Barrette accused of manipulating the numbers (Le Devoir)

By Amélie Daoust-Boisvert
Originally published on January 15, 2015
See original French text here: http://www.ledevoir.com/societe/sante/429001/travail-des-medecins-barrette-accuse-de-manipuler-les-chiffres

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Photo: Michaël Monnier Le Devoir

Québec deliberately omitted to take into account work days that they considered as too short to arrive at the conclusion that family doctors do not work enough. This strategy has been judged as dishonest by the Fédération des médecins omnipraticiens du Québec (FMOQ) [federation representing general practitioners].

Minister Gaétan Barrette has been stating, since the end of November, that 60% of doctors work less than 175 days per year, for an average of 117 days. But Québec fused “small days” of work to account only for days that bill for at least $665 of services. This represents a threshold of about seven hours of work and allows doctors to be compared to, for example, teachers, asserts the press secretary of the minister, Joanne Beauvais.

The documents that Le Devoir obtained from the cabinet of the minister in January after a request made in mid-December show in this way that for all general practitioners, the “real” average for all family doctors is rather 196 days of work per year. If we take into account only the 80% best paid doctors, which eliminates doctors working part time, the average climbs up to 216.5 days.

All these numbers are accurate, but they sometimes make for a somber portrait, and sometimes for a brighter one. The economist for the FMOQ, Denis Blanchette, reckons that the minister’s famous “117 days” are dishonest. While two half-days only count for one, “days that bring in $1200 of billing, or 16 hours of work, are not counted as two days in this calculation,” he denounces. This way of calculating days worked has never been used at a negotiation table, he adds.

Manipulation of the numbers? Gaétan Barrette defends himself. “It is a fair calculation,” says Joanne Beauvais.

Questioned Wednesday morning due to an ad by the FMOQ working to counter the information peddled by the minister, this latter party affirmed not wanting to give into a  “war of numbers”. “The number of doctors is increasing and the number of services is decreasing. It doesn’t take a PhD in economics or in health to come to the right conclusion!”

The volume of medical acts realized and days worked is, in effect, decreasing, no matter what statistics we use.

Despite an increase in medical personal of 5.6% between 2005 and 2010, the number of patients being seen decreased by 6.9% and the number of patient-contacts by 12.2%. This decrease is the same for male as it is for female doctors.

The FMOQ recognizes this.  “This is feminisation, young doctors, the weightiness of the clientele,” explains Denis Blanchette. “But at the same time, we do less quick walk-ins and more taking on of patients, particularly vulnerable ones. We delegate more to nurses and to other professionals.”

According to the RAMQ’s public data, the same data used by the minister’s cabinet, researcher Damien Contandriopoulos also concluded last year that the productivity of doctors was declining despite increasing renumeration.

Gaétan Barrette was enraged by this study when it came out. He just about trapped the researcher in an open letter that appeared in Le Devoir.

“I affirm here that his work is superficial and partial,” denounced the man who was president at the time of the Fédération des médecins spécialistes du Québec (FMSQ) [federation for specialist doctors]. “This ‘crude’ data does not allow us to evaluate the productivity of doctors,” he added. One of the principal reasons for which the renumeration of doctors had increased without an increase in productivity, he asserted, was due to a process of catching up in terms of compensation with the rest of Canada that was in progress. He also invokes other factors, like the feminisation of the field and a generational shift, lack of access to hospital resources and parental leaves.

And men, and women?

The majority of the documents that were provided to Le Devoir regarding the statistics behind the project of Bill 20 were public data from the RAMQ.

Le Devoir also received an undated document on “the evolution of the practice of general practitioners”. This document was produced with an eye to responding to journalists’ questions on the project of Bill 20 in December, with data and analyses produced by the MSSS before the arrival of Gaétan Barrette to his position, says Joanne Beauvais, who added to this information some email responses to questions posed by Le Devoir.

As well as averages in days worked that come out higher, we also find a different analysis by sex.

60% of female general practitioners work less than 175 days per year, compared to 54% of  male general practitioners in the same situation.

If we take into account all family doctors, even those who work part time, the average of days worked is 190 for women and 202 for men. Consequently, the gross renumeration of male family doctors is 27% higher than that of women, a gap of almost $50 000 per year in 2011-2012. It seems justified to believe that the 30% penalties anticipated by the project of Bill 20 for insufficient productivity will have a greater effect on women.

We also learn that the more years of practice a doctor has, the more patients they follow. On average, each family doctor followed 564 patients in march 2014. But the numbers are 376 for doctors who have less than 5 years of practice and 1086 for those with more than 35.

Many of the most recent numbers cited in this document are from 2010-2011 or 2011-2012.

The minister is ready for certain adjustments, suggests his press secretary, Joanne Beauvais, by email. The project of Bill 20 could “take into account maternity and pre-retirement leaves. The number of patients will also be weighted according to the degree of vulnerability and the socio-health region. For example, a patient dealing with dependencies who lives in a disadvantaged community could count as two patients. This will be the subject of negotiations.”

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Translated from the original French by Language and Dissent, a collectively-run blog supporting the anti-austerity struggle in Quebec. These are amateur translations written by volunteers; we have done our best to translate these pieces fairly and coherently, but the final texts may have their flaws. If you find any important errors in any of these texts, we would be very grateful if you would share them with us via email (languageanddissent [at] gmail [dot] com). Please read and distribute these texts in the spirit in which they were intended; that of solidarity and the sharing of information.

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