In Quebec, exhausted paramedics feel ignored in yet another election campaign

With hundreds of thousands of Quebecers still waiting for a family doctor, and hospitals often overwhelmed and operating over capacity, health care has featured prominently in the province's election campaign.

But for all the emphasis on health-care solutions, little has been said about the pre-hospital network, which costs more than half a billion dollars a year, and where critical staffing shortages that threaten the quality of care, reports show.

That's not surprising to many paramedics who work in Montreal, one of the regions hit hard by the shortages.

"They usually don't even bat an eye about the pre-hospital network," said one paramedic, who's worked with Montreal and Laval's ambulance service, Urgences-santé, for close to five years.

CBC News isn't naming the worker, who said their job could be on the line if they speak to the media. The company declined an interview about the election.

"It's just demoralizing more than anything else," the worker said. "People are leaving, there's less and less staff, call volume is going up and up."

The ambulance service has been dire labour shortages for several months, as paramedics quit, retire or go on leave. Those departures include 24 who quit or went on temporary leave from May to July of this year — double the number who left between August and October of last year.

Most days, Urgences-santé operates with only half as many paramedics as it needs. Weekends and overnights are even worse, its union, the Syndicat préhospitalier, says.

Another blow to the sector came in August, when the Université de Montréal suspended admissions to its advanced emergency pre-hospital care program for the 2023-2024 school year.

A letter to students cited the Health Ministry's intention to reduce the number of advanced-care paramedics working outside Montreal as a factor in the decision. The new program only had its first graduates in 2018.

As for the election campaign, promises about pre-hospital care have been few and far between — and many of them seem out of touch with what paramedics are asking for, union leaders and workers say.

What's being promised

Québec Solidaire (QS) wants to get rid of the patchwork of public and private ambulance services across the province by making them all publicly run. Right now Urgences-santé is the only ambulance in the province that's publicly owned.

The QS and Parti Québécois (PQ) also promised to abolish scheduling that asks some paramedics to be available 24/7. 

"This is dangerous. They are tired, they make mistakes,"said Vincent Marissal, the QS incumbent in Montreal's Rosemont riding. 

"We have to correct that as soon as possible. It's the lives of the people that are in danger here."

Meanwhile the Coalition Avenir Québec (CAQ) and Parti Québécois (PQ) support the creation of a professional order for paramedics, something some paramedics have been pushing for since the 70s.

The two Urgences-santé workers CBC spoke to said paramedics feel a professional order would allow them to provide more advanced care, while others say the only thing that's required for that is political will.

Currently, Quebec paramedics aren't allowed to treat patients with medications used in other provinces, such as those used to treat a seizure or manage pain for a broken leg. 

"My worst call is any call where somebody's in pain but I can't help them to manage that pain," said one paramedic with Urgences-santé with more than 30 years experience. It's especially tough when paramedics can tell the person won't make it to the hospital, the worker said.

"That's what makes me cry at night, when we can't help."

"Quebec is pretty much telling patients that you don't deserve the same standard of care as the rest of Canadian citizens do," the other worker said. "It's a slap in the face of the population, that Quebec now is looking at its advanced care system, and saying: 'No, we don't want this.'" 

The CAQ also wants to widen paramedics' scope of practice by assigning them home visits and tasks at ERs to ease the strain on hospitals. It was the only major party to decline CBC's request for an interview on this subject.

"It'll take paramedics to do all those tasks, and we don't have them," said Claude Lamarche, interim president of the union representing Urgences-santé workers.

He's not against either idea, but said they don't do much to solve the crisis at hand. He says nothing will change as long as wages and pensions at Urgences-santé continue to lag behind those offered by competing ambulance services.

"We need to make Montreal sexy," Lamarche said. "They aren't applying and those who do apply don't stay long."

Still, the political candidates CBC News spoke to pointed to campaign promises they said will help paramedics, such as increasing the number of training opportunities for medical students or reorganizing CLCSs to ease the strain on ERs.

More money or smarter spending?

The Liberals say it's a problem of funding not keeping up. 

"It's not normal that the demand across the province has increased dramatically within the last four to five years and that the budgets haven't followed that," said André Fortin, the incumbent Liberal candidate in the Pontiac riding.

However, funding commitments for the ambulance network have yet to be outlined in the Liberals' financial framework document.

Besides a commitment of $225 million for a publicly run helicopter network in remote regions, announced by the CAQ, none of the major parties have announced funding commitments for the sector either.

Hal Newman, a former paramedic in Shefford, Que., said it's not enough to just throw money at the crisis.

"Simply pumping money into the system isn't going to work because if it's a privatized system and we pump money into a private company, there's absolutely no assurance that it's going to trickle down to the employees," he said.

Aside from Urgences-santé, ambulance companies in the province are private, but they do receive provincial funding. However, how they use that money isn't subject to oversight — something that's also been criticized by Quebec's auditor general.

That amounted to roughly $360 million in funding to private ambulances that couldn't be accounted for by health authorities over 2018 and 2019, according to a 2020 audit, just over 60 per cent of all funding to the sector then. 

The annual funding to private ambulances has climbed to $703 million since then. Meanwhile the amount going to Urgences-santé went from roughly $115 million in 2018 and 2019 to nearly $168 million today. 

"Funding for ambulance companies is not based on the actual cost of the services provided. The Health Ministry and regional health authorities know neither the financial situation of these companies, nor their real profit," the auditor general wrote in 2020.