When Quebec doctors demonstrate
Quebec doctors are right to denounce Bill 2, which is opppressive and sets illusory targets. But there were reasons for protesting long before that.
Quebec doctors are angry. On Sunday evening, several hundred of them protested outside Radio-Canada’s studios in Montreal, where Health Minister Christian Dubé was invited at Tout le monde en parle, Quebec’s mainstay talk-show.
On a large yellow cardboard sign, a doctor had written “LAISSEZ-NOUS SOIGNER AVEC HUMANITÉ” (Let us treat patients with humanity).
Another sign read “SYSTÈME BRISÉ BRAVO DUBÉ” (Broken system, bravo Dubé).
Another read “PROTÉGEONS NOS SOINS DE SANTÉ — NOUS VOULONS LA DÉMISSION DU PREMIER MINISTRE LEGAULT ET MINISTRE DUBÉ.” (Protect our health care—we want Premier Legault and Minister Dubé to resign).
Finally, one read, “CAQCAQ Legault = L’Égo — Dubé = Dupés.” This last one is a bit trickier to translate, as the wording includes a pun on poop and the name of the political party governing Quebec since 2018. In brown letters and with a representation of a pile of feces.
From a strictly anthropological point of view, there is something fascinating about this sample, which shows how, in anger and powerlessness, even the brightest of the bright can regress to primitive and juvenile arguments. It is worth taking them one by one.
Humanity: it has long since deserted large parts of our healthcare system. It’s not the doctors’ fault, but we’re not going to be fooled into believing that “humanity in care” was the first thing the doctors’ unions brought to the negotiating table over the years.
The “broken” system: it dates back well before Christian Dubé. The minister could have made better use of the last five years, but the same could be said of his predecessors over the past 40 years, including his boss, who is also a former health minister and is partly responsible for the current mess.
(It was Premier Legault who forced doctors early in their careers to spend a dozen hours a week away from their clinics, whether for working in a hospital or a long-term care facility, for example. This peculiarity of practicing medicine in Quebec was put in place more than 20 years ago. To this day, it takes doctors away from primary care, more so than in any other province.)
The call for the resignation of the Minister of Health and the Premier: Seriously? It’s one thing when it comes from an anti-vaccine conspiracy theorist who shares chemtrail videos, but it becomes a little more worrying when a doctor believes such a course of events is even remotely possible.
CAQCAQ with matching emoji: twenty years of study to end up with scatological schoolyard slogans?
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Quebec’s Bill 2, which imposes a set of constraints, penalties, and even fines on uncooperative doctors, is an exaggerated response. It casts a wide net and is somewhat flawed. It contains errors that show that those who wrote it did not fully understand what they were doing. As for the few individuals who really have an overview of the bill, they tend to disavow it.
But if it exists today, it is partly because medical associations have too often behaved like rapacious unions, always wanting more for their members, with the interests of patients being only a secondary consideration, or at least secondary to that of increasing their already enviable remuneration. The medical rubber band had been stretched for a long time, and it finally snapped.
This may be the first time that doctors in Quebec have felt so personally abused. That their fate no longer depends solely on them. That they feel a certain vulnerability. That they have ceased to be the tail that always wagged the dog. That after enjoying a status of near-omnipotence for decades, they are becoming almost ordinary citizens.
Many doctors talk of disillusionment, disappointment, disengagement, and early retirement. We are afraid of the consequences, and rightly so.
After all, it is we who, collectively, dug the hole we are now trying to climb out of. If a group of just over 20,000 individuals holds the fate of a population of 9 million people in their hands, it is because somewhere along the line, we have seriously messed up.
I understand why doctors are angry. Still, I would have liked to see doctors protest when they were given outrageous pay raises that were completely disconnected from their effect on access to care and our capacity to pay for those raises.
I would have liked to see doctors protest every time one of their organizations lobbied to limit the number of medical school admissions, and when a former minister — who was also a doctor — reduced the number of admissions eight years ago. If we had done the opposite, we might be starting now to get our heads above water. But we’re drowning.
I would have liked to see doctors protest every time one of their organizations steered our public decision-makers to prevent the expansion of the scope of practice of nurses, pharmacists, and all health professionals who, in their fields of expertise, can do as well as or even better than doctors, and at a lower cost.
I would have liked to see doctors protest every time we learned that a doctor trained abroad was forced to move to another province or go back to their country.
Finally, I would have liked to see doctors protesting for the patients who died on waiting lists, or for all those who are slowly wasting away in indignity and filth, or who are waiting to die in a room shared with a stranger.
It is probably unfair to put it this way, but it is still a strange coincidence, whether it is doctors or others, that people always start shouting louder when it is about their wallet.
A freedom-killing and deceptive law
There is no doubt that Bill 2 has the potential to severely curtail freedoms, not only for doctors, but also for anyone who dares to express strong disagreement. Heavy fines are planned for those who wish to defy the law or even simply criticize it.
Everyone in Quebec seems outraged, on both the left and the right, but what else could we expect from an increasingly autocratic government that has accustomed us to preventive suspensions of fundamental rights (please see Bill 21 and 96) and has just tabled a draft constitution that, in addition to perpetuating the trampling of these rights, gives the ruling party the power to prevent a legal challenge to any law it deems essential? The CAQ is only being consistent with itself, whether it be on the rights of religious or linguistic minorities, the right to appeal to the courts, or freedom of expression. Assuming that this part of the law passes the test of the courts, will it really be applicable and enforced?
That’s not all. Bill 2, which spans over a hundred pages, details what work schedules should include and how to ensure their enforcement through a system of denunciation. If the government wants to exert that much control over doctors, why not simply change doctors’ status from independent workers to employees, as is the case in many European countries, instead of relying on an elaborate scheme that will poison the workplace? It is really hard to imagine that Quebec’s health care system will function any better with yet another layer of bureaucracy piled on top of everything else.
There is no doubt that Bill 2 is also illusory and deceptive. Its unrealistic targets are more like wishes than objectives supported by policies based on facts, data, and best practices.
The bill guarantees that all Quebecers will be registered with a doctor or a group of caregivers (which may include nurses) by 2027. Maybe Santé Québec, the province’s new public agency that oversees health care operations, will find a way to “register” all Quebecers, but that won’t increase the overall number of doctors or access to timely care. This is pure fiction, a misleading election campaign slogan inscribed into a law.
The same goes for so-called “national targets”: 90 minutes for emergency care, 4 hours for ambulatory patients, 14 hours for stretcher patients, 12 months for surgery, and so on. These targets are a sham. Even if they were achieved, Quebec would still lag behind other Western countries in terms of access to timely care. And Quebec patients would remain in their natural state: waiting.
Reform after reform, instead of changing the fundamentals of health care (resources, practices, and incentives to adopt the best ones), Quebec’s Health ministers, whether they are doctors or not, are just trying to make a system comply by giving it orders and setting targets and constraints.
It has never worked, and it never will. Instead of implementing the best public policies, we rely on magic thinking, hoping that results will improve simply by moving things around and adding more rules. We are working backwards.
Bill 2 will not create doctors, nurses, hospital beds, imaging equipment, operating rooms and time management methods that aren’t from another century, or computer systems that aren’t from another millennium. Their absence is contributing to Quebec’s health care system’s current decline as the demand for care continues to grow faster than the system and those who support it can provide.
So here we are, with wishes and illusions, and believing in them. Bill 2 is steeped in willful blindness and large-scale lies that may be believed by incompetent politicians who know they risk being booted out of office in less than a year. It is desperate legislation by politicians who sat on their hands for seven years, after other politicians sat on theirs for 10, 20, 30 years.
There is little about the CAQ’s latest power grab that will improve health care in Quebec, and much more that is likely to deteriorate. But even without Bill 2, we were in bad shape to begin with, and have been for a long time.
We’re in for at least a decade of misery if we do everything right from now on, but we might still have a chance of getting out of this mess. I talked about that in this piece when the bill creating Santé Québec was introduced two and a half years ago. It was a step in the wrong direction. Bill 2 takes us further in that same direction, by creating more problems than it solves.
I don’t know how we’re going to get out of this without more damage being caused. Our only chance is to collectively realize how much we’re screwed.
We’re lacking everything, including doctors and the rest. (On that topic, politicians need to stop saying that there are enough doctors in Quebec or elsewhere in Canada. That’s not true.) There will be no miracle. Putting Quebec’s health care system in back into shape will require a sens of sacrifice and duty. It will require putting grudges and personal interests aside for the greater good. It will also require creativity, intelligence, and a good dose of humility, if only to admit that many mistakes have been made on both sides.
But there is little sign of this in the current discussion, and even less so among leaders, whether they be doctors or politicians.