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Reflections during the Voting Period

Today is July 12, 2011

I am writing these thoughts just at the time when the Quebec Federation of General Practitioners has mailed out a ballot along with the documents it had promised to all family physicians in Quebec, explaining the agreement in principle. In the coming weeks, we will learn your verdict on this long process.

I certainly could have waited for the results of the vote, but my reflections would have been tinged by whatever the outcome was. In any case, I will have the chance to comment a bit later.

The past few years have been one of the most exhilarating times in my career of close to 30 years of union activity.

It all started in the spring of 2008 when I chaired a committee on promoting the value of family medicine and it ended in June 2011 when the Ministry of Health and the Federation reached an agreement in principle. Between these two points in time, we have succeeded in situating family medicine at the centre of the social concerns of the citizens of Quebec. We have succeeded in shifting the focus in health care from hospital waiting lists to access to a family physician. Everyone agrees about this, even our specialist colleagues. The MSSS has even made this issue a priority in its five-year plan for 2010 to 2015.

I believe that we have been successful in shifting the orientation of the managers from the hospital-centred vision dating back to the mid-1950s and bringing them into our world of first line care. Through our outspokenness and our straightforward approach we demonstrated the serious nature of our process which was also yours, i.e. that of all specialists in family medicine in Quebec.

This was not a simple task, in fact, quite the opposite. Our biggest opponent, much to our surprise, and without any doubt, turned out to be the president of the FMSQ. History will remember this, and if it is forgotten, we will see to it to remind everyone of what happened!

What will you decide now that the dice have been thrown? We had reached the end of the exchanges. The positions of the MSSS were clear, entrenched and were not going to move any further. We had committed to present the entire agreement in principle for review and decision of the majority. This was the only way to proceed in this case, given what is at stake in these negotiations.

We have reached the point where it’s up to you to express your opinion.

Will you accept this agreement, taking a pragmatic approach and telling yourself that this is the first skirmish on the theme of equity, taking the view that the battle has just begun? This draft agreement corresponds to what family physicians in Quebec wanted except in terms of closing the salary gap with the other specialists. Only time will allow us to judge how this issue will evolve. This is what the monitoring letter will allow us to do.

Are you going to reject this agreement because all of the objectives were not reached, since it is obvious that in spite of substantial investment in family physicians, I would even venture to say a historic investment by the government, there is still not enough to reach the finish line?

The government did indeed lack the funds needed to reach our objective, which can be explained in the current economic context, but there was also a lack of political will to avoid making a very difficult choice. By not significantly modifying the balance of power that could have facilitated the arrival of the next generation, the government backed away from taking a clear and decisive stand for family medicine. Surprisingly, it has opted for the technique of baby steps!

In either case, your leaders are ready! If the agreement is accepted, now that we know the sums available, the FMOQ intends to start work on the organization of care as early as this fall.

If the majority rejects the agreement, it will be the beginning of a long and hard battle. Magical thinking will not suffice, nor will good reason carry the day. We will all have to join forces in solidarity, because such a choice will certainly have consequences.

In just under a month we will know what you have decided collectively and we will continue, in one direction or the other, this struggle to the finish for respect.

I wanted to leave you with these few thoughts when I still do not know what you will choose for all family physicians, but at the point when all possibilities are still open.

Yours in solidarity,

Dr. Marc-André Asselin

AMOM President

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