of Health and Social Services has been expired since March 2015.
In the weeks prior to Operation "Code Red," the message was framed around safeguarding health care for the people of Quebec. We obviously cannot criticize such a laudable mission, but the rhetoric rings hollow when considering the FMSQ's indifference to government actions that have had major impacts on people's health and well-being in recent years.
For example, in June 2012, the federal government implemented drastic cuts to the Interim Federal Health Program (IFHP), preventing thousands of refugees, refugee claimants and other migrants with precarious status from accessing health care across the country. The consequences of the cuts were disastrous. The FMSQ issued a press release expressing some concern about the implications on medication coverage, but the cuts were never explicitly denounced in and of themselves. Meanwhile, organizations like the Canadian Medical Association, the Royal College of Physicians and Surgeons of Canada and Ontario's Council of Medical Officers of Health supported the campaign spearheaded by Canadian Doctors for Refugee Care condemning the IFHP cuts (which were ultimately reversed in April 2016). The FMSQ did not.
We find it unacceptable that Quebec physicians - many of whom are overworked, exhausted and discouraged - must work in deteriorating conditions
In 2015, workers from the public sector in Quebec led forceful campaigns to improve their working conditions and wages. The negotiations with the current provincial government included our colleagues working in the public health-care system, who are directly impacted by the deleterious policies imposed by Minister Barrette and denounced by the FMSQ. Although Médecins québécois pour le régime public issued a public statement expressing its discomfort with ever-increasing physicians' incomes in a context where austerity measures were being forced onto other health-care workers, the FMSQ did not display any tangible solidarity with our colleagues. Perhaps more shocking, the FMSQ (and its counterpart, the Fédération des médecins omnipraticiens du Québec) had previously negotiated a deal whereby Quebec physicians would benefit from an increase in income that would be proportionally equivalent to the hard-fought gains eventually obtained by those in the public sector!
Finally, in November 2016, the National Assembly adopted Bill 70. While this legislation ostensibly seeks to integrate those on social assistance more quickly into the workforce, it introduces a penalty that can deprive a welfare recipient of a third of their monthly payment (from $628 to $404). Many community groups and unions vehemently denounced the further stigmatization of those on social assistance. A group of psychiatrists published an open letter (with over 500 signatories working in the health-care sector) criticizing this punitive approach and the harmful impacts this policy would have on the health and well-being of people who would be forced into more precarity. The FMSQ abstained, yet again, from intervening.
Let there be no doubt: As physicians practising in Quebec, we are unequivocally opposed to the provincial Liberal government and Minister Barrette's overhaul of the health-care system and centralization of powers (notably Bill 130, but also Laws 10 and 20), which undermine the principles of universality and accessibility that are supposed to be central to our health-care system. On a regular basis, we are humbled by the efforts and dedication of our physician colleagues towards patients. We find it unacceptable that Quebec physicians -- many of whom are overworked, exhausted and discouraged -- must work in deteriorating conditions while concurrently being treated with disdain and hostility by Minister Barrette. Meanwhile, we also find it particularly lamentable that working conditions have deteriorated significantly across the board for health-care workers in the public system.
However, we can't ignore the significance of decisions like mandating Lucien Bouchard to represent the FMSQ in future legal actions. In the 1990s, then-Premier Bouchard's Parti Québecois government accelerated the erosion of our health-care system through massive cuts in the context of the "virage ambulatoire," motivated by his zero-deficit policy.
MP Gaétan Barrette, former president of the FMSQ. (Photo: La Presse Candienne)
We can't ignore that the last time the FMSQ mobilized its members like it did for Operation "Code Red" was in 2006, when Gaétan Barrette -- then president of the FMSQ -- negotiated a deal with the provincial government (current premier, Philippe Couillard, was minister of health at the time) that resulted in the explosion of medical specialists' income (i.e., a 66 per cent increase between 2004 and 2014). The FMSQ went so far as to reward him with a severance package worth $1.2 million when he quit the FMSQ to run in the 2014 provincial elections with the Liberal party. Thanks to Gaétan Barrette's "victories" while president of the FMSQ, physicians' incomes continue to increase in both absolute and relative terms (i.e., the percentage of the total provincial budget devoted to physicians' remuneration has gone from 5.7 per cent in 2006-7 to 7.6 per cent in 2015-16), thereby threatening the very sustainability of the public health-care system in Quebec.
We can't be honest with ourselves by responding to the FMSQ's calls to save the health-care system if these calls serve only its own interests and so long as it remains silent on major issues impacting the health of Quebec's population, including the on-going attacks against the most marginalized groups of our society by successive governments. We therefore wait for the day when the call for solidarity put forth by the FMSQ will not only apply to medical specialists, but will be extended to the entire population of Quebec.
We will welcome the time when the FMSQ becomes a more democratic organization and breaks away from the corporatist-union approach accentuated during the president Barrette era, and mobilizes against minister Barrette's draconian reforms by developing a common front with other groups and sectors also opposed to them. At the end of the day, if the goal is truly to save the health-care system, the FMSQ must adopt an approach rooted in solidarity and social justice rather than self-interest.
The original version of this piece was sent to a few dozen medical specialists across the province. Several expressed support, but were not able to sign on publicly. The following medical specialists are signatories to the original text:
Amir Khadir, microbiologist - infectious disease specialist, Montreal
Catherine Dea, public health & preventative medicine specialist, Montreal
Chi-Minh Phi, pediatrician, Montreal
Francis Livernoche, pediatrician, Sherbrooke
Jennifer Turnbull, pediatric emergentologist, Montreal
Marie-Hélène Lizotte, pediatrician, Rimouski
Matthew Weiss, pediatric intensivist, Quebec
Michèle Mahone, internist, Montreal
Yasmine Ratnani, pediatrician, Montreal
Nazila Bettache (internist) and Samir Shaheen-Hussain (pediatric emergency physician) are medical specialists and activists for social justice.
The authors would like to acknowledge the contributions of Dror Warschawski and Guillaume Hébert to this text.
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