Winter 2020 (Volume 30, Number 4)
AMRQ Update
By Nathalie Langlais, MD, FRCPC
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The fall of 2019 will be remembered for tight and sometimes
difficult negotiations between the Fédération des
médecins spécialistes du Québec (FMSQ) and the Ministry
of Health and Social Services. You will recall that the
Ministry, wanting to achieve large, one-off savings, wanted
Quebec specialists to agree to substantial fee reductions,
which did not happen. Instead, as a result of these negotiations,
l'Institut de la pertinence was born, a truly unique platform
where all medical associations now have the opportunity
to present their views on potential recurring savings
in their respective practices. For example, some may want
to reduce their fee schedule or eliminate procedures that
have become superfluous or obsolete, while others may
want to propose changes to clinical measures, such as their
frequency and/or relevance, target patients, etc., based on
the increasingly widespread principle of "Choosing Wisely."
For the Association des médecins rhumatologues du Québec
(AMRQ), this is a welcome exercise that will allow us to put
forward innovative ideas and solutions aimed at providing
the best possible care for our patients. The objective here is
therefore twofold: to improve efficiency of care while taking
part in this exercise. This is a great opportunity to present
our views on measures that we believe will be welcomed by
both the Ministry and our colleagues.
In the spring of 2020, the COVID-19 pandemic struck
Quebec, which nobody had expected. Quebec was the
worst-affected province in Canada with a high rate of infections,
25% of which were among healthcare professionals.
Quebec’s residential and long-terms care centers or centre
d'hébergement et de soins de longue durée (CHSLDs) were hit
hard, and specialist physicians were called in to assist this
particularly vulnerable population. In rheumatology, our
practice then changed completely and, overnight, telemedicine
became the new way of doing things. Most of our
activities continued with this new reality. We were less affected
by the offloading of clinical activities compared to
physicians in other specialties. During the first wave of the
pandemic, many activities had to be suspended, including
surgeries and endoscopies, and many radiology examinations.
These disruptions in service and the postponement
of operations and examinations will impact our healthcare
system for years to come. During this same time period,
many rheumatologists assisted by working COVID units
and provided care to hospitalized patients; we are grateful
to them. For about six weeks at the beginning of the pandemic,
Quebec's Public Health Department requisitioned
the majority of hydroxychloroquine reserves for COVID
cases with the result that only certain patients, including
lupus patients, were able to continue their treatment. Our
association made every effort to ensure that they would
continue to have access to the drug. Unfortunately, our efforts
were unsuccessful until Public Health finally changed
its ruling and allowed patients who had been deprived of
their medication to resume treatment.
We are now in the second wave of the pandemic and
this time the virus is circulating throughout the community
and is now affecting a younger population. Given this
sad state of affairs, Public Health has unfortunately had to
make the decision to impose new restrictions on the public
with the hope of limiting the spread of the virus, especially
with winter at our doorstep, and the season of flu, colds and
other viruses that could complicate matters.
In keeping with our Hippocratic oath, we must observe
government directives and guidelines, and show our support
for our patients.
In closing, I wish you all the best in staying healthy and
keeping your spirits up during these difficult times.
Nathalie Langlais, MD, FRCPC
President,
Association des médecins rhumatologues du Québec
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