Quebec's family physicians, specialists, residents and medical students have until Sept. 30 to convince provincial Health Minister François Legault not to let bureaucrats from regional health councils to decide how, where and when they may practise.

On Aug. 22, Legault notified the 4 federations representing the province's medical professionals that he intended to amend the Health and Social Services Act on Oct. 15. Under his proposals, all Quebec physicians would have to sign a 2-year "commitment," subject to automatic renewal, that would turn them into employees of regional health boards.

"These proposals are in no way acceptable," says Dr. Jean Rodrigue, director of communications with the Fédération des médicins omnipraticiens du Québec (FMOQ). "The minister's intention is to draft every physician in Quebec into the public service."

The regional boards would determine the type, location and hours of practice for each physician within their jurisdiction. Physicians who fail to fall in line would face stiff penalties, and physicians practising outside their "assigned jurisdiction" would not be paid. Doctors operating an autonomous business in unsanctioned areas would have to bill their patients directly for services.

Dr. Stanley Vollant, president of the Quebec Medical Association, says that based on its track record, he has no faith that the government will be able to administer the plan effectively. And, he adds, the government has put no counter offers on the bargaining table to address poor working conditions, lack of access to facilities and other problems.

"There is a complete and deliberate loss of choice," adds Rodrigue. Physicians would no longer be free to choose their place and scope of practice. And, he warns, under the new plan, physicians would owe their allegiance to the government, and this will undermine physician advocacy on behalf of patients. He says the new proposals are so unreasonable that the 4 federations have flatly refused to discuss them. Instead, they are sitting down with government officials to explore alternatives.

"Doctors in Quebec will not accept that our status will be different from the one doctors have across Canada and in the United States," emphasizes FMOQ President Renald Dutil.

The federations "will take any action necessary to prevent those proposals from becoming law," says Rodrigue. "We hope to convince the minister that this is the wrong way to ask for the collaboration of physicians."

These negotiations have ramifications for all Canadian physicians, warns Rodrigue, because if the Health and Social Services Act is modified in the way Legault proposes, "it will leave very little room for negotiation." And it could also have a domino effect across the country.

Legault's new proposals follow the passage of Bill 114, Quebec's hotly debated emergency-medicine legislation. The law was adopted July 25 after a Shawinigan man died en route to hospital after being turned away from a closed emergency room near his home.

As of Sept. 13, bailiffs — operating under the auspices of Bill 114 — had ordered about a dozen physicians to report for 14 emergency-room shifts at hospitals in Shawinigan, Dolbeau and Jonquiére.

Meanwhile, physicians complain that the province has made little effort to solve the administrative and bureaucratic problems that led to the emergency-room staffing problems, and has done nothing to cap the working hours of ER physicians, putting public health at risk.

Dr. Stéphane Ahern, president of the Fédération des médicins résidents du Québec, says the legislation is dangerous because several US studies have shown that working more than 30 hours per week in an ER increases the risk of medical error.

At some hospitals, doctors who used to volunteer for ER duty are now hanging back so that they won't be overworked if drafted to serve elsewhere by a health board. Not surprisingly, the health boards are finding it difficult to attract new graduates in regions where the bailiffs are active.

In one incident, the Saint Maurice health board tried to force Dr. Pierre Bareil, who lives in Cap-de-la-Madeleine but works in Quebec City, to cover 3 emergency-room shifts in that region on days when he was already scheduled to work elsewhere. Only phone calls from those institutions got him off the hook. Faced with the prospect of even more stringent legislation, Quebec physicians are on the verge of losing hope. Vollant predicts an exodus. "After practising in Quebec for 5 or 6 years, many of my colleagues in Baie Comeau are planning on taking the Canadian and American exams.

"We already have shortages of physicians and specialists in Quebec," he says. "If more doctors leave the province, the situation will be unliveable."

Journal of Psychiatry — Heather Pengelley, Montreal