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

A proposed overhaul of Quebec's health-care system would eliminate mandatory overtime for nurses and change the way family doctors are paid, switching to payment on a per-patient basis, Radio-Canada has learned.

According to a 90-page document obtained by Radio-Canada, the Legault government plans to revamp the system by 2025. The plan includes 50 main measures, ranging from speeding up the processing of paperwork by hiring 3,000 new clerks this year, to changing how emergency rooms are run. 

The document — entitled "More Human, More Efficient" — said the province needs to ensure "that the [health-care] network becomes a more attractive work environment" if it's to succeed in recruiting much-needed staff.

To that end, it said the government will eliminate mandatory overtime for nurses "once and for all."

"We must no longer tolerate absences or unfilled positions being systematically covered by staff through overtime," it read.

Instead, the government aims to overstaff the system, to enable it to handle absences without relying on forcing nurses to work overtime.

The plan is to undertake a "massive" recruitment campaign, including hiring more than 1,000 nurses from abroad, in addition to the hiring of the new administrative assistants, who would be expected take the burden of paperwork off clinical staff so they can better focus on patient care, the document states.

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

"It is clear that a sustained effort to recruit and retain personnel will be necessary over the next few years in order to improve access to services," the document reads.

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

"It is by first meeting the needs of the public network that the government will be able to better regulate the use of private agencies," the document states.

End to fee-for-service payment for GPs

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

Under the new plan, family doctors would no longer be paid per act, but instead based on how many patients they have. Legault has long said one of the reasons so many Quebecers cannot 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 stepping back from a promise to get everyone a doctor.

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

Under that plan, Quebecers would call a phone number where a nurse would direct them to the appropriate medical service, whether that's seeing a doctor or lining them up with some other method of care.

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

However, there are also proposed reforms to how emergency rooms would operate. 

Every hospital would have a "command centre" that would tackle reducing wait times. The centre would be staffed by workers from different sectors, including the at-home care team and mental health professionals.

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

The aim is to reduce the wait time in every emergency room to no more than 90 minutes, the document states.

Should patients have right to demand a GP's care?

The Liberal opposition critic for health, Monsef Derraji, asked Thursday why it took the government four years in power before coming up with a plan to improve front-line care.

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

"As a patient, I think if I want to see my family doctor, I will say it. I don't want [the government] to 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 one general practitioner, it's a welcome change.

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

He said health care in the province is a "broken system," but that 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 from a nurse practitioner, a nurse, a dietitian, a social worker, a psychologist or doctor."

"Providing more of those sorts of allied health professionals would be much more effective than simply hiring more doctors."