Pay equity: Pediatricians file injunction against Quebec's FMSQ

The Association des pédiatres du Québec (APQ) has thrown a wrench in the works by cracking the facade of unity with the Fédération des médecins spécialistes du Québec (FMSQ). The APQ accuses the latter of “violating its obligations” and “failing in its duty of fair and equitable representation” by allowing inequities to persist in the remuneration of pediatricians— a predominantly female specialty—and, more generally, female specialist physicians. After years of trying to get the FMSQ to move on this issue, the APQ and its president, Dr. Marie-Claude Roy, have finally turned to the Superior Court. On Thursday, they filed a request for an injunction denouncing, “the patent inequalities, arbitrary treatment and lack of representation of which pediatricians are victims,” with the aim of forcing the FMSQ to rectify the situation.First reported by La Presse, the news was confirmed by Profession Santé (sister publication of the Medical Post and part of Canadianhealthcarenetwork.ca), which consulted the court document in question.It states that, “Pediatrics is the second medical specialty with the highest proportion of women [after obstetrics and gynecology]. Pediatricians are therefore among those who bear the brunt of this systemic discrimination, which is part of a trend to undervalue certain tasks traditionally associated with feminine and maternal roles.” To justify its request, the APQ calculated the average adjusted revenue (AAR) of specialists in the eight associations with the highest percentage of women, such as pediatrics, geriatrics and obstetrics. Their AAR is $152,767 less than that of physicians in the eight associations with the most men, such as urologists, orthopedic surgeons and nuclear medicine physicians. “This represents a gap of 30%,” the injunction application points out.According to the APQ, this discrepancy is explained in part by lower fee-for-service remuneration for female-dominated specialties. It points out that, “The average remuneration for medical acts performed by female-dominated specialties is $79, whereas it is $133 for male-dominated specialties. This represents a difference of 68%.”This observation had already been made by a study carried out on behalf of the Association des obstétriciens et gynécologues du Québec (AOGQ). Its results, published last September, show that certain medical procedures performed on women are significantly less well-remunerated than their male equivalents, with differences ranging from 33% to 218%, even though, according to the AOGQ, there are no medical arguments to justify this. For example, uterine brachytherapy is paid at $82.70, compared with $262.60 for prostate brachytherapy, a difference of 218%. An egg retrieval for in vitro fertilization is paid at $369.45, while a sperm retrieval for the same purpose is paid at $949.95, a difference of 157%.“This phenomenon is part of a systemic undervaluing of certain skills associated with care work and invisible work, such as social, relational, emotional and interpersonal skills, which are at the heart of pediatricians' work,” stated the APQ, which considers that the chronic undervaluing of these skills can be explained by the fact that, “They have long been considered an extension of the traditional role of mother or wife—tasks that should not therefore be remunerated.” When contacted by Profession Santé, the APQ and its president declined to be interviewed. “Given the sensitive nature of this process, APQ has chosen not to comment publicly on the file at this time. We prefer to let the process take its legal course,” replied the association's general manager.For its part, the FMSQ sent us a written statement asserting that its role is to “represent the interests of 11,000 physicians and its 35 associations.” The federation said it “launched a major equity exercise in 2022, which aims to review the monetary distributions between associations so as, in particular, to reflect the real value of medical acts.”It continued: “Pediatrics has just decided to go to court to assert its sole interests in this exercise, even before its conclusion,” wrote the FMSQ, declaring that it will continue to work in concert with all its associations “to move this important issue forward.” It concluded by writing that it will evaluate the whole matter and determine the followup needed.Opaque remunerationIn its request for an injunction, the APQ criticized the way in which the remuneration envelope for medical specialists is distributed. These specialists must share the $5 billion negotiated with the Quebec Minister of Health Christian Dubé, who wants more control over how the medical federations spend the amounts they receive from the government.In particular, the pediatricians point out that the portion of the overall envelope granted to them, “represents 81% of that granted to ophthalmologists, even though the APQ has twice as many members, and (they) do at least five times as much work during unfavourable hours.” They also report that their envelope is equivalent to 49% of that of radiologists, even though the APQ has 10% more physicians.Beyond that, pediatricians claim to be treated unfavourably, saying for example that their billing manual does not allow them to apply complexity codes, unlike other FMSQ member specialties. They also criticize comments made in February by the federation’s Direction des affaires économiques, which allegedly stated that rates for pediatric hemato-oncology should be subject to restrictions, as it was necessary to protect patients from pediatricians who might prescribe chemotherapy only because it is paid for.According to the APQ, “Only the FMSQ can really rectify— or perpetuate—these inequalities of treatment,” because it has a monopoly on protecting the pecuniary interests of its 35 member associations. It also decides on the distribution of the global envelope granted to specialists and has the power to modify the value of certain procedures. “Yet the FMSQ has refused to seriously consider the APQ's requests on this subject, (which) have met with systematic opposition.”After his election in 2021 as president of the FMSQ, Dr. Vincent Oliva acknowledged that the disparity in remuneration between specialties was a “priority issue” for his new administration. A project was launched to analyze the relative value of procedures performed by different doctors, with the aim of reducing disparities between specialists.The pediatricians said that the team in charge of this exercise was “composed exclusively of men,” whose independence they doubted, since they reported directly to the federation's board of directors. The APQ claims to have solicited this team, but that it remained indifferent to the issue of gender inequity and refused to listen to its claims and those of other associations.Despite this, the association says it has tried on several occasions to raise awareness of the issue with the federation and its president, to get them to rectify the situation to no avail. In March 2023, the assembly of delegates even adopted a resolution calling on the FMSQ and its board of directors to, “implement remuneration equity as a guiding principle of the exercise” on the relative value of acts. The APQ affirms that “the FMSQ is bound by this resolution.”Ultimate impasseThe association testifies that it also took steps in June 2023 to obtain greater transparency from the FMSQ regarding the remuneration of specialist physicians and the way it allocates the overall $5 billion envelope negotiated with the Quebec ministry of health and social services (MSSS). Indeed, it claims that the Federation, “leaves its member associations in the dark as to the distribution tool it uses to divide the sums of the global envelope that are not directly allocated to the various associations.” These questions remain unanswered still. Discord reached a breaking point last summer. Considering that “the FMSQ seems to have completely ceased fulfilling its duty to defend and represent the APQ's interests,” and that it, “fails to follow up and treat (its) requests seriously,” the pediatricians sent the federation a notice of mediation to resolve the crisis. After a few letters exchanged between the lawyers for each side, the FMSQ refused to take part in the mediation.Among other things, it is asking the Superior Court to order the federation to: take the necessary measures to correct the lack of representation of pediatricians; to disclose to its member associations the details of the distribution of the sums granted by the ministry of health”; and to “implement a gender-based analysis approach.The association also hopes that the Court will declare that, “the discrimination suffered by female medical specialists is systemic,” and that the FMSQ, “failed in its duty to defend the interests of the APQ,” as well as “its duty of fair and equitable representation” of pediatricians. It ordered it to “deal with the APQ's requests relating to changes to the billing codes in a fair, objective, transparent and standardized manner.”

Pay equity: Pediatricians file injunction against Quebec's FMSQ

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