Doctors and medical specialists are calling the Quebec government’s proposed new bill, which would create major changes to the province's health care system, “catastrophic.”
Bill 20 — or, An Act to enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation — would impose minimum caseloads for family physicians and would end universal funding for in vitro fertilization.
“The minister is abusing his power,” said Diane Francœur, president of the Quebec Federation of Medical Specialists.
Minimum caseloads for family doctors
The Liberal government's Bill 20 will impose minimum caseloads for family doctors and specialists — meaning some doctors will need to see more patients or face penalties if they don't.
Health Minister Gaétan Barrette said that while family doctors in other provinces see about 30 patients a day, Quebec's doctors see about 14.
As a result, he said too many Quebecers end up going to a hospital emergency room.
“Younger doctors do make the choice today to have a better quality of life. The issue of giving full services to the population seems not to be in the equation," Barrette said.
The Quebec Federation of General Practitioners says it's stunned by the proposed bill.
It said the government never took the time to discuss the problem with the province's doctors, adding that coercive measures have failed to work in the past and could affect the quality of medical care.
Barrette denied that he's pushing doctors out of the province.
“If they were to leave Quebec, they might face the impossibility of finding a job.”
Barrette said he hopes after the new law comes into effect in 2016, every Quebecer will have access to a family doctor.
Parti Québécois health critic Diane Lamarre said the bill puts too much focus on numbers while ignoring quality of care.
“Incentives and disincentives — this is not the way physicians want to work. They want to work in partnership and being evaluated with the good outcome they have with their patients,” Lamarre said.
IVF dropped from RAMQ
Bill 20 also includes a plan to suspend public health insurance coverage for in vitro fertilization.
In addition, only women aged 18 to 42 would have access to IVF treatment — after passing a psychological evaluation.
At a news conference Friday afternoon, Barrette expanded on the proposed bill.
He said some exceptions could be made for women who have tried other therapies but had failed to conceive. However, women who had had a tubal ligation, men who had had vasectomies or a parent or parents who already had one child would not benefit from this exemption.
He also said that doctors who advised their patients to seek IVF treatments outside of the province would be subject to hefty fines.
If passed, Bill 20 would also limit the number of embryos with which a woman can be implanted to one at a time, except for women aged 37 or older. They would be able to be implanted with two embryos.
Under the proposed bill, the only assisted reproductive measure that would be covered by RAMQ is artificial insemination.
Women seeking IVF would benefit from a variable tax credit, based on their income.
Infertile couples, fertility doctors furious
"We are blown away to see that infertile couples – who have long campaigned for recognition of infertility as a disease – are not being considered as they should be," said Virginie Kieffer, president of a Quebec association of infertile couples.
The Quebec organization representing fertility doctors says it will do everything in its power to defeat the provisions of Bill 20 that would end universal funding for in vitro fertilization.
Dr. Francois Bissonette called the decision "catastrophic,” adding that Quebec's inclusion of IVF treatment under medicare has been a model for the rest of the country.
IVF program a victim of its own success
The new bill is Barrette’s response to an IVF program that has been so successful that it overran its budget.
In his previous job as head of the Quebec’s Federation of Medical Specialists, Barrette criticized the program.
He called it an "open bar" and said it was not an essential service.
Quebec was the first province in Canada to fully fund IVF treatments.