Residents score a strikeout

General strike by Quebec medical residents ends with satisfactory outcomes

A collective sigh of relief resonates from the medical community as the Fédération des Médecins Résidents du Québec (FMRQ) and the Government of Quebec progress into the final stages of solidifying a contract for Quebec’s medical residents. Had recent salary negotiations not been successful, detrimental repercussions of the recent strike in Quebec would have continued.

The FMRQ is an organization that advocates for Quebec residents – doctors who have finished medical school, but are completing their obligatory postgraduate training in their specific fields. According to the FMRQ, there are 3,000 residents in Quebec who work an average of 72 hours a week in over 100 health institutions.

Dr. Joseph Dahine, internal medicine resident, FMRQ board member and president of the Association des Résidents de McGill, explained that the residents’ main grievance was that their pay was 30 per cent less than that of their equals in other provinces. This disparity in pay appears to make Quebec a less attractive option for potential residents.

“In 2011 there were 106 unfilled residency positions in Canada and an alarming 84 of those spots were in Quebec,” said Dahine. “At the end of the day, when doctors are choosing where to go for residency, polls have shown that pay has an overwhelming influence. Studies have [also] proven that residents are more likely to practice [medicine] in the same places they had been trained [for residency]. This results in a hemorrhage, whereby Quebec is losing doctors to other provinces.”

Yet some students do not believe that Quebec residents asking for pay parity with residents from other provinces is fully justified. “Considering that tuition for medical education at the University of Toronto is $75,000 and $22,000 at McGill, it doesn’t make much sense to expect the Quebec government to close the gap between salaries,” said April Rose, a third year medical student at McGill.

Initially, residents tried to express their grievances without sacrificing medical education or patient care. “We tried to create promotional material to inform people of our demands,” explained Dahine. “But that wasn’t enough. The government was not rational in their negotiations and offered ridiculously low salary raises just to appease [our demands].”

It was under these circumstances that on July 11, 2011, residents decided to completely stop teaching medical students. This tactic had its greatest effect when it was communicated to the Quebec government that third year medical students were at risk of failing their clinical core rotations, which could pose the threat of postponing graduation. This put pressure on the government to begin taking the residents’ demands more seriously.

Yet, though this maneuver reached its target, the collateral damage to medical students and the burden placed upon staff and medical education administrators were substantial. In many instances, hospital staff had to supervise students directly so that students could continue their education without interacting with residents.

Pediatrics, the branch of medicine concerned with the medical care of infants, children, and adolescents, is thought to be the core rotation hardest hit by the strike. Half the students doing pediatrics during the strike did not receive any ward exposure, which is where general pediatrics is optimally learnt. Dr. Preetha Krishnamoorthy, program director of the Undergraduate Medical Education in Pediatrics, explained how the residents’ decisions to stop teaching required her to completely revamp the curriculum. “When residents decided to suspend teaching, we had to pull students off of wards and find alternative subspecialty options that would allow them to fulfill their core requirements. We just had to make it work because we didn’t want to delay their graduation.”

Though the pediatric training for this year’s medical students was a difficult experience, Krishnamoorthy states that it was not necessarily a negative one. “In the end we made it work because the students really stepped up to find alternative solutions that made everyone happy,” she said. “I was incredibly impressed by the maturity, poise, and professionalism by which everyone worked together.”

Nevertheless, according to Esli Osmanlliu, executive president of the Medical Students’ Society of McGill, 62 per cent of third year medical students said the strike had affected their education. “Although there still was support for the FMRQ demands by medical students, we strongly believed that a prolonged teaching strike would have had long-term effects on medical education and the eventual quality of care delivered in Quebec, which is a risky business for all stakeholders,” he said.

General strike becomes a reality
Despite all that was taking place, negotiations between the FRMQ and the government remained at a standstill and the FRMQ was forced to subscribe to their last resort. On September 19, 2011 at 8:00 am the FMRQ decided to initiate a full-on general strike. This meant that 10 per cent of all residents would stop working entirely every day.

“The strike was the big gun that required residents to leave the hospitals,” said Dahine. “With the onset of the general strike, negotiations intensified. The [Quebec] government recognized the imminent threat a general strike would have on patient care and how chaotic it would be in the hospitals. So they were pressured to give us their best offer in the shortest amount of time.”

Fortunately just 3.5 hours after commencing, the strike ended on September 19, 2011, at 11:30 a.m., after FMRQ members received an offer that they deemed satisfactory. This latest offer gives Quebec residents a 20.3 per cent increase in salary over five years. Specifically, there will be a 6 per cent annual increase in salary, a doubling of on-call hourly wages, and a $210 teaching stipend for every rotation. Non-monetary gains include personal on-call rooms rather than shared rooms and a better maternity leave package. In addition, the 16-hour work shifts negotiated earlier this summer are to be fully implemented by July 1, 2012.

At present, two out of the four union members – McGill University and University of Laval – have approved the offer. The University of Sherbrooke and University of Montreal will be voting this week.

“This is a huge achievement since sleep deprivation studies have proven the adverse effects of 24-hour calls,” said Dahine. “In fact, Quebec is a pioneer in this arena since other provinces still have 24-hour calls.”

However, some students, including Rose, have doubts. “Many residents and senior staff question whether the advantages of cutting down on the hours are ultimately worth it since shift work may affect continuity of patient care and because trainees are exposed to and therefore learn a lot more medicine through 24-hour calls,” said Rose.

Nevertheless, after all this, Dahine believes that the greatest achievement of the strike was proving the value of residents in academic and community hospitals. “Now, no one can deny that residents are an integral part of the healthcare system both clinically and academically.”