Red tape and waiting lists push doctors out of healthcare and toward independent practice

Emmanuelle Faubert, Troy Media

When workers quit a workplace in large numbers, we tend to dwell – and rightly so – on what that workplace is doing wrong.

When those workers are doctors, though, and what they’re leaving is our government-run health system, the focus shifts from what might be changed to convince them to stay to what can be done to make it harder for them to leave.

We saw this at play in a recent Globe and Mail article on Quebec family doctors leaving the government-run system to work for, or launch their own, independent healthcare facilities. Instead of asking why doctors were leaving, the authors focused almost exclusively on what pieces of legislation made it possible for them to work outside the system.

So why are more Quebec family doctors leaving the government-run health system?

For starters, doctors leaving for independent practice say it allows them to focus more on a set number of patients, treating cases with varying degrees of gravity. In contrast, the government-run health care scheme would have them work more on urgent and critical care.

While such care is obviously necessary and laudable – treating illnesses such as cancer should remain a priority – what these doctors have recognized is that there’s a whole range of patients with less severe but nevertheless critical medical conditions who go untreated for years on government-managed waiting lists.

Patients with manageable diseases, such as asthma, can spend months on a waiting list just to get some tests done when they visit their regional hospitals in Quebec. These people spend a long time worrying about what medical issue they might have, suffering from an untreated ailment, all because the health system doesn’t prioritize them.

As Dr. Jad Hobeika explains, he left the government-run system because he was “uncomfortable with the number of patients on waiting lists” for some ailments, and he decided to do something about it by joining an independent practice. He can now provide treatment for those patients for whom long waiting lists were the only kind of care government-run establishments would provide.

For others, leaving the government-run health care scheme is a way to concentrate on their passion for medicine, as opposed to filling out endless forms.

According to a report by the Canadian Federation of Independent Business, Canadian doctors spend about 19 million hours per year filling out paperwork. Put differently, out of every 40 hours a family doctor works in this country, about 9.7 hours is administrative work.

Some of this is insurance or employment-related – the famous “doctor’s notes” used to justify an absence come to mind – but a good part of it is also directly connected to our single-payer insurance scheme.

In Quebec, the billing system is so complex that an entire cottage industry of public insurance billing professionals has popped up to reduce the burden on doctors billing medical acts to the government-run health plan.

As such, some doctors pay thousands of dollars per year for administrative subcontractors to enter the medical treatments they’ve provided into the correct box of long administrative forms so that they can receive their compensation.

It’s no wonder some opt for an independent practice, where billing is much simpler and more direct.

And then, of course, there’s also the question of more flexible scheduling, as doctors working within the government system have much less say about where and when they work.

Given these realities, it’s no wonder some doctors are looking to spend less time working within the government healthcare scheme and more working as independent providers.

Unfortunately for them, Quebec’s legislation doesn’t allow for mixed practice. This means that doctors who want to bill the government-run health plan for medical acts are prohibited from having any other clients. This sort of “either/or” approach means that if you’re tired of dealing with some aspects of the government system, your only option is to leave it altogether.

If Quebec were to allow this, some doctors in independent clinics would no doubt choose to work part-time within the government-run system as it offers more income stability.

And instead of focusing on what legislation can be adopted to keep doctors captive in the single-payer system, maybe we could think about addressing their concerns and try to understand why some of them decide to leave for independent practice.

Emmanuelle Faubert is an economist at the Montreal Economic Institute.