Dr. Gaudreault’s assessment: proud of Collège des médecins du Québec 

Dr. Mauril Gaudreault is proud of the direction the Collège des médecins du Québec (CMQ) has taken over the past eight years. Under his leadership, the College has become much more vocal on certain social issues, which has sometimes generated considerable controversy.

The Canadian Press spoke with Dr. Gaudreault, who, at the age of 78, has officially completed his duties after two terms at the head of the professional order, as dictated by the CMQ regulations which impose a limit of two consecutive four-year terms.

His successes included bringing the Collège des médecins du Québec closer to the public, contributing to the expansion of professional practices, and becoming a social actor, summarizes Dr. Gaudreault over coffee in Montreal. He was also the first president to undertake a major tour of Quebec’s regions to meet with healthcare professionals and the public.

His most controversial stance was to ask doctors to cease their pressure tactics while medical federations were in the midst of negotiations with the government on their remuneration.

Several doctors perceived it as political interference by the College in an already heated standoff with Quebec. Calls for his removal were made, but ultimately did not occur. Dr. Gaudreault did, however, receive a motion of censure passed at a special general meeting, a first in the history of the CMQ.

“Psychologically, I found it very difficult. It was the most challenging period of my presidency,” he confides. But he doesn’t dare call it a mistake, because he still manages to find some positives in it.

Although it “caused a stir within the medical community,” he has no regrets. It was an action that absolutely had to be taken, he asserts. “A professional order is there to protect the public by ensuring quality medicine, […] and in my opinion, and this is the opinion of many, when the order witnesses actions that could compromise this public safety, we have a duty to act, to react, and to speak out clearly,” he affirms.

He also believes that this has helped to raise awareness of what the College exists for, one of its key issues.

The CMQ conducted extensive consultations in 2019 to better understand public and physician perceptions of the College. The conclusion: the public did not feel protected by the College and confused it with medical federations.

“It was the consultation that made us realize this, because we weren’t speaking out often enough. People didn’t know us. […] People told us: ”for the Barrette reform, we didn’t hear from you, you didn’t speak out, you didn’t even go to the parliamentary committee”, recalls Dr. Gaudreault.

The College was therefore too far removed from the public, but also from doctors, and was not sufficiently present in the public sphere.

That has changed. In recent years, the College has notably spoken out in favour of removing polluting anesthetic gases from healthcare facilities and opposed the environmental concessions granted to the Horne Smelter. “I’m quite proud of that. We’ve done it for other societal issues as well,” says Dr. Gaudreault.

Is family medicine becoming extinct?

Dr. Gaudreault hung up his stethoscope in 2014 after a 40-year career as a family physician in the Saguenay–Lac-Saint-Jean region. At the time, a family physician took care of all members of the same family unit, addressing their overall health.

Today, it’s not uncommon for not everyone in the same family to have access to a doctor. Is family medicine as we knew it destined to disappear?

No, says Dr. Gaudreault, but it might be less popular. He believes that the recent change in physician compensation, which allocates 50 per cent of their remuneration to capitation (based on the number of registered patients), could bring back this type of medicine.

“The practice of medicine, from now on, is a team-based practice. […] Let’s just talk about family doctors; for them to be able to work as a team, fee-for-service remuneration will never allow that,” he said.

He cites the example of treating homeless people, the CMQ having recently published a report on this issue. “The fact that the doctor has to leave his office or hospital to go and meet these people, that will never happen with the current remuneration model,” he emphasizes.

Stop the denigrating speech

Family medicine is undervalued in Quebec, acknowledges Dr. Gaudreault. It remains the most overlooked specialty when students choose their medical residency placement. “It is our social responsibility to better value the practice of family medicine at all levels of society, including among political decision-makers,” he says.

“I’m talking about political decision-makers, but also the medical community. And I think that this kind of internal professional denigration is no longer acceptable.”

Dr. Gaudreault’s presidency was also marked by the COVID-19 pandemic. According to him, this accelerated teamwork with other professional orders.

The expansion of professional roles continues to gain momentum today. Nurse practitioners (NPs) can have patients in their own name, pharmacists have more autonomy in treating several diseases, and we should soon see other measures for physiotherapists, among others.

“There was resistance from the medical community regarding the openness that the College was showing. We were very open regarding the expansion of professional practices,” says Dr. Gaudreault.

The doctors were mainly wondering whether other professionals had the necessary skills. “Once competence has been demonstrated, it is well received by the medical community,” maintains Dr. Gaudreault.

Dr. Nathalie Saad, a respirologist, succeeded Dr. Gaudreault. She became the first female president of the CMQ. During her term, she intends to focus her energy on issues surrounding the aging population, primary care, and access to healthcare.

—The Canadian Press’s health coverage is supported by a partnership with the Canadian Medical Association. The Canadian Press is solely responsible for this journalistic content.