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harls
Feb 27, 2008, 5:03 PM
Thought this would be an interesting discussion. This affects me directly as my wife is a nurse at the Hôpital de Hull.

http://www.cbc.ca/canada/ottawa/story/2008/02/21/ot-outaouais-080222.html


Experts float idea of unified Ottawa-Outaouais health system

Last Updated: Thursday, February 21, 2008 | 8:20 PM ET

CBC News

A single health-care umbrella group spanning the Ottawa River would be more efficient and effective than the separate Ontario and Quebec systems that serve Ottawa and Gatineau residents now, say experts inside and outside the region's health-care industry.

Douglas Angus, a professor at the University of Ottawa's Telfer School of Management, believes such a group would do a better job of attracting and retaining personnel to fill shortages on both sides of the river, as the regions would no longer be competing with one another.

"Even though there's a provincial boundary, the health issues should be dealt with as a larger region," said Angus.

Last year, the Outaouais health and social services budget was $556 million, but the Quebec region spent $70 million on top of that to get its patients treated in Ottawa.

The Outaouais is short of doctors and nurses in part because under the current system, the Quebec government doesn't pay doctors and nurses in the Outaouais as much as Ontario pays their Ottawa counterparts.

Boosting their pay to Ontario levels could lead to protests from health professionals in other parts of Quebec.

Although forming a single regional health-care system could result in the need to pay higher salaries to professionals in the Outaouais, Angus believes unifying the system would produce savings by making it more efficient. He said combining resources would avoid unnecessary overlap and could lead to better service.

Some senior administrators within the health care industry agree that health care providers on both the Ontario and Quebec sides of the National Capital Region should cooperate more.

"Certainly we could benefit from working together," said Jean Bartkowiak, who is on the board of directors for Ottawa's SCO Health Service, which runs four long-term care centres in Ottawa. "Whenever I have the opportunity, I try to impress that notion."

Bartkowiak, who also used to manage the Gatineau and Hull Hospitals, said there is already a dialogue going on among his colleagues.

"My hope is that that would lead to maybe a more unified health environment in the future," he said.

MNA believes in Quebec health autonomy

Quebec Liberal MNA Benoît Pelletier, the minister responsible for the Outaouais, said he wants more partnerships between eastern Ontario and western Quebec. For example, he said he wants Gatineau patients to be sent to Ottawa instead of Montreal when services aren't available in their own region.

"But I also believe in the autonomy of the Quebec system," he said.

The Quebec government is now willing to go farther to solve the region's health care problems, he said, adding that he has asked health-care providers in the region to make recommendations in spring.

However, if the Outaouais's health services continue to decline, residents may come to the conclusion that they cannot get from Quebec what they need, said Geraldine Hutton, the former head of the Outaouais health board.

"Quebec does not understand the Outaouais region," she said.

Hutton said many residents pushed from the 1950s to the 1970s for Canada to establish a national capital district like the District of Columbia in the U.S., and she thinks if things continue the way they have been going, the public will begin clamouring for such a government district again.



This last part I bolded intrigues me. I think a consolidated health region could benefit both cities. What do you fellow forumers think?

Aylmer
Feb 27, 2008, 5:07 PM
I think a NCR would definetly improve things (transport, Healthcare, Growth)
But not like DC: We would share a municipal government but we wouldn't have a common province.

:)

eemy
Feb 27, 2008, 5:19 PM
The logistics would certainly be complicated. Right now, Quebec isn't a part of the Canada Health Act, which I believe streamlines some of those cross-border health care issues. For example, it is just as easy for my Mom to get paid for treating a Manitoban as it is for her to treat an Ontarian. Billing for patients from Quebec is far more lengthy and difficult.

I do think a federal districts would serve the NCR well. Ottawa is really at a disadvantage due to its remoteness from Toronto where Ontario politics really focuses.

harls
Feb 27, 2008, 5:27 PM
Moving patients from Gatineau to Montreal for complex surgeries makes no sense when facilities are readily available across the river. A 2 hour ambulance ride could mean life or death in some cases, why should people's lives be at stake when they don't have to be? Makes no sense to me.

Things should be positioned geographically, not politically.

ajldub
Feb 27, 2008, 6:37 PM
Unfortuately Harls there are many things about the complex Quebec-ROC relationship that don't make sense to anyone. Although I would love to see a federal district for Ottawa-Gatineau because it would take out a bunch of really unnecessary levels of government from the region's affairs, I doubt it will happen in my lifetime if ever.

AuxTown
Feb 27, 2008, 10:55 PM
Moving patients from Gatineau to Montreal for complex surgeries makes no sense when facilities are readily available across the river. A 2 hour ambulance ride could mean life or death in some cases, why should people's lives be at stake when they don't have to be? Makes no sense to me.

Things should be positioned geographically, not politically.

Just a couple of insights into this issue. First thing, we do not ship anyone to Montreal for emergency surgery, it is all performed at the Ottawa Hospital. It would be ridiculous to risk someone's life for the sake of a provincial border. Second, there is one reason and one reason alone why people from Quebec can't use Ontario medical facilities; the Quebec government pays their doctors crap! That is the reason for the severe doctor (and especially quality doctor) shortage in Quebec. When patients come to Ontario, the doctors here are only paid 2/3 what they normally make. The only exception is CHEO who has a secret deal. The Quebec government gives a large amount of money to Ontario so that their residents can use CHEO and that the doctors get paid properly. This is to avoid having to build any decent pediatrics facility in Gatineau, but now with the doctor shortage most Gatineau families use the CHEO ER like a walk-in clinic. It always frustrates me that Quebec has not signed the Canada Health Act so that they can pay their doctors peanuts and to, in essence, screw over Quebec residents from getting the universal health care they deserve.

ajldub
Feb 28, 2008, 9:28 AM
Nobody gets transferred to Montreal because there is no medical or surgical emergency that couldn't be handled at one of the Ottawa sites. The only reason I could foresee someone from Ottawa getting transferred to Montreal would be for a very obscure neurosurgical consultation - which wouldn't be an emergency. If Quebec's only problem was the way it pays its doctors and nurses that would be one thing. And letting the Outaouais join Ottawa to create a federal district would be great news, but what are the odds that the Quebec government would ever hand over part of its jurisdiction to the federal government without a HUGE buyout? Slim to none. Maybe in a few generations things will change...

Acajack
Feb 28, 2008, 3:14 PM
A few points :

- A huge buyout? Quebec territory is not for sale. Gatineau is the fourth largest city in Quebec. Would Canada or Ontario even consider lopping Windsor off and have it join with Detroit and Michigan? I know Quebec and Ontario are the same country but still… Quebec won’t even transfer small bits of land to the NCC to enlarge Gatineau Park (although it would still remain Quebec territory officially), so an entire city/region is unconscionable. It would be political suicide.

- No one ever gets transferred from Gatineau to Montreal for emergency surgery. Yes, patients from Gatineau do go to Montreal for certain treatments for the simple fact that, as a much larger city even than Ottawa, there are certain specializations available in Montreal that aren’t offered anywhere in Gatineau OR Ottawa even. Some patients from Ottawa and Eastern Ontario also go to Montreal for specific treatments on occasion.

- CHEO does have a special deal with Quebec and welcomes Quebec patients with open arms. I believe that the Quebec Ministry of Health actually contributed to the financing of CHEO when it was built. As well, money collected in the Outaouais during the huge Quebec Opération Enfant Soleil telethon (equivalent to the Children’s Miracle Network Telethon) also goes to CHEO.

- Merging the Gatineau and Ottawa health networks would only move the problem a few kilometres east. As Quebec Health Minister Philippe Couillard said recently, then you would have the Petite-Nation and the Laurentians (both located not too far from Gatineau) asking for special status, then the next region over, and so on, and so on…

- People should not forget that salaries in Quebec (and everywhere else for that matter) are based on the average cost of living. Nurses in a given province make pretty much the same salaries whether they live in the expensive largest cities or cheaper rural regions. This is true with Quebec nurses’ (and also teachers’) salaries, which are largely lower than in Ontario because they are geared to a society where the cost of living is quite a bit lower. The “rub” is that the Outaouais abuts Ontario, where salaries are higher to take into account the higher average cost of living across Ontario when compared to Quebec. So many teachers, nurses and doctors from Gatineau can get the best of both worlds: the lower Quebec cost of living plus higher Ontario salaries.

Acajack
Feb 28, 2008, 3:21 PM
That is the reason for the severe doctor (and especially quality doctor) shortage in Quebec.

Not sure if I fully buy into the “quality doctor” argument, which is often applied to Quebec vs. Ontario and also more broadly to Canada vs. the U.S.

Though I’ve heard all the arguments about better equipment and research funding (particularly in the States), in a lot of cases, it all boils down to cash. And I’m not sure if someone who jumps at the first chance to make lotsa cash (especially when the taxpayers back home have funded the vast majority of their med school education!) is always a person who holds the Hippocratic Oath very close to their heart.

AuxTown
Feb 28, 2008, 11:27 PM
Not sure if I fully buy into the “quality doctor” argument, which is often applied to Quebec vs. Ontario and also more broadly to Canada vs. the U.S.


As a medical student graduating in two months I can tell you that it is a fact that Quebec does not have the same quality of physicians that Ontario has. Not only do they pay their doctors significantly less, but they pay residents on average about $11000 less per year (which is significant seeing that residents only make between 50-70k). They also take salary away from residents when they want to do electives anywhere outside of Quebec (nowhere else in Canada is this common practice). So it's not just a matter of money, but also of opportunity. For example, people training in glamorous specialties like Cardiac Surgery need to do some placements at world-class centres like the Ottawa Heart Institute, The Cleveland Clinic, or Texas Heart if they want to be taken seriously. The training system in Quebec makes it difficult for residents to do such rotations, making it not a very smart choice for the best candidates in cardiac surgery to go there. Thus, all of the top medical students from accross Quebec (at least the ones that are functional in English) are doing their residencies in Ontario and Alberta (lots more money in Alta) and most are not coming back to work in Quebec after their training is finished due to the poor salaries and disastrous hospitals. At the same time, you can count on your hand the number of out-of-province students applying for residency spots in Quebec for the same reasons mentioned before. Quebec can do what it wants with its money but, if they want to start attracting a bigger quantity (and a higher quality) of physicians, they better start shelling out the same cash as the rest of the country.

p_xavier
Feb 29, 2008, 3:10 AM
Quebec can do what it wants with its money but, if they want to start attracting a bigger quantity (and a higher quality) of physicians, they better start shelling out the same cash as the rest of the country.

Absolutely. Is it still the rule that Canadians need to pass another medical exam if they want to practice in Québec? (I know it was the case 3 years ago). There is nearly 15% more doctors per capita in Québec compared to Ontario. Blame it on how francophones can't manage properly. It's too much in their culture for hoping of a change.

Québec: 2.05 per 1000 Ontario 1.79

The problem with Québec, is that it's Québec. People like to be different for the sake of being different, they don't like to be compared to other countries or places, because they are "unique". My family doctor is from Montréal, he was born in France, he speaks perfect French, he took a year before he spoke to me in French. He said he's seen as a traitor. Why did he leave? Because he can't do surgeries, they have too many quotas, too many administrative documents to fill, it doesn't stop.

GOOD THINGS GROW IN ONTARIO. THAT INCLUDES IDEAS.

ajldub
Feb 29, 2008, 9:55 AM
Hey OTown I'm graduating this spring too. What programs have you applied to?

AuxTown
Feb 29, 2008, 1:20 PM
Family Med, you?

Acajack
Feb 29, 2008, 2:16 PM
Blame it on how francophones can't manage properly.

Either I’m missing something here or this smacks of racism.

StephL
Feb 29, 2008, 2:26 PM
Blame it on how francophones can't manage properly.

Yeah but we're more fashion and epicurious. I work with a bunch of anglos in Ottawa and very often at lunch time I have to explain what I'm eating cause they have no clue what couscous (!), raclette, or arugula is (and these people are professionals with university degrees).

So the juxtaposition of anglos and frenchies here in makes it for an interesting region, you can show us how to manage and we'll show you how to be less square and enjoy the good things in life. :-)

Acajack
Feb 29, 2008, 2:35 PM
(Sarcasm on)

Sure folks….
Francophones can’t manage.
White people can’t dance.
Asians are antisocial and introverted.
Jews are eccentric.
Black guys can’t play quarterback.

(Sarcasm off)

One can’t dispute that the world’s many peoples are all different, but I find this discussion is taking a slightly disturbing turn.

StephL
Feb 29, 2008, 2:45 PM
My previous comment was to be taken tongue-in-cheek.

I think the real issue for the differences in pay for nurses and doctors between the 2 provinces has to do with the fact of one province having a better economy and being richer than the other so its population can afford the higher salaries and offer better work conditions. In my opinion that's what it boils down to.

Acajack
Feb 29, 2008, 2:51 PM
StephL :

Je m’excuse si tu pensais que je te visais avec mon sarcasme. C’était plutôt à D Jeffrey que je m’adressais.

Jamaican-Phoenix
Feb 29, 2008, 2:54 PM
Hate to break it to you Acajack, but les Francophones aren't a race. ;) :P

Acajack
Feb 29, 2008, 3:14 PM
Then neither are the Jews I suppose? But that hasn’t prevented people throughout history from doing all sorts of bad things to them.

“Race” is of course a concept that is impossible to nail down. However, French-speaking Canadians are an easily identifiable human group, and as such can most certainly be victims of racism.

ajldub
Feb 29, 2008, 7:43 PM
ortho. We had our interviews in Ottawa at the Heart and Crown the same night you guys did; we were downstairs... there were some good looking girls interviewing for that program!
:banana:

p_xavier
Feb 29, 2008, 10:04 PM
StephL :

Je m’excuse si tu pensais que je te visais avec mon sarcasme. C’était plutôt à D Jeffrey que je m’adressais.

Je suis francophone, pis ça change pas le fait que les francophones savent pas gérér. La belle "culture" dont tout le monde sont si fiers de leur peuple, c'est un amalgame de stéréotypes. You can't have a culture without stereotypes, these go hand in hand together.

So just say that to Couillard, where he said that the CUSM was better managed, it was because of the Anglo culture. The same thing was said about Expo 67.

If you can't appreciate the difference of cultures, too bad for you. As a group, francophones manage less well than anglophones. That doesn't mean that a francophone can't manage well, or that can't be changed for the future.

ajldub
Feb 29, 2008, 10:50 PM
Thought I'd throw a little gasoline on the fire here: you actually can make a convincing argument that pur laine Quebeckers are a distinct race unto their own. Genetically speaking, the population is a product of what scientists call the 'founder effect', whereby a small group in a population breaks off from the rest and interbreeds through successive generations, thereby increasing the incidence of their own genes. One gene I can think of in Quebeckers would be Friedrich's Ataxia, a genetically based neurological disorder also seen in high incidence in Ashkenazi jews(another founder population), and far more common in Quebec because a colonist named Guyon(whose ancestors include the Dions) managed to survive with this disease beyond his reproductive years. Also, and this goes for 'pur laine' American colonial descendants too, most of them have larger frames and wider, load-bearing hips because they were more useful in building log cabins, defending against native attacks etc. So maybe Quebec is a race after all, as well as a nation and a way of life and all that other great stuff. You never know!

Acajack
Mar 3, 2008, 2:14 PM
D Jeffrey:

Actually, francophones are/have been in charge of several of Ottawa’s hospital. Jean Bartkowiak, quoted in the article above, is a francophone, and Jacques Labelle was in charge of the Ottawa General for quite some time.

My point was that I don’t think that anyone’s capacity to manage things (or play quarterback for that matter) should be rated based on blanket statements such as: X group can’t do X well. I want to be valued, and in fact think everyone should be valued, based on what they can do, rather than be prejudged based on one’s ethnic origin, language or whatever other trait. Or, as Martin Luther King Jr. said, on the “integrity of their character”.


Ajldub:

Interesting stuff. You point to Friedrich’s Ataxia, and there many other instances of the incidences of particular disorders more common in specific population groups. Interestingly enough, when my wife was pregnant with our first child, during our prenatal class the nurse if anyone was originally from the Île-aux-Coudres, an island in the St. Lawrence River east of Quebec City that for many years was quite isolated from the shore. Apparently children born of two parents from the same island are at high risk for certain problems, and this is a routine question asked in all prenatal classes across Quebec.

Finally, ajldub, the old stock francophone population in Quebec (and also francophones throughout Canada and the Franco-Americans in the U.S.) is largely descended from the 60,000 original settlers of New France, although in many if not most cases with a good dose of aboriginal and Irish blood thrown in.

But indeed, all of this still makes, as you say, this population group a very unique “mix”.

p_xavier
Mar 3, 2008, 4:39 PM
D Jeffrey:
My point was that I don’t think that anyone’s capacity to manage things (or play quarterback for that matter) should be rated based on blanket statements such as: X group can’t do X well. I want to be valued, and in fact think everyone should be valued, based on what they can do, rather than be prejudged based on one’s ethnic origin, language or whatever other trait. Or, as Martin Luther King Jr. said, on the “integrity of their character”.

I absolutely don't care in any individual case because I find it a waste of time and money. Just for the sake of political correctness, we have decisions made for one individual instead of thousands of people. These people should still have all the rights tho, but I'm talking about economic questions.

I was teaching stats for many years, I will still do a group X and Y depending on statistics. You're playing the emotions game here. You're also mixing, what is, and what will be. Statistics are a representation of the RIGHT NOW. It's like saying, black people, as a group, are better at basketball. Since more black people for cultural and economics reason, of course they are better. It doesn't mean that any other race can't be better than them.