O Quebec

O Quebec,Remember when I graduated from your emergency medicine program? I could have stayed and looked after patients who needed me, but you had so many hoops to jump through, like: Your own separate provincial licensing exam;Plans territoriaux des effectifs en médecine de famille (PREM), which forbid doctors from setting up a practice or working at a hospital of our own choosing. You choose for us, and good luck getting a PREM in Montreal (or any predominantly anglophone area);The French exam that you would only schedule when I was working out of province, and that many professionals fail repeatedly; plus the biggest kicker for me . . .Activités médicales particulières (AMP), where all the newly graduating physicians have to commit part of their schedule to obstetrics, geriatrics and emergency medicine—the most schedule-disrupting specialties—or get docked 30% of our billings.I'd work in emergency rooms anyway. But I attended a meeting where they talked about AMPs. All the grey-haired doctors in the room nodded their heads, and I realized they had sold the new doctors out. Because of course you escape the penalty if you've been in practice for 15 years.This, on top of an already-underfunded system with patients crammed into the waiting rooms and emergency departments? No thanks.I left, along with much of my EM graduating class. We considered speaking to the media, but a Montréalais doctor warned us that it could backfire. The public might simply hate McGill graduates even more for leaving en masse.So we left quietly.You've probably heard that the Quebec government is now attacking its remaining physicians, whom they blame for the woes of their health caresystem. They rammed through a new law (Bill 2/Loi 2) overnight.And why did they have to "invoke closure" and prevent debate?Zero new money, meaning no additional compensation, no nurses, no increased access or anything like that. God, no.But my friends have pointed out that lowlights for physicians include:Cutting physician fees by as much as 50% by tying billing to impossible targets.Forcing physicians to stay in-province by threatening to fine us by as much as $20,000 PER DAY.Threatening that if three or more physicians within ONE REGION alter their practice (get sick, have a child, retire), ALL will be punished.Claiming that all patients in Quebec will now be assigned a doctor—after chasing away all the doctors. So anyone who does stay will drown under the weight of additional patients.Lowlights for patients:Bringing in overseers to monitor physician-patient interactions (hello, authoritarianism; goodbye, confidentiality and any budget-saving).Colour-coding patients according to their health (again, zero confidentiality, and as someone who has experienced Quebec bureaucracy, I have zero confidence in accuracy or ability to change your colour code).Patients won't actually get a physician, but they'll be assigned to a local clinic.My friends have compared medicine to an abusive relationship before. They've say, "when people tell you who they are, believe them." Quebec, thanks for telling us who you are. Many believe that this is a tactic for drawing attention away from the government's many scandals and its fiscal insolvency, which includes doubling the amount spent on administration while crushing its MDs.Quebec doctors, how are you doing? I understand if you refuse to speak out because you'll be targeted afterward. However, I hear that so many of you applied for a New Brunswick medical license that the website crashed.Some of my friends have vowed to fight.Others may be chained by family and housing issues.But at least 300 doctors have already applied for licenses elsewhere. This is smart to me. Protect your options before the government closes them. Someone already posted about the Collège not giving letters of good standing—they may be inundated, but you want to be one of the physicians with a letter in hand.Please don't wait for court challenges.Don't wait to see if the government pulls back any more. As one of my colleagues put it, they crapped in the toilet bowl, removed two pieces of stool, and said, "Look!"For docs who live elsewhere, don't get complacent.I hear other provinces are watching to duplicate these tactics, so no one is safe. In the short term, I regularly look after patients from Quebec and expect an increasing tidal wave of "refugees from Quebec," as one colleague put it, increasing our wait times and straining our resources.Province of Quebec, I love many things about you. You are where I developed my skills delivering babies, intubating patients, diagnosing breast cancer and setting bones. You made me laugh in theatres and introduced me properly to sushi and dance festivals. I didn't bother to buy dessert in New York City because I knew you made it better and cheaper. People are so fashionable that it's a pleasure to watch you walk down the street. I nearly cried whale watching near the Gaspésie, and last year I attended my first ever NHL game, cheering on the Habs. But when the government declares open season on physicians, I consider it too risky to stay.If you do stay, protect yourself.I already made my own decision.You know how Charles de Gaulle said, "Vive le Québec libre"?Leave Québec. Soyez libre.

O Quebec

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