At the best of times, the health portfolio in Quebec is not for the faint of heart.

Yet Dr. Philippe Couillard, Quebec's new minister of health, sounds undaunted by the challenge even though he is a political neophyte - probably because the 46-year-old neurosurgeon is clearly accustomed to working under pressure. "I realize the scope of the task and mandate that the premier has entrusted me with," Couillard told eCMAJ. "But I feel entirely ready to assume it."

So why would a neurosurgeon make the leap into politics? "It proves that there isn't just money in life, right?" said Couillard, who also served as the head of surgery at the Centre hospitalier universitaire de Sherbrooke. "I have an interest in public service, and I want to make a contribution."

He has his work cut out for him. The previous Quebec government was dogged by health care controversies because of long waiting lists and congested emergency rooms. Couillard recently announced an annual injection of $240 million to help address those and other concerns, including $60 million to shorten surgical waiting lists and $25 million to unclog ERs.

Couillard came face to face with these problems while practising in Sherbrooke. "The vast majority of people are satisfied with the quality of care they receive," he insists. "The problem is access - the waiting lists. People no longer have confidence that they will be able to see their doctor in time, they no longer have confidence that they will have their surgery or diagnostic test in time. And that is what gives rise to this loss of confidence, this cynicism toward the public system."

The government plans to announce additional investments in health in its upcoming budget, but Couillard says solving the system's problems will require more than money. Another key element, he says, is the plan to reform regional governance. Couillard spent a week in Alberta before the election call at the behest of Liberal leader - and now premier - Jean Charest. "It's not that we are going to do the same thing as in Alberta," he says. "But there are certain elements that were done there that will strongly inspire us, including the method of financing the regions.

For instance, "we want the management to be a lot closer to the places or the levels where the services are offered." The Liberals want to replace Quebec's regional health boards with "structures that are lot more flexible and a lot more integrated."

Couillard has already spent more than half of his life in medicine. A doctor by age 22, he was a neurosurgeon at 28. He practised at Montreal's Hôpital Saint-Luc and then spent 4 years in Saudi Arabia. Upon his return in 1996, Couillard moved to Sherbrooke. He has also served on the council of the Royal College.

Although pundits question his lack of political experience, they also acknowledge his familiarity with the system. "Already the people in the ministry have remarked just how much easier it is to brief me on dossiers," said Couillard. "Having practical knowledge makes a big difference."

Sherbrooke neurosurgeon Jacques Boucher considers Couillard's decision to enter the political realm a "big loss" to medicine because he was at the height of his career. He describes his former colleague as a decisive person who "will have a very independent spirit" as a politician.

Couillard performed his last procedure 3 days before the Quebec election on Apr. 14. Boucher says Couillard relished complicated cases, and this should serve him well in government. "Philippe loves challenges more than anything else," he says.

And as Quebec's new minister of health, he certainly faces some sizeable ones.

—Brenda Branswell, Montreal