It could be argued that the incoming president of the Canadian Medical Association (CMA) is a trifle impatient. After all, Dr. Robert Ouellet says that he is “allergic” to pilot projects and “a bit against consensus because I am a man of action.”
The problem with consensus, the 62-year-old radiologist explains, is that it smacks of more discussion, more study, which essentially impedes the goal of improving access in Canada's health care system. “It's not the time to do studies. We have so many studies. In Quebec, we are champions at this,” says the former Quebec Medical Association president. Rather, the CMA should take the plunge and make concrete proposals for change.
The second consecutive private clinic owner/operator to assume the CMA helm, Ouellet will succeed Dr. Brian Day on Aug. 20, 2008, at the association's annual general meeting in Montréal, Quebec.
Ouellet opened Canada's first private computed tomography (CT) scan clinic and now owns a stake in 4 other clinics in Quebec, including a pair of magnetic resonance imaging (MRI) clinics that his radiation technologist wife, Diane Marceau, oversees.
Ouelett wants to inject more competition into the system and foster more public–private partnerships. “Nobody wants to privatize the system like it is in the US,” he says, adding that every other health care system in the world has a mix of public and private delivery and that nobody has copied Canada's single payer system.
Raised with 2 siblings in the Montréal suburb of Longueuil, the son of a plant supervisor studied medicine at the Université de Montréal and after interning, entered a pediatrics residency. It soon lost its appeal and Ouellet shifted into radiology. “I like technology. I am an Aquarius, and believe in that. Aquarius as a sign is always thinking, always looking at the future, what is coming up.”
Ouellet first worked for a hospital radiology department in Trois Rivières, while enjoying regular rotations further north in LaToque, where, for a week every fall, doctors and residents disappeared into the woods to hunt.
In 1981, he was invited to join the staff of the newly minted Cité de la Santé hospital in Laval, near Montréal. Six years later, he was head of the radiology department when the hospital's chief executive officer informed him that it would be 2 years before the hospital could purchase a CT scanner, despite heavy demand.
The administrator was more than willing to send patients to a private clinic if Ouellet and colleagues were interested in opening one, so they began raising money and opened a CT clinic in 1987, staffing it, on a rotating basis, with 5 hospital radiologists, who are allowed to toil outside the public system because CT scans, MRIs and ultrasounds, if provided outside a hospital, are not covered by the province's health plan. Each spent about 15% of their time at the clinic.
In 1997, Ouellet opened the province's first private MRI clinic, again serving patients referred by his hospital, which didn't buy its own machine until 2002. But patients also came from as far as Gatineau, some 200 km to the west.
Ouellet stresses that patients need a prescription to receive services at the clinics, while test results are sent directly to doctors. “It's not like the US where people can just walk in off the street and ask for a full body scan.” Those not referred by hospitals, or workers compensation or auto insurance programs, pay out of pocket unless they have private insurance, which can cover as much as 80% of costs.
Quebec's pharmacare program, with its mix of public and private insurance coverage and deductible and copayment features, is a model for potential reform, Ouellet says. He notes that prescription drugs are not covered by the Canada Health Act. But while people don't want deductibles and copayments in the rest of the health care system, they seem quite satisfied with the way the pharmacare program operates.
The CMA is ideally positioned to promote systemic change by appealing to the hearts and minds of Canadians, Ouellet adds. A solution from doctors will “be good for the patients and good for the doctors.”
Ouellet also hopes to boost CMA membership among Quebec doctors, only about one-third of whom are now Quebec Medical Association (and hence CMA) members. That's long been sought and while membership has increased, particularly among medical students, the association's goal of signing up 75% of the province's doctors before this year's annual general meeting has proved elusive.