2023-05-08 21:50:21
(Quebec) The vast reform of Christian Dubé does not go far enough to improve access to health care, according to the College of Physicians. Bill 15 is too focused on what happens in the hospital and not enough on local care, deplores the professional order.
“The patient must be taken care of before he has to go to the hospital, and following an episode of care, the patient must leave the hospital in good conditions […] I am talking here regarding the first line and home care,” illustrates in an interview the President of the College, Dr.r Mauril Gaudreault.
According to the professional order, Bill 15, which aims to make the health and social services network more efficient, is “exclusively focused on the organization of care within institutions” and does not focus sufficiently on this happens outside, such as in family medicine groups (FMGs), health care clinics, home care and hospitalization.
“The College is of the opinion that it will therefore not be possible to significantly improve access to care throughout the territory without planning and management oriented towards local care”, it is stated in a brief that will be presented Tuesday to parliamentarians as part of consultations on the legislative text of Minister Christian Dubé.
“The silence of the bill in this regard leads us to question the government’s ability to remedy the overcrowding experienced in the emergency rooms where patients end up when it is impossible for them to obtain an appointment in a clinic. writes the College.
“I think that we should not limit ourselves to what happens inside establishments, access to care is throughout the territory”, points out the Dr Gaudreault. The College also recently toured a dozen health centers in Quebec.
“Everywhere, everywhere, I noticed problems of access and quality of care, with even certain regions where there were citizens who were deprived of care. It is not true that we can continue like this, something must be done to improve access, ”he underlines.
The College of Physicians is in favor of Christian Dubé’s reform project, which aims to entrust all the operational aspects of the Ministry of Health and Social Services to Santé Québec, a new government corporation. The Department will be able to focus on its planning role.
But Minister Christian Dubé must go further when the legislative text does not contain enough “concrete measures for better access”, apart from a few possible solutions, notes the College.
The latter recommends that Mr. Dubé modify his bill to add the notion of “proximity care”, which must be provided by integrating all of the network’s resources, including community resources, into the management of Santé Québec. .
The voice of doctors “diminished”
Another source of concern, the College of Physicians believes that Quebec “seems to want to diminish the importance of medical leadership” in its reform by “diluting” the authority and responsibilities of the councils of physicians, dentists and pharmacists (CPDP) in the organization of care.
In the current form of the bill, the CPDPs will report to the medical director and the interdisciplinary council of the establishment. The College sees in this “a loss of independence of this body”.
“The reduction in the scope of medical involvement comes with a significant risk of demobilization and disengagement of the medical profession”, warns the College. Physicians are also excluded from the establishment councils, which will replace the boards of directors.
Moreover, the College believes that the clinical governance bill “concentrates the powers in the hands of a restricted group of managers, leading to a real risk of arbitrary decision” since “the same people will be responsible for both ‘granting privileges and determining penalties’ for physicians.
The new structure provides for the addition per institution of a medical director, who replaces the current director of professional services, and two other management positions, one for family medicine and the other for specialized medicine.
“We agree, but it can’t be these only people. We seem to forget that within institutions, there have always been department heads, physicians who assume responsibilities. […] We have to put that back on the agenda, ”underlines the Dr Gaudreault.
Maintaining the CPDPs according to their current structure is a solution recommended by the College.
After a two-week break, special consultations on the imposing Bill 15 resume on Tuesday. In addition to the College of Physicians, the unions of family doctors and medical specialists will be heard.
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