exclusive: 28 quebec medical specialists quit ramq this year to go fully private

more than two dozen medical specialists — including five anesthesiologists and four orthopedic surgeons — had opted out of medicare by mid-july and have gone fully private despite a law last year aimed at stemming the exodus of doctors from the public sector to the for-profit sector, the gazette can reveal.what's more, the total number of doctors in quebec who have opted out stood at 821 as of july 14, down by just 1.5 per cent from the corresponding period last year, according to a review of the data by the régie de l'assurance maladie du québec. by comparison, fewer than 20 doctors have pulled out of medicare in all of the rest of canada.facing a public outcry over the exodus of doctors to the private sector, the coalition avenir québec government adopted bill 83 on april 24 last year, compelling all newly graduated physicians (whose education and training are subsidized by taxpayers) to practise in the public system for the first five years of their careers. the law also gave santé québec the discretionary power to disallow doctors from opting out in regions where access to certain medical services is threatened.a gazette analysis of the latest ramq data has found that no general practitioners opted out of medicare from jan. 1 to july 14, suggesting that all newly graduated doctors refrained from going fully private. however, santé québec did permit 28 medical specialists to opt out, giving them the ability to bill patients directly up to tens of thousands of dollars for a wide range of medical services that would otherwise be covered under medicare."this means that the government and santé québec are not willing to close the loophole that allows the doctors to (fully) enter private practice," said dr. xavier gauvreau, president of the pro-medicare group médecins québécois pour le régime public."the law clearly states that if there is a need in a particular region for a particular specialty, then you cannot allow this opting out to occur. but we've seen this trend since last year that they're allowing the specialists to opt out. the vast majority of the requests from the specialists were accepted, yet almost all the requests from general practitioners were rejected."if santé québec allows those transfers to the private sector," gauvreau added, "it means they don't consider the situation to be problematic in those specialties, which is complete nonsense when we take a look at the state of the health-care system right now. people don't have access to health care, but they're still allowing doctors to opt out."the opted-out specialists also include three dermatologists, three plastic surgeons, two urologists, two obstetrician-gynecologists, two ear-nose-and-throat specialists, two ophthalmologists, one general surgeon, one endocrinologist, one radiologist, one pneumologist and one specialist in rehabilitation.in total, 271 specialists have opted out to date, compared with 273 last year. meanwhile, a cumulative total of 550 gps have withdrawn from medicare, down from 561 last july.

wait lists surge for orthopedic surgery

although santé québec has boasted of a dramatic drop in the number of patients waiting more than a year for elective or non-urgent surgery, wait times remain a major problem for cancer and cardiac operations, with some heart patients dying before they receive a call to go to the hospital. and even among elective surgeries, access still poses a problem.for example, wait lists for hip and knee replacements have doubled since 2020. a record 28,530 quebecers were on wait lists for orthopedic surgery in july, including nearly 1,000 who had been waiting more than a year. the number of quebecers in need of a consultation with an orthopedic surgeon in the public system rose to 62,871 from 59,974 last year, with more than 45,000 waiting in pain beyond medically acceptable delays.yet despite such access obstacles, santé québec let four orthopedic surgeons leave the public system, with the total number of such opt-outs at 35. today, nearly one out of 10 orthopedic surgeons practises in the private sector in quebec.catherine brousseau, a spokesperson for santé québec, cautioned against reading too much into the ramq data."the data in the ramq report requires context before any conclusions can be drawn," she said in a statement on wednesday. "many specialist physicians become non-participants (in ramq) for short periods before rejoining the public plan, while others leave the network to retire. the published data represents a snapshot at a given date and can vary from day to day. therefore, caution is advised before interpreting year-to-year variations as a long-term trend."still, the long-term trend over the past quarter-century has shown a steady rise in the number of specialists working exclusively in the private sector.gauvreau, a medical resident in psychiatry, likened those doctors who have opted out to vampires sucking the public system dry."this is a clear case of the vampirization of the system," he said. "the surgeons who opt out of the public system take with them all their staff, including the anesthesiologists, inhalation therapists and nurses."the only ones who profit from the system that the caq put in place are the private clinics," he added. "the patients don't benefit from it. the caregivers don't benefit from it. and the system gets worse and worse."but dr. pascal-andré vendittoli, an orthopedic specialist and president of the fédération des médecins de pratique privée du québec, has countered that cash-strapped hospitals are not giving surgeons enough or time, and that's why they have no choice but to go private.aderfel@postmedia.comx.com/aaron_derfel

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