Montreal Health Care suffering from Rochon's 'Programme of Inter-regional Equity'
There are reasons why Montreal hospitals are particularly stressed these days. Exemplified by a television interview of a Hudson man in the Lakeshore Hospital Emergency, the fundamental answer lies in regionalisation of health care funding. . Based on the place of residence, the recent programme of "Equité Inter-regionale" redistributes health funding on a per capita basis without regard to where health services are being delivered. At the moment 34% of Montreal`s hospital services are delivered to patients who reside off island especially from the suburbs north and south of the City.(Milles Isles 43%, Norman Bethune 72.7%, Marigot 45.1%). The money to care for these patients is given to the region of residence and does not follow them to their place of care.
Since 1994 the budget for Montreal region has been decreased dramatically by the sum of 123.9 million dollars while the surrounding regions have seen an increase of 30 million dollars. Next year Montreal(40% of the population) has to deal with to 50% of the cuts while Laval can expect a 5% increase. If all goes according to plan the Montreal Board budget will have decreased by 500 million by the year 2000. Remember that a cut of 160 million closed nine hospitals.
Medical staffing on the island has also been severely restricted and, in the next three years, it is planned to decrease the number of specialists by 36 with a net increase of 136 to the surrounding regions. It is apparent the government has plans to close a further 1400 to 1800 beds on the island and transferring 30 % of our resources off Island.
The logic behind these figures, if any, does not take into account the age of the population, the daily commute of the population to the city for work and other activities, the high demand of city centre populations such as the homeless and HIV communities, the seeking of health care in the English language and the severity of the illnesses of referred cases. Further ,the fact that Montreal is a centre for training ,research and super-specialized cares not considered.
These changes will inevitably result in the decrease in the access to and standard of health care in the Montreal region and a restriction of patients right to portability of health care.
Montreal is not just another of 16 medical regions of Quebec, indeed each one is unique and the criteria used to assess needs must be refined. Our politicians and bureaucrats refuse to recognize it. Given the significance of off island political power in the national assembly to both major political parties in Quebec, as well as their disproportionate power in our medical associations (and even Alliance Quebec), we can understand, but not condone, the silence in response to these changes. The Equality Party feels that these changes represent, at best, a naive misunderstanding of medical systems, at worst a misplaced political interference in proper patient care.
Dr. Mark Roper
4500 Sherbrooke St. West,
Westmount, Quebec H3Z 1E6
937-8000 (fax)937-8884
The Editor,
The Gazette,
250 St. Antoine,
Montreal, P.Q. H2Y 3R7
January 26, 1999
Dear Editor,
My letter to you on the 12th of this month (Government should get tough with Unions) has created a significant response both within the hospital and in your editorial section. This is a complex and controversial issue that calls for clarification greater than a short Letter to the Editor allows and I thank the Gazette for allowing space for this in the commentary section.
First of all, I write this letter as a patient advocate. Although, it is difficult to enter this field of discussion, when faced with the unnecessary suffering of my patients in a deteriorating medical system I am bound to point out areas I feel would improve it.
Secondly the title of my letter(chosen by the Gazette) should have read Government should get efficient with health care workers. It is quite evident to me that there is great wastage of money and manpower within the present collective agreement of hospital workers that does not respond to the needs of patients. This may indeed mean getting tough with some areas that are without benefit. However the corollary is that other areas may require greater rewards.
I have worked many years at the Montreal General starting 25 years ago when I was a porter for a summer job. I have had the pleasure of working with many dedicated, efficient personnel who are worth every penny and more of what they are paid. They, as well as their patients suffer from the inefficient rewards system of the collective agreement, through decreased staff, cuts in maintenance, and lack of rewards for their initiative and excellent work.
A few facts. The details of the collective agreement are worked out by Quebec, based on similar agreements with other civil servants and applied throughout the hospitals and other health care institutions of the province. As a result the director of the hospital has control of less than 25% of his budget. The MGH was cut 6.7 million dollars (148.7 to 142) in the last five years while at the same time salaries and benefits increased by 4.9 million(106. to 110.9 million).A hospital cut of 4.5% is thereby transformed into a cut of 27% in non salary and benefit expenses such as equipment, maintenance, lab tests, and forces the closure of clinics, wards and operating rooms.
This creates the unique environment in a hospital where the North of generous union agreements meets the South of deep medical cuts. In my daily work experience as a community and emergency physician, and Hospital Department administrator, I am exposed to the resultant dramatic contradistinctions . I will present instances of them in alternating order as they often occur in my real experience.
- My patient, whom I visit in the Hospital, is sitting on a potty. No one has come to help him off despite being finished half an hour ago. When I inquire, I am told that two wards are now sharing an orderly. He will be returning in half an hour and my patient will be then placed in his bed.
- An orderly has hired an accountant to manage the funds equal to 80% of his annual salary which will be loaned to him interest free as he leaves for a year to try a new job. If it doesn't work out he can return to his previous job with another years seniority and pay back his loan over four years. The hospital borrows approximately one million dollars annually for the "Deferred Leave Benefit Programme" every year. There are usually one or two defaults from bankruptcy or leaving the country , so with interest it costs the hospital about one hundred thousand dollars a year.
- A young lady with abdominal pain waits another hour for her pregnancy test to rule out ectopic pregnancy. We could have had it immediately with the simple tests used in drug stores but they were cut to save money.
- A young clerk from emergency approaches me laughing. She just finished her Masters and is heading to Vancouver for a job and had come in to sign her departure papers. She was on standby all year but had been too busy to come in. She did not work a day all year. She was surprised to find out she was owed one weeks holiday pay and one weeks sick pay and received a nice cheque.
- The Emergency is busy. We would like to admit patients but we can't . There are three beds empty but there is not enough nursing staff to take care of them.
- The paid maternity leave of the Employment insurance programme(15weeks at 55% of salary) is supplemented to twenty weeks at 93%.Cost to the Hospital last year 809,361 dollars. Furthermore leave may be extended to two years without pay but with benefits which include holiday and sick pay, accumulation of seniority and insurance and pension plans maintained. Therefore an employee having had her third baby may be in her sixth year of maternity leave having received sixty weeks of almost full salary benefit plus vacation and sick days and may return to work at her old position at a higher pay scale because of the seniority she has accrued.
- The total budget of the Department of family medicine, which has approximately 7000 visits per year, has been drastically cut to just over 70,000 dollars a year . It has one secretary and .7 of a receptionist. Patients have a hard time getting through on the phone. Request for nursing support has been refused as was request for new pentium computer. A letter is sent advising me, the director , that there is no budget for printing of cards and stationary using the new MUHC letterhead. The budget for salary of director is the same. I am told we have to cut further.
- Union grievance procedures, where employees lodge a complaint against the Hospital or vice versa, cost the Hospital 182,256 dollars last year. The hospital must pay cost of hospital lawyer, employee representative and arbitrator.
- A patient of mine breaks his hip. He waits three days for his operation because we cannot afford to open another operating theatre. He develops a blood clot prior to the operation(usually a post-op complication) and suffers a near fatal pulmonary embolism prior to his surgery.
- After two years of work any unionised employee qualifies for Job Security(surely the most absurd of benefits in modern times ) If a position is closed the employee retains all salary and benefits while not working. He must take a position if one is found within the hospital sector within a radius of fifty kilometres. If one is not found his benefits remain, while not working, until retirement and his full pension commences.This has become a more likely scenario since the closure of hospitals has begun. Total cost of this program for all the Quebec hospitals last year was 50.8 million dollars.
- The surgery department has numerous requests for surgical equipment refused due to lack of funds. Because they are so essential, they borrow the equipment from the manufacturer in the hope that funding will be available next year. Studies are underway to assess the effects of delays of breast cancer treatment. They would be unethical if services were more available. New lab tests and medications are unavailable for cost considerations.
- With pressure of job cuts, and job security looming, generous package deals are made with employees. Some are hired back as temporary workers. Cost last year to all Quebec hospitals 143.5 million dollars. (N.B. More than total budget of MGH)
- Job hunters from Florida tempt talented young nurses to Florida. A very talented secretary in family medicine is bounced from her position by someone with more seniority.
- Unfortunately the only way to get an increase in salary or keep a job is seniority or job security. Job performance or standard of service to patients do not enter into the equation. Raises are built into the agreement according to time served. As the employee population ages the average salary paid increases. Three out of four nurses hired in Quebec are part timers without benefits. Understandably young talented workers are under rewarded and tempted by better offers elsewhere.
The collective agreement that has recently expired and is up for negotiation is an anachronistic and inefficient agreement, that endangers the future of medicare. The government balks at changing it and it's other collective agreements for fear of political damage from the well organized union lobby. However they should be aware that health services are deteriorating to such an extent that the political cost from the general public of not acting may be greater.
Changes need to be made that, in the end, benefit all concerned.The collective agreement should be patient based. Nowhere are services to patients specifically prioritised or rewarded. This should be an immediate priority and a patient representative should be at the negotiation table. Furthermore, benefits and salaries should be brought in line with the private sector. Quite simply, pay people who work well more money and pay people who don't work less. They both deserve it. As a result we will have more money to treat patients better. They deserve it even more.
Finally, it is food for thought that the inefficiencies mentioned in this letter are reflective of a wider problem within our civil service that our levels of government are failing to act on. They shy away from acting on these while taking measure that decrease by over 25% areas of medical care to people at their weakest and sickest moments. That's terrible.
Dr. Mark Roper
March 3, 1999
Dear Editor,
Dr Roper Answers His Critics
My comments on the efficiency of the collective agreement have drawn some critics. I do not disagree with many of their comments.
I agree that take home pay is too low, workloads are unfairly increasing, and that workers should have the right to earn decent wages and benefits that parallel the private sector (including maternity leave). I also agree that the government has seriously abrogated its responsibilities and imperiled the health of its citizens by actually cutting hospital budgets while allowing salaries and benefits to increase.
What they fail to grasp is that by eliminating the numerous inefficiencies in the collective agreements of public service unions, as I have argued, we would improve all these issues. It would also address the reprehensible situation that three out of four new nurses are being hired in this province as part time employees and denied full employment status. Most importantly, the health care of patients would improve.
It should give Ms. Magrichuck pause to know that during the last ten years, while she has not received a raise, the budget for salaries and benefits at the MGH has increased from $69,677,225 to $100,845,907 . Where has that money gone? The answer will certainly not come from her union's senior officers such as Mr. Cordeiro , who seems, by his letters, blissfully unaware that 1,100 health care employees stayed home last year receiving full pay, draining the system of 50.3 million dollars. (Not to mention the 143.5 million used to buy out other employees) Wouldn't this money have been better spent paying competitive salaries, hiring new employees full time and improving the standards of health care delivered to patients?
Another writer, Mr. Da Silva, evidently considers being paid to do nothing part of the right to earn a decent living and shame on me for repudiating it given the generous salary and benefits enjoyed by myself. Firstly let it be known that my salary for being Director of a Department is exactly 0 dollars a year and I even have to pay for the new hospital stationary and cards out of my own pocket. Secondly, shame would be more appropriately felt by those health care workers who sit at home collecting full salaries and benefits while watching the crumbling of our health system on their television sets. Even more shame should be felt by the politicians responsible for the perpetuation of these outdated and inefficient agreements.
Mr.Cordeiro expresses hurt at being criticized by a "family member" of the health care field. Let me be clear, I write these criticisms as a patient advocate. He should understand that I won't stand in solidarity with his fellow health care brothers and sisters and support an insupportable agreement while my patients suffer injury and death because of lack of funds?
This collective agreement, Mr. Cordeiro's so called "blueprint for job democracy", with it's job security, leave benefits, seniority based raises and non-competitive hiring practices , would not be out of place in the Iron Rice Bowl of Maoist China. It needs to be dragged into the modern day with a truly competitive and efficient rewards and benefits system based on excellence in patient care.
Inevitably it is the government's responsibility to deal effectively with this issue and negotiations are ongoing. If it fails, by bowing to political pressure, there will remain a congenital defect in our medicare system as it heads into the next century, prejudicing it's future and its projects such as the MUHC.
Dr. Mark Roper
The Editor,
The Gazette,
250 St. Antoine,
Montreal, P.Q. H2Y 3R7
April 22, 1999
Dr. Fieschi should be congratulated for her letter of the 14th of April.
There is indeed a long waiting list to find a family doctor as there seem to be long lists for everything else in medicare. It also seems
that the government is doing everything it can to make it worse.
These actions make sense when we understand the mercenary concept of 'cost control by inconvenience'. The concept was first popularized in by the US insurance companies by throwing insurmountable paperwork at doctors. The concept applies to any medical service that is given freely.
The payer controls costs by making it's services as inconvenient as possible every step of the way, from seeing your family doctor, getting your scan, to seeing your specialist and finally getting your
surgery if you need it.
It is, of course, the opposite of what should be a patient-oriented system.
But this is easier and prevents more 'politically inconvenient' decisions on improving efficiency within our government run medicare system. Perhaps we are at fault for letting the government get away
with it or perhaps it is an inherent part of having politicians run the medical system.
In any case, Madame Marois has recently stated there is no shortage of doctors in Quebec. So the next time you are inconvenienced in trying to find one give her a call at ????????.
Date: Wed, 30 Jun 1999 00:15:01 -0400
From: "Dr. Mark Roper"
The Editor,
The Gazette,
250 St. Antoine,
Montreal, P.Q. H2Y 3R7
June 23, 1999
With the collective agreement season upon us there is one key question to ask. Where is the money going to come from?
We do know that the federal increases in Medicare funding are going to
towards paying off accrued debts of the hospitals. We also now know that for next year MUHC will suffer another two million
dollar cut in its operating budget. I can also tell you that the Montreal General Hospital with a budget of 140 million dollars pays 110 million for salaries and benefits or approximately 72 percent.
The standard in the United States is 55 percent.
I predict that in the coming years there will be a further 5to 6 percent
increase in the salaries and benefits budgets of hospitals in the setting of a decreasing annual budget.
This has been the government's pattern over the last five years. This will result in nearly 80 percent of hospital budgets going to salaries and benefits. (Graph soon come) In a highly technological field such as hospitalized medicine, one can imagine implications of this trend.
1993/4 '94/5 '95/61 '96/7 '97/8 2000
Total budget 148.7 149.2 148.4 141.7 142 141.5
Salaries & Benefits 106 106 103.6 107.1 110.1 116
Dollars Remaining 42.7 42.9 4 4.8 34.6 31.1 24.5
The answer to this untenable tendency is to guarantee the hospital certain budgets outside of salaries and benefits to run, maintain, and equip their hospitals to do their functions adequately. Let the
governments find money elsewhere for the collective agreements (that they negotiate), in their overinflated bureaucracy instead of threatening the lives of our sick patients.
Date: Wed, 30 Jun 1999 00:05:36 -0400
From: "Dr. Mark Roper"
Saturday 6 March 1999
Hospitals' pain relieved:
Wed 884
Mark Roper letter 2000
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