Two young ER doctors quit Montreal jobs, blaming Quebec's broken health-care system and Bill 96
Two young emergency room doctors, raised and trained in Montreal, are leaving their jobs after only two years to move back to Toronto – and they say the Quebec health-care model and Bill 96 are to blame.
The doctors, who work at the Jewish General Hospital, are headed back to Ontario, a move they've made before – but this time, they say they don't expect to return home anytime soon.
The married couple says they can't see a way forward in Quebec for themselves and their two boys, aged three and one.
So two different Toronto emergency rooms are preparing for their arrival, with jobs waiting for them.
"It was a really tough decision," said Dr. Daria Denissova, 34. Her husband, Dr. Philip Stasiak, 37, said they made it "with a heavy heart."
"I love Montreal. It's the city I grew up in, and to leave it again for the second time, it's disappointing," Stasiak said.
They are leaving at a time when the Quebec health-care system has been heavily criticized for being fragile.
Montreal alone is short 18,399 health-care workers, according to the government's July 4 health-care system dashboard.
But after all their agonizing, it became clear to the doctors that compared to the hospital system they remember in Toronto, Montreal's working conditions, which they consider to be tough and inflexible, are incompatible with raising a healthy family. They say those conditions are a natural consequence of government rules limiting hiring.
And if they still had doubts about the move, Quebec's new language law, commonly known as Bill 96, sealed the deal for them.
The doctors have no trouble communicating with patients in French or English. They're trilingual: Denissova also speaks Russian, Stasiak speaks Polish.
But they're somewhat concerned that the law aimed at protecting the French language could affect patient care and make an already fraught workplace all the more burdensome.
"It's very fuzzy. What are going to be the true implications of this? Is it political posturing? How are the laws going to be applied?" Stasiak said. "No one really knows."
He expects at the English-designated hospital he works at, he'd be able to continue to use his better judgment, but the unknowns still rankle.
Will it be felt in "my interactions with patients, is it my interactions with my colleagues, when I speak to a consultant or a nurse or someone else from an allied health profession? What about my charting?" he said.
"We're perfectly bilingual, but the thing is, there are so many acronyms in medicine... and to describe that to someone else who needs to have that information transmitted… wouldn't it be better to continue it that way?" Stasiak said.
"I don't like it, as a principle, that you should dictate as to who I should speak to in English or in French," Denissova said, when what matters most is communicating effectively with patients.
"It's infuriating that this is even a conversation to have," she added. "Are people going to have to show their eligibility certificates when you go to the hospital for care?"
They aren't alone in their concerns. Other medical groups, namely Quebec's College of Physicians, have been sounding the alarm about Bill 96 for months.
In an email to CTV News on Monday, Quebec's College of Physicians reiterated that the organization "will remain vigilant" regarding Bill 96 as "the reform could have an impact on the doctor-patient relationship."
"I just didn't want to live in a place where I didn't feel, anymore, was representing my views and values," said Denissova.
THREE PRIORITIES: FAMILY, FRENCH FLUENCY AND FREEDOM OF CHOICE
The much larger issue looming over the young parents, however, is how Bill 96 might limit their children's academic choices when they get to CEGEP age, and after they'd attended French elementary and high schools, as their parents did when they were kids.
"We would want them to have the freedom to choose between, 'You know what? I want to go to an English CEGEP or a French CEGEP,' which is the choice that we had made," said Stasiak.
But they fear changes in the language law might make that impossible.
Bill 96 caps enrolment levels at English-language CEGEPs, and it's expected to make the colleges more and more difficult for francophone and allophone students to get into as their growth will be halted at 2019 levels.
Given the restrictions, the pair wants to ensure their children don't spend all their younger years studying in French in a province that might, later on, slam the door on their future success.
"They're freezing English CEGEP enrolment, and they're prioritizing students coming from English schools – and this is now," said Denissova. "What is it going to be in 10 to 15 years?"
The only possible solution would be to send the boys to private English schools in Montreal that offer a grade 12 option, so they could bypass CEGEP altogether and graduate with an Ontario Secondary School diploma.
But then, their French fluency could take a hit, the pair noted. They say they're in a catch-22 unless they leave Quebec.
"I think the biggest irony is that now we're going to be going back to Toronto, we're going to be sending them to a private French school," Denissova said.
"We want them to be perfectly fluent in French... but not at the expense of their future freedom and future choices and career opportunities," she said.
EMERGENCY ROOM COLLEAGUES ARE 'UNDERSTANDING'
The couple says it's hard to believe they've come full circle and are leaving home again.
They left for Ontario the first time because they could not get permits to practice in Montreal after they completed their residencies at McGill University teaching hospitals.
The government determines how many doctors a region or hospital can hire, using a permit distribution system known as PREMs/PEMs (Plan régional d'effectifs médicaux) – and there weren't any available to them.
So for five years, they worked in emergency rooms in Toronto.
"Then, once we had our first child, we decided, you know, it would be really nice to go back. I miss the French. I miss Montreal as a city. We're going to be closer to our parents," Stasiak said.
Those Montreal elements were great for them: the grandparents, the house, the neighbourhood. After about a year, however, reality set in, they said.
"It hit me that, oh my goodness, this is such a rougher work environment and also there was Bill 96 that was all over the news, so all of these things started dawning on me," Denissova said.
She wondered if they could sustain the workload -- many shifts, and shifts 30 to 50 per cent longer than in Toronto, she calculated -- and remain healthy over the next 20-plus years if they continued on the same course.
The environment, they said, has nothing to do with the way their particular hospital is managed, something Denissova observed when she picked up a few ER shifts at a different Montreal hospital to help her understand the issues she was up against.
Both young doctors believe the "onerous" workload has much to do with the province's permit system.
"Because of the PREM system, the work conditions are a lot more difficult. The work is a lot less flexible in terms of hours, in terms of shifts," Denissova said.
When it comes to that assessment, she has an ally in a veteran Montreal GP who has just taken the health ministry to court over the PREM system and the way it's being used to distribute – or not distribute – family doctors in Montreal.
"It doesn't make any sense that we have restrictions on recruitment," Dr. Mark Roper said, "when we have such a lack of personnel, a lack of emergency doctors. That doesn't make sense, right?"
He believes having more family doctors in Montreal would relieve pressure on swamped emergency rooms because the family doctors would see more patients in their offices and do ER rotations.
"We would for sure welcome and benefit from more physicians," Denissova said. She added that she's discouraged to see that doctors decades her senior are still over-working just as much as she and her husband are.
Nor does she envision they will ever have a flexible work schedule that would allow them to provide better care for their children and get them to and from daycare and school – unless various aspects of the system change dramatically.
"This is true," said Roper. "The PREM system and the PEM system, which is more the manpower controls for hospitals, force the heads of departments only to use full-time doctors, and the part-timers have a very difficult time."
They're so short-staffed, said Denissova, that it would put too much pressure on the rest of the team if she were permitted to scale back her hours for a few years – something she will now be able to do in Toronto.
"Pretty much as soon as I spoke to the department in Toronto where I worked before, they said 'Yeah, of course, we'll take you happily, however many shifts you want to work.'"
The hospital told her that "'if you want to work less hard for a few years of your life because you have younger kids, we can accommodate whatever you want,' she said. "So the contrast was striking."
Telling colleagues in the Jewish General ER about their decision was "tough," said Stasiak.
"These are people that we trained with, that we know, that are our friends -- I feel like we're in a way even maybe letting them down a bit, and they're also disappointed," he said.
"But everyone is very understanding. They get it because they see the conditions," he said.
"We need to do what's best for us, for our family," even if that means leaving others behind.