Obstetrics
The FMSQ is questioning the MSSS on the actual needs of communities
’’ Are there really areas we cover that don’t actually need to be covered? ’’ - Dre Diane Francoeur, FMSQ President
Article published on 5 March 2020
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Health - The Fédération des médecins spécialistes du Québec (FMSQ) was not informed by the Centre intégré de santé et de services sociaux (CISSS) de l’Outaouais of the closure of the obstetrics wing at the Shawville Hospital, as announced on February 24th.

The president of the FMSQ, Dr. Diane Francœur, told CHIP 101.9 that she learned of the closure through news media without being consulted beforehand, which could have an impact on the effectiveness of the regional coverage plan provided in the agreement signed in December between the FMSQ and the ministère de la Santé et des Services Sociaux (MSSS)..

Francœur also questions the ministry as to whether hospitals requests for deployment correspond to the needs of the communities affected by these measures, without however making it a “political issue”.

“Management needs to take the bull by the horns” - Diane Francœur
Coordination between the FMSQ, the ministry and the hospitals has to be done by the Directeur des services professionnels et de la pertinence clinique of the regional health centers. This position, at the CISSS de l’Outaouais, is held by Dr. Nicolas Gillot since June 2019.

In the case of the Pontiac, Dr. Francœur deplores the lack of communication between the CISSS de l’Outaouais and the FMSQ.

She maintains, however, that the FMSQ does not intend to “abandon” the obstetrics wing in the Pontiac, because it is essential for the region:

Dr. Diane Francœur also maintains that the safety of pregnant women and their unborn children should remain the priority.

Inter-provincial agreements: a possibility?
When asked if it would be relevant for pregnant women to give birth safely in Ontario, given the proximity to the Pontiac, Dr. Francœur replied that the scenario should be studied by the Ministry of Health :

Dr. Diane Francœur finished by welcoming the common will of the parties involved in the medical specialists in Quebec and that everyone should do their part in order to bring lasting solutions.

On February 24th, the Centre intégré de santé et de services sociaux de l’Outaouais announced a new interruption of service in obstetrics at the Pontiac Hospital, this time for 6 months, until September. This closure is mainly due to a lack of nursing staff.

To ensure an effective rotation of the obstetrics nurses at the Shawville Hospital, 12 full-time trained nurses (2 nurses per hour over a 24-hour period) are required. At the time of the closure, there were 3 full time nurses available.

The CISSS de l’Outaouais has ensured that the obstetrics service in the Pontiac “will not closed” definitely, and that the objective is to restore it.

In 2018, an agreement was signed between the MSSS and the FMSQ to fill in for doctors specialized in anesthesia in regions due to the services being threatened by the lack of staff. This agreement took a few years to be confirmed, since there were many positions to fill. “The department wanted coverage in the six basic specialties (anesthesia, obstetrics, surgery, internal medicine, psychiatry, pediatrics),” said the president of the FMSQ. According to her, there are about 1,500 medical specialists missing in Quebec’s health facilities.

Since December 1st, 2019, there was another agreement signed between the MSSS and the FMSQ to meet the need of obstetrics and general surgery, with the goal of minimizing the interruptions of services that mainly affect hospitals in the regions, notably the Pontiac. Its establishment is however only scheduled for April 1st, 2020, “the time to find people who will commit for the whole year”. The FMSQ is currently recruiting staff to be able to provide continuous and annual coverage of services in all regions of Quebec.

Statistics (source : FMSQ)

Anesthesia
In 2019, in Quebec, the FMSQ provided 47 weeks of anesthesia coverage. This coverage was organized with two teams. That being said, for 47 weeks, 7 days a week, 4 people were on rotation, covering the needs of anesthesiologists throughout Quebec. At all times, there were two anesthesiologists available to assist their colleagues needs.

There has been no anesthesiology support resource in the Pontiac since December 1st.

Surgery
Specifically to the Pontiac hospital, from the signing of the agreement (December 1st, 2019) until February 21st (date of closure of obstetrics at the Pontiac Hospital), 6 surgeons (including some who could perform caesareans) were sent, each providing 1 week of coverage. A total of 6 weeks were provided for surgery/obstetrics coverage at the Pontiac hospital.

Note: The FMSQ is responsible for providing human resources/medical specialists to avoid service interruptions, but it is the MSSS that is responsible for choosing the structures and regions that will receive these resources as a priority.

The full interview in French with Dr. Diane Francœur is available here.

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