The Legault government recently tabled a bill that would force new Quebec-trained doctors to spend the first five years of their careers working in Quebec’s public health network. New doctors who choose to work in the private sector or move to another province would face fines of up to $200,000 per day.
The bill not only ignores the value of medical services provided by doctors during their training, but it may backfire and actually result in fewer physicians working in Quebec—whether in the public or private sector.
Here’s why.
The government’s ostensible justification is that it costs Quebec taxpayers between $455,000 and $790,000 to train a new doctor, including residency, which in the government’s view requires new doctors to care for the people who paid for their training.
However, this view ignores the fact that medical students and residents provide services in hospitals and clinics during their training, so a portion of the expenses associated with their training should be seen as compensation for delivering services that would otherwise require hiring other health-care professionals.
And while the government is correct in citing an uptick in the migration of doctors from the public sector to the private sector, it fails to acknowledge this is a signal that working conditions in the public sector are increasingly less attractive than in the private sector.
It’s also worth noting that many Quebecers are willing to pay for the public system (and publicly subsidized physician training) and for private care, which suggests the private system is also valued by patients.
The imposition of an outrageously large fine may trap a small cohort of doctors in the public system for a short period of time, but it will also make medical education and residency training in Quebec less attractive to future doctors. Again, this policy may actually contribute to the increasing scarcity of doctors in the province, the opposite of the government’s intention.
Forcibly shackling new doctors to the public sector for a period of time is also not really a solution for the long term. Doctors may still leave for other opportunities if working conditions in the public sector fail to improve relative to alternative options. Instead of threatening physicians with fines, the government should improve the public system to retain physicians and better serve patients.
Finally, the Quebec government also subsidizes the education of other professionals including lawyers, accountants, scientists, and professional managers. Should these people also be essentially forced to work in the public sector for some period of time? Taxpayers and students in Quebec would likely balk at such a policy.
The growing number of doctors working exclusively in Quebec’s private sector is prima facie evidence that Quebec residents value the services they receive at private clinics. Rather than using financial penalties to keep specific cohorts of young doctors practising in the public system for a short period of time, the Legault government should utilize an efficient private sector more intensively in conjunction with an improved publicly funded health-care system.
Simply put, the solutions to Quebec’s health-care woes will not be found in penalties for new doctors, but in actual improvements to the system.
