Opinion: Forcing new doctors to stay in Quebec would demoralize them even more

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Premier François Legault’s recent threat to force Quebec-trained doctors to practise in the province after they finish training, by using the notwithstanding clause, is a perfect example of missing the point. As an Ontario-trained doctor doing surgical residency in Quebec, I urge the government to instead ask itself why some physicians are feeling forced out despite a desire to stay in the Quebec public system.

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In 2024, an age in which computers exist, I had to utter this last week at work: “The addressograph doesn’t show up well without carbon paper when the forms are faxed.” If that sentence seems alien, it is because technology like addressographs and fax machines was abandoned by the general public decades ago, but is somehow still crucial in the “modern” Quebec health-care system. Many health networks in other provinces long ago updated to full-service electronic medical systems, making patient care safer and more effective, and tempting new Quebec doctors to jump ship.

Inadequate and outdated technology aside, language laws have also been alienating world-class talent. English is the universal scientific language. I am bilingual and regularly speak French, with the understanding that I should be able to speak in whatever language results in the best communication with patients.

However, English-speaking medical workers and patients may feel like they are in a climate of rejection because of recent Quebec government initiatives. These include the Health Ministry directive regarding the use of languages other than French in health-care settings (revised after outrage from the anglophone community), and the Office québécois de la langue française sending a francization adviser to visit the operating rooms of Santa Cabrini, a hospital founded by Montreal’s Italian community. The No. 1 reason for medical errors is poor communication, yet such actions by the government have risked worsening communication.

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Even if limiting doctors’ right to choose where they want to work was ethical, it isn’t justified by the claim that medical trainees must compensate the government for the cost of education. First of all, medical students and even residents, who have already earned their MD, still pay tuition, putting many of them hundreds of thousands of dollars in debt.

Secondly, despite being a mere “learner,” as the Health Ministry recently asserted in contract negotiations, my job duties include drilling holes in people’s skulls and performing chest compressions on dying patients. How much am I paid for these tasks? Just $6.74 per hour based on the hours I worked last week. (I don’t get paid overtime for a 126-hour workweek; we are only paid based on a 35-hour workweek.) I have completed 10 years of post-secondary education, have three university degrees, and my pay for life-saving work is far less than the minimum wage of $15.75. Not to mention, medical residents in Quebec are the lowest-paid in Canada. A first-year resident in Quebec is paid $49,258, while their Ontario counterpart is paid $67,045.

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Considering all this, the situation actually sounds like a steal for Legault’s government. Negotiations for a resident salary increase in Quebec have been at a standstill since the collective agreement expired in March 2021, however, with the Health Ministry arguing that residents don’t even deserve to be paid equivalent to hospital orderlies because the latter “have completed their training,” according to the Fédération des médecins résident(e)s du Québec.

By the time doctors finish residency training in Quebec, many are burned out from systemic inefficiency; unsafe working conditions stemming from poor communication and lack of adequate resources; language policing; increasing debt and, quite frankly, feeling completely taken for granted. Despite all of this, 60 to 77 per cent of graduating physicians in Quebec still choose to practise here, with three to four per cent working only in the private sector, because we love this province as much as we love what we do.

Maybe the key isn’t forcing us to stay against our will; maybe it lies in making Quebec health care an environment in which we want to stay. What happened to using a carrot instead of a stick?

Dr. Caroline Esmonde-White is doing her residency training in surgery at McGill University. This piece reflects her own opinions only, not those of her department or university.

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