Quebec to end mandatory overtime for nurses and pay family doctors per patient, leaked document says

A plan to overhaul Quebec’s health care system would eliminate mandatory overtime for nurses and change the way family doctors are paid, moving to pay-per-patient, Radio-Canada has learned.

According to a 90-page document obtained by Radio-Canada, the Legault government plans to overhaul the system by 2025. The plan includes 50 key measures, ranging from speeding up the processing of paperwork by hiring 3,000 new clerks this year , to the modification of the emergencies function.

The document — titled “More Human, More Efficient” — states that the province must ensure “that the [health-care] network becomes a more attractive work environment” if it is to succeed in recruiting the staff that is so badly needed.

To that end, he said the government would eliminate compulsory overtime for nurses ‘once and for all’.

“We must no longer tolerate absences or vacancies being routinely covered by staff through overtime,” it read.

Instead, the government aims to overstaff the system, to allow it to manage absences without having to force nurses to work overtime.

The plan is to undertake a “massive” recruitment campaign, including the hiring of more than 1,000 nurses from overseas, in addition to the hiring of new administrative assistants, which should ease the paperwork burden of the clinical staff so they can better focus on patient care, the document says.

The government is determined to eliminate compulsory overtime for nurses, which would address a major complaint from nurses, especially since the start of the pandemic. (Radio Canada)

Each facility would also be allowed to manage its own schedules, with input from staff.

“It is clear that a sustained effort to recruit and retain staff will be necessary over the next few years in order to improve access to services,” the document states.

The government also wants to reduce the system’s reliance on private agencies to provide temporary nurses and orderlies. Currently, many hospitals and long-term care homes rely on these agencies to fill positions when they are short-staffed, at a higher cost.

“It is by responding first to the needs of the public network that the government will be able to better regulate the use of private agencies”, indicates the document.

End of fee-for-service for general practitioners

The government also intends to radically change the way front-line health services are provided, starting with the way family doctors are paid.

Under the new plan, family physicians would no longer be paid on a fee-for-service basis, but rather on the basis of the number of patients they have. Legault has long said that one of the reasons so many Quebecers can’t find a family doctor is because too many general practitioners limit the number of patients they see.

There are some 945,000 Quebecers who are still on the waiting list for a family doctor, according to the document. However, the government seems to be going back on its promise to have a doctor for everyone.

The leaked document outlines alternatives for frontline care, including giving nurse practitioners, paramedics and pharmacists more power to treat patients.

Under the plan, Quebecers would call a phone number where a nurse would direct them to the appropriate medical service, whether to see a doctor or to align them with another method of care.

It is hoped that under this plan, fewer Quebecers would need to go to a hospital emergency room for health issues that could be treated elsewhere.

However, reforms are also proposed regarding the operation of emergency rooms.

Each hospital would have a “command center” that would address wait time reduction. The center would be staffed with workers from different sectors, including the home care team and mental health professionals.

The center would aim to discharge patients as soon as their condition is no longer critical but would ensure that the patient “continues to benefit from services outside the hospital if his state of health requires it”.

The goal is to reduce wait times in each emergency room to no more than 90 minutes, the document says.

Should patients have the right to demand the care of a general practitioner?

Liberal Opposition Health Critic Monsef Derraji on Thursday asked why the government took four years in power to come up with a plan to improve frontline care.

He said his biggest concern about the plan was whether Quebecers would have access to a family doctor, if that’s their preference.

“As a patient, I think if I want to see my family doctor, I will say so. I do not want [the government] say, you’ll see another professional,” Derraji said.

“There is no guarantee [in the plan] that if I want to see my family doctor, I will.

For a general practitioner, this is a welcome change.

Dr. Marc Cotran, 45, is giving up his family practice in Montreal and returning his license on April 1.

He said health care in the province is a “broken system”, but letting other medical professionals treat patients more directly is just common sense.

“Patients don’t necessarily want a doctor. They may think they need a doctor, but what they need is care,” Cotran said. “Care can be provided by a nurse practitioner, nurse, dietitian, social worker, psychologist or doctor.”

“Providing more of these types of allied healthcare professionals would be much more efficient than just hiring more doctors.”