Have medical degree, must travel

While waiting lists lengthen, Quebec's graduating doctors have to go elsewhere to find work

17. Actualité archives 2007

In the lead-up to the March 26 election, Premier Jean Charest promised that his government, if re-elected, would hire 1,500 more doctors and 2,000 more nurses. Health Minister Philippe Couillard chimed in, saying that Quebec would be able to hire more doctors and nurses because enrolment in Quebec medical schools was up and more doctors would be graduating in the years ahead.
Just let the schools do their work and, presto, the manpower shortages that have forced the Quebec health-care system into low gear will vanish.
Such a nice, sunny portrait. So deceptive.
Saleem Razack, a pediatric critical-care doctor at the Montreal Children's Hospital and associate professor of pediatrics at McGill University, couldn't believe his eyes when he saw the Liberal Party election ads promising 1,500 new doctors.
"Most of us in the system felt that the promise was dishonest," said Razack, 42, who is also the director of the pediatric residency program at McGill. "We have well-trained, committed, fluently bilingual graduates in Quebec who cannot get jobs now."
I spoke to two such graduates, both of whom studied medicine in Montreal. One is doing a post-residency sub-specialty in the U.S. The other is in Montreal, completing her eighth year of a 10-year specialist program.
Neither wanted to be quoted by name. Nor did they want specific details of their educational history known. They are still hoping to get medical positions in Quebec and don't want to jeopardize their chances by speaking to a newspaper.
The doctor in the U.S. has the total support of the teaching-hospital department he wants to join. The head of the department is tireless in his efforts to persuade the Quebec government to give his star resident a position, and with it, the all-important billing number.
Even though this doctor's specialty is in an area with waiting lists, the government is categorical: He cannot be hired. According to its planning documents, there is no shortage.
Despite the fact that he wants to move back home to Quebec, he might have to resign himself to becoming one of the more than 12,000 Canadian-trained doctors who end up in the U.S. "I can't wait forever," he said. "I have to get on with my life."
The other doctor is a specialist in a field that cannot meet the demand for services, but on which the government has placed a hiring freeze. Even if a doctor in her field were to retire tomorrow, that person cannot be replaced.
She is hoping that in two years' time, when she will have completed her sub-specialty training, the government will have lifted the hiring freeze.
This year, she said, about six of her colleagues - fully trained doctors who have also completed their specialist training - have left Quebec because they could not get work here.
"They're trying to buy time until the freeze is lifted. They'll do a master's degree or go out West to fill in a maternity leave."
People always assume that she wants to leave for a better salary elsewhere, she said. "But I'm completely committed to Montreal. My family is here. My husband's family is here."
On the issue of meeting medical needs in the regions outside Montreal, she said, "I would be happy to spend two weeks a year working in the regions if the government said that's part of your Good Samaritan requirement, but it's not practical to uproot your family for two or more years."
More than 20 years have passed since Quebec instituted its current punitive system of paying doctors the full scheduled amount only if they leave Montreal to work in outlying regions. Thanks to the recent research published by the Canadian Medical Association Journal, we can now assess, in part at least, its effectiveness.
To no one's surprise, what has happened is that doctors are not leaving Montreal for Abitibi, they're leaving the province altogether. A pay gap of 35 per cent between what a doctor earns in Quebec and elsewhere in Canada, the program of forced relocation and the added difficulties of restrictions on operating-room time and equipment all conspire to push young doctors out of the province.
That promise to hire 1,500 more doctors? "It's the Big Lie," said the young woman who still hopes to practise in her home town.

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