The role and status of the medical specialist
Medical specialists work mainly in hospitals and specialized clinics. In addition to their clinical duties, some also supervise residents and medical students, as well as teach at universities. Many of them are also involved in medical research.
As part of their profession, medical specialists collaborate with treatment teams to provide continuous care to patients with various health problems. Multidisciplinary teams of health care professionals are found in many medical facilities and groups.
For example, an orthopaedic surgeon may work with a general practitioner, physiotherapist, kinesiologist, occupational therapist, etc. An endocrinologist may work with a team of nutritionists, psychologists and kinesiologists. The patient is therefore at the heart of the medical interventions made by specialists.
Medical specialists operate in the Quebec health care system as self-employed workers. This status allows them to preserve their professional autonomy, meaning that they are assured of being able to freely exercise their professional judgment independantly in the treatment of their patients, without external interference.
On the other hand, the self-employed status of physicians implies that physicians have no pension funds, sick leave or government-paid vacations. Moreover, if physicians practice in an office, they must assume the resulting costs out of their remuneration: rental of premises, insurance, salaries and benefits of their employees, supplies, etc.
The medical profession is exclusive. Only members of the Collège des médecins du Québec have the right to use the title of physician and to practice medicine.
Three principal types of remuneration
All fees for physicians practicing in the Quebec public health system are paid by the Régie de l'assurance maladie du Québec. The three principal types of remuneration are fee-for-service, salary and mixed remuneration.
The majority of medical specialists are remunerated on a fee-for-service basis. A billing code is specifically assigned to each medical procedure (examination, medical consultation, surgery, diagnostic or therapeutic intervention performed by a physician). This code gives the right to a certain amount established under agreements negotiated with the government. The value of a procedure may vary and is determined by taking into account various factors (complexity, frequency, time of day, etc.).
Although quite rare, some medical specialists are paid on a salary basis. In this system, the physician receives a sum of money for each hour worked or a fixed annual amount.
Other medical specialists have chosen to benefit from a mixed remuneration, i.e. combining fee-for-service and salaried work. The physician then receives a basic lump sum (per diem) for their attendance at work, as well as an additional fee per procedure. This type of remuneration is well suited to the practice of a specialty with specific clienteles (children and the elderly) or when the volume of activity is not constant, for example when a physician practices in a region far from major urban centers.