Quebec is deliberately limiting the number of pediatricians
Its waiting-list push is focused on adult services, leaving kids behind
Once upon a time Quebec was “crazy about their children”. This province was once known for its innovative policies to support and strengthen families: access to universal daycare, parental leave, and community-centered programs for early child development. The Ministry of Health invested in training adequate numbers of pediatricians to care for infants, children and youth, and in supporting Centers of Excellence in our two internationally-recognized free-standing children’s hospitals, the Montreal Children’s and Sainte-Justine. There was even some cooperation at the FPT (federal-provincial-territorial ) level to look at comprehensive plans to care for, educate, and develop our greatest resource: children.
The dream has gone wrong. The government has turned a blind eye to the statements of people like James Heckman, a Nobel laureate in Economics, who, as reported in the Gazette by Peter Hadekel (“A healthy society can have huge payoffs” June 15, 2007), states that investment in early child development (including physical health, socioemotional health, and education) gives a rate of return between 17 and 20 percent for each dollar invested. In the health care sector, the number of pediatric trainees has decreased dramatically from 15 per year in the 1970’s to 5 per year at the Montreal Children’s Hospital. What this means is that academic departments in all the universities of Quebec cannot fill their teaching, and most importantly, their clinical service slots, leading to tremendous strain on the incumbent clinicians who still wish to deliver excellent care. Parents are not aware of this clear decision of the government to decrease clinical services for children by limiting physician numbers. Thus community pediatricians, overbooked and overworked, daily turn away 10 families who are pleading for someone to look after their newborns. The government response is that the family physicians will look after these needs, yet 1/3 of the population of Montreal cannot find a family physician. The Public Health Department of Quebec cannot deliver on their vaccination projects without community physicians; there are not enough nurses. As noted in a recent Gazette Op-Ed piece (“Fair play for doctors” June 16,2007), medical and surgical residents in Quebec know they are not valued, they know their incomes are 40% less than the rest of Canada, and they are not free to choose where they will practice after completing their training. A large number of qualified medical students who wish to train in Pediatrics are refused and go elsewhere in North America. Presently, if a pediatrician retires or leaves a teaching hospital, he or she cannot be replaced. Family physicians are not allowed the training time to learn about care of the ever-growing number of infants and children with complex physical and mental health needs. The government has not supported the development of partnerships between the few pediatricians remaining and the family physicians, one way of ensuring quality of care and better service delivery. Dr. Thérèse Côté-Boileau, President of the Pediatric Association of Quebec, has iterated a wonderful vision of how pediatricians and family physicians could work together, but the government does not listen.
As recently noted in La Presse by our colleagues at Hôpital Sainte-Justine, there are thousands of developmentally-delayed children on waiting lists for over 1 year for ABA (Applied Behavioral Analysis) therapy, language and occupational therapy. However provincial policies to improve access to care have targeted solely adult services (hip and knee replacement, cataract surgery, oncological treatment) While much needed, these policies also result in less attention and funding for the above critically needed services. The government, but hopefully not our Quebec society, seems to have chosen to accept a different level of care for children; it is ready to live with an unacceptable level of morbidity for children.
One gets the impression that bureaucrats in Quebec are fussing more about restructuring (Réseaux Universitaires and CSSS) and building personal legacies than listening to the needs of the population, both in large cities and in the peripheral regions. The policies are conflicting. The government says they want to improve access to care but simultaneously there are decisions to decrease critical human resources. Nevertheless the dream can be renewed. If the government truly listened to the needs of parents, children and youth, experts in developmental psychology and child development, and community and academic clinicians, there might still be hope.