Quebec’s ailing health-care system

By Krystle Wittevrongel
and Maria Lily Shaw

Quebec’s health-care system is suffering from poor accessibility. More than 20 per cent of Quebecers currently don’t have a family doctor. The overcrowding of hospital emergency wards and the long wait times that result are also notorious.

A key to improving the health system’s capacity is to address the shortage of physicians in the province. And that means examining the overly intimate connection between the College of Physicians and the government. The considerable influence the College has on the decisions made by the government is detrimental to the well-being of patients, whose needs and interests often don’t align with the College’s. For instance, the public’s need for a greater number of physicians may run counter to the College’s at least implicit interest in keeping doctors’ salaries high.

Krystle Wittevrongel

Maria Lily Shaw

But addressing the shortage of doctors in the province also means introducing several key reforms, all of which have already been tested in other countries with universal taxpayer-funded health-care systems.

The first dose of reform would be to increase the participation of entrepreneurs and the private sector in the provision of health-care services. Having a greater number of privately run facilities in the province would improve health system access and complement the efforts of the government-run system. Despite many unfounded fears, greater private involvement need not threaten universality. Rather, proof of its efficiency can be seen in countries with high-performing universal systems such as Sweden, France, and the United Kingdom.

The second dose of reform is to increase the number of doctors in the province. In 2019, the number of physicians per capita in Quebec was 52 per cent lower than the average – the average in other high-income OECD countries with universal taxpayer-funded health systems. It’s no wonder so many Quebecers do not have access to a primary-care provider.

The shortage of doctors is due in part to regulatory barriers that impede the integration of physicians trained outside the province. Quebec has the lowest proportion of foreign doctors in the country, at just 8.2 per cent, compared to the national average of 25.7 per cent, despite an agreement with France that’s supposed to make it easier for French doctors to practice here. One problem is that the application process can take two years to complete.

Easing the regulatory burden of practising in Quebec for all doctors (not just those from France) could help reduce the shortage. That’s not to mention the added burden represented by Bill 96, which regulates the language of interaction between doctor and patient, has Quebec health professionals worried and confused about the future. Political interference in doctors’ work can make medical careers less attractive in Quebec and very likely deter doctors from other provinces from practising here.

Another contributor to the problem is medical school quotas, which are an obstacle to increasing the number of home-grown physicians. At the moment, only 966 students can be admitted into Quebec’s medical faculties each year, with universities refusing more than 9,500 applicants per year. Allowing universities to decide for themselves how many students to admit into their medical faculties would help address the shortage of doctors in the medium and long term.

Just how many doctors are we missing? At the current rate of growth of Quebec’s pool of practising physicians, it would take the province 37 years to reach the 2019 OECD average. Especially given our aging population, we clearly can’t afford to wait that long, so we need to start getting creative in the use of existing resources. One way to do this is to allow other health-care professionals, such as specialized nurse practitioners and pharmacists, to make full use of their expertise. By relying on the skills of these care providers, doctors can be freed up to consider more specialized and complex cases or to see more patients.

To ensure Quebec’s health-care system functions properly and is accessible to all, the province’s government needs to consider how best to increase the number of physicians in the province, and fast.

Krystle Wittevrongel is a Public Policy Analyst and Maria Lily Shaw is an Economist at the Montreal Economic Institute. They are the authors of A Prescription for Quebec’s Doctor Shortage.

Krystle and Maria are Troy Media Thought Leaders. For interview requests, click here.

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