There are times when Quebec politics feels like a Shakespearean drama. Case in point: The current outcry over a contract with the province's medical specialists.
To understand the nuances, some historical background about the complex cast of characters – and the even more complicated math – is needed.
In 2003, François Legault, then the health minister for the Parti Québécois government, signed an agreement with the Fédération des médecins spécialistes du Québec (FMSQ), promising to evaluate and correct the disparities in pay between doctors in Quebec and their counterparts in the rest of Canada. At the time, Quebec docs earned about 30 per cent less than those in Ontario.
Today, Mr. Legault is the Leader of Coalition Avenir Québec and likely the next premier, if the polls are right.
In 2007, Philippe Couillard, then the health minister for the Liberal government, signed a deal with the FMSQ, promising a 25.3-per-cent fee increase for specialists by 2016.
The head of the FMSQ at the time was Gaétan Barrette, who is now the Health Minister in the Liberal government of Dr. Couillard.
In 2014, Dr. Barrette renegotiated the deal with the FMSQ to spread the past two years of the promised increases over seven years. A "trailer clause" was added guaranteeing doctors increases at least equivalent to others in the civil service – 5.25 per cent over five years.
In 2018, the FMSQ deal was again "remodelled" to spread the remaining increases over until 2023, and the "trailer clause" was dropped.
All of which sounds quite mundane – until the dollar details leaked out.
The latest contract, which has been negotiated but not yet signed, calls for specialists to receive an a further increase, of 11.2 per cent, from 2015-23, which translates to $511-million. On top of that the province will fork out a $1.5-billion lump sum to specialists in 10 years.
That raised some eyebrows.
The FMSQ insisted they were getting no increase over eight years because parity with other Canadian doctors would be achieved over 18 years, instead of the 10 years promised initially.
Then the government tried to spin the deal as a money saver: The Liberals claimed the renegotiating actually saved $3.3-billion because the annual increases for specialists were less than for other civil servants.
That's when the backlash began in earnest.
Claude Castonguay, an iconic figure known as Quebec's father of medicare, called the deal "revolting" and said the claims of cost saving were "nonsense."
Public anger boiled over when media reports showed that Quebec specialists had not only caught up with their Canadian counterparts but surpassed them.
A medical specialist earns, on average, $403,537 a year in Quebec, compared with $367,154 in Ontario, according to the Canadian Institute for Health Information.
Between 2009 and 2016, the average earnings of a Quebec specialist increased a whopping $160,000 and they will continue to increase until 2023.
What the raw numbers don't capture is the context – the fact that these increases come at a time of widespread upheaval in Quebec's health system. Dr. Barrette, vowing to cut the fat, has revamped administrative structure, and imposed draconian measures on health workers.
Nurses in the province – who are currently negotiating a contract – are up in arms over policies such as mandatory overtime, and staging wildcat sit-ins to protest their work conditions. Seeing wads of cash go to specialists has redoubled their rage.
Meanwhile, little attention has been paid to family physicians. (Quebec is the only province that negotiates separate labour contracts with specialists and general practitioners.)
The Fédération des médecins omnipracticiens du Québec (FMOQ) recently signed a deal that gives them fee increases of 1.8 per cent annually for eight years, and there was nary a whisper of complaint.
(Meanwhile, in Ontario, doctors fees are actually being rolled back, causing political and labour woes there too.)
The reason is that Quebec's family docs earn a lot less than their counterparts in other provinces, an average of $255,428, compared to $311,373 in neighbouring Ontario, again according to CIHI.
Quebec will spend $4.7-billion on specialists and $2.9-billion family docs this year, and there are roughly 10,000 in each category.
This gap underscores one of the most pressing issues in medicine, and in Canadian health policy more generally – fee relativity.
Health care is a hands-on business, and nothing matters more to care than health professionals. We should pay workers, including physicians, well, but also fairly.
Right now, things are out of whack, and that it is – as Mr. Castonguay stated so bluntly – revolting.