Practice in Institutions


Under review

Medical practice in institutions represents a considerable portion of the clinical activities of physicians in Québec. Many factors explain this situation: the complexity of health problems; the sophisticated technologies used in modern medicine; the necessary input of other health and social services professionals; the need to bring these professionals and resources together into functioning entities; and the need to hospitalize and provide accommodation for a great many patients so as to ensure the continuity and quality of their care.

One can expect that, in future, an even greater number of physicians will practice in a variety of health care facilities. Under a new provision of the Act respecting health services and social services (LSSSS), all family physicians must commit themselves to devoting part of their practice to special medical activities (AMP), notably in the emergency room or with patients admitted to a hospital centre or to a residential and long-term care centre (LSSSS, ss. 360 and 361). Physicians who do not make this commitment could see a reduction in pay imposed upon them. The Act respecting health services and social services has an equivalent provision for all medical specialists who do not have privileges in an institution operating a hospital centre and whose specialty is stipulated in an agreement concluded to this effect (sec. 361.1). The terms and conditions of a physician’s participation in special medical activities (AMP) are specified by agreement with the Federation of General Practitioners of Québec (FMOQ) or the Federation of Medical Specialists of Quebec (FMSQ), whichever is applicable.

Almost all health care institutions in Québec are public. Professional medical practice in these institutions is governed by several pieces of legislation, notably:

  • An Act respecting health services and social services (LSSSS) and the ensuing Organization and Management of Establishments Regulation (ROAE);
  • The Professional Code and the various regulations ensuing from it, among them The Code of Ethics of Physicians;
  • The Medical Act;
  • The Health Insurance Act and the agreements concluded with the medical federations pursuant to this law.

In their relations with health institutions, physicians enjoy a special position because of their status as independent workers. They  are neither members of the personnel of these institutions (LSSSS, sec. 236); nor executives, nor employees. Physicians are not subject to the provisions of the Labour Code or the Labour Standards Act, which apply to other health workers (Health Insurance Act, sec.19).  Medical residents are considered employees of the institution and are subject to the above laws. But they still maintain their professional independence as medical doctors and are thus subject to the Code of Ethics of Physicians of Québec.

Physicians are independent professionals, and the agreements concluded between the ministère de la Santé et des Services sociaux (MSSS) and the Quebec Federation of General Practitioners, and the Quebec Federation of Medical Specialists reaffirm this independence, notably by ensuring the freedom to provide therapy and freedom to choose their place of practice, as well as respecting the personal and private nature of the physician-patient relationship, an important aspect of which is professional secrecy. The freedom to provide therapy means that physicians have the right to decide on the medical care required, to prescribe the appropriate treatments and their mode of administration (Agreement on health and hospital insurance between the MSSS and the FMOQ, Art. 7.04). Institutions must respect this professional independence, within the framework of their mission and their resources (Agreement on health and hospital insurance between the MSSS and the FMOQ, Art 8.01).

While the special status enjoyed by physicians has its guarantees, it also has its obligations. Physicians must respect the rules  in effect in the institution, provide the professional services attached to their functions and assume on-call duties in their department or service. In choosing to practice in an institution, physicians also agree to be part of a health care team with constant concern for the quality of care given to their patients. When physicians practice in institutions, they, of necessity, have close relations with the health care network. Hence, the importance of knowing its structures, the internal organization of its institutions and the elements creating an even more specific framework for medical practice.