A Quebec doctor with experience in both the public and private healthcare systems says private clinics are the clear winner when it comes to patient care.
Private clinics were formally allowed in Quebec following a 2005 Supreme Court ruling that helped spur legislative action permitting them to perform select surgeries.
Initially limited to just three procedures, Quebec’s private clinics now offer more than 50 different procedures covered by the province’s public system. It has given both doctors and patients a choice they didn’t have before.
“I never wanted to work in private,” Dr. Naila Debbache, a physician with a private clinic, told True North. “I started in public but there were so many rules. The first one was that when you work in Quebec as a doctor you have to first apply for a permit for the area where you want to work. I wanted to work in Montreal so I applied for a Montreal permit.”
Debbache was denied a permit for Montreal – a sought-after location for doctors – but was given one for Mascouche, an hour north.
Another obligation as a doctor in Quebec’s public system is that you must select a mandatory clinical activity from a list provided, which may include hospital work, long term care or working in a rehabilitation centre, depending on what’s available to choose from at the time.
After having to choose a mandatory clinical activity she didn’t want and six months of working in Mascouche, Dabbache decided to move back to Montreal.
She continued to practice there within the public system, however, working in Montreal without a permit led to the province garnishing her salary by 30% as a standard punitive measure.
“That’s when I decided to leave,” said Dabbache, who has now been working for a private practice for 10 years.
Quebec has the most private healthcare clinics in Canada, meaning if residents want to pay the price, they won’t have to deal with the ever-increasing wait times plaguing public healthcare.
Absurdly long wait times to see a doctor in Canada have become normalized in recent years and the problem has gotten exponentially worse over the past three decades.
According to the Fraser Institute, the average wait time to see a general practitioner and receive care was 27.4 weeks in 2022, with wait times increasing by 6.5 weeks just since the onset of the COVID-19 pandemic.
Dabbache’s practice operates three clinics around Montreal, where patients can often get a same-day appointment for the cost of around $200.
“It could be more, it could be less, depending on whether you’re booking an appointment for just one issue or if you want an overall checkup,” she said. “For specialists and procedures it will usually cost more but for a regular family doctor, an appointment will be between $200 and $300.”
Dabbache usually sees around 10 patients a day, with general appointments lasting between 30 to 45 minutes each.
“It’s better for the doctor and it’s better for the patient because you actually have time with them,” said Dabbache. “It’s not a five minute appointment, you actually have time to answer their questions. You have the time to examine them and it’s much more freedom for the doctor.”
However, the decision to work in the private sector was a difficult one for Debbache, who said it conflicted with her values, saying that she entered into medicine to help those most in need.
Working in a hospital also allowed her to meet and work with more specialists but the lack of work-life balance and overbearing bureaucracy eventually caused her to change her mind.
One of the benefits the private sector offers doctors is more schedule flexibility, as they can see half the amount of patients for the same money.
While the money is a draw for private physicians, it can also be the downside at times when patients need follow-up appointments, noted Dabbache, “and they have to pay every time they come.”
“Another downside is extremely high expectations from patients because they pay so much and sometimes their expectations aren’t realistic,” she added. “Basically, we practice the same medicine (as public). It’s just that they get to see you quicker but sometimes they think we have more knowledge or something, and that’s not the case.”
She said the transactional fee-for-service care can be awkward, too.
“Especially if they come to see you and it’s nothing and you don’t want to prescribe them anything, it puts you in a weird position because they just paid you $200 and you have to be like, ‘it’s nothing, it will just go away on its own,’” said Dabbache.
Allowing for more private clinics comes at a time when Canadians are becoming increasingly disillusioned with their provincial healthcare system. A recent poll by the Montreal Economic Institute found that 50% of Canadians were unhappy with how provincial governments have handled healthcare policy.
