Will Quebec lose 600 doctors when mandatory vaccination in the health-care sector kicks in?
With the deadline for mandatory vaccination fast approaching for employees of the health-care system, it seems Quebec’s health ministry is busy preparing to ensure its edict will be enforced.
“In the next few days, the MSSS (Health Ministry) will provide the College with the number and names of physicians who are not vaccinated,” College of Physicians’ spokesperson Leslie Labranche told CTV News.
After Oct. 15, doctors, nurses, respiratory therapists, midwives and other types of workers and staff will be suspended without pay from their jobs if they haven’t complied with the ministerial directive.
Many of their fully vaccinated colleagues are now worrying about how severe an impact their disappearance will have on patient care, given that the province already faces a shortage of workers.
Unvaccinated doctors will not even be permitted to conduct tele-health visits.
The vast majority of doctors in Quebec, 97.5 per cent, are fully vaccinated according to the Quebec Institute of Public Health (INSPQ).
But the focus now is on the flipside. How many MDs are inadequately vaccinated? That number stands at about 600, according to the INSPQ, which has been tracking vaccination rates since Dec. 14.
“As low as that rate is [2.5 per cent], I would have predicted it to be zero,” a Montreal family physician on medical leave told CTV News in an interview.
Ingrid Kovitch said, “there is no one who understands both the devastation of this disease, as well as the safety and efficacy of the vaccine, better than physicians.”
Her first instinct was to question the veracity of the figure, she said - and that turns out to be a fair point.
It seems the ‘600 doctors' number is the INSPQ's best estimate. Even the public health experts making the calculations can’t be sure it’s accurate and as a result, how bad the fallout in the health care sector could be.
That’s because they’re working from information provided to them by the College of Physicians - specifically, lists of doctors who have paid the professional order’s fees and are presumed to be practicing.
“Obviously, we're working from these lists and they could be incomplete or sometimes they have more individuals on that list than people actually practicing,” said Dr. Gaston De Serres, an epidemiologist at the institute.
Some doctors may have retired in the interim or could be on sick leave, he said.
“There is some wiggle room there that nobody could completely reconcile because it would require an enormous amount of effort,” De Serres said in an interview.
Such are the challenges of working with large data sets that don’t always match.
The fortunate consequence of the best-they-can-do analysis is that the vaccination rate for MDs may be even higher than reported and there won’t be as many doctors sent packing in about ten days.
The INSPQ team tries to refine its surveillance of health-care workers’ status by cross-referencing the various orders’ lists with the province’s vaccine registry.
“From the vaccine registry, we can, most of the time find people...sometimes the name of an individual may be wrongly spelled,” but De Serres said they usually have a date of birth to help them ensure they’ve identified the proper individual.
When it comes to nurses in Quebec, the latest INSPQ vaccine surveillance indicates that 93 per cent have received an adequate number of doses. That figure drops to 87 per cent for auxiliary nurses.
Given the number of nurses registered as of March 31, 2021 with the two separate professional Orders of both groups of nurses, that would mean that after Oct. 15, about 5,634 nurses and 3, 803 auxiliary nurses would be suspended across the province.
The Quebec Order of Midwives (OSFQ) has strongly urged all its members to get fully vaccinated to protect themselves and the pregnant women they care for.
“Pregnant women are more likely to have severe symptoms of COVID‑19, particularly in the second and third trimesters,” reads a section on Quebec’s COVID-19 website.
A statement issued by the OSFQ in August concurred and said “...this pandemic is unprecedented and public health considerations in these circumstances outweigh individual considerations.”
But only 78 per cent of the 180 midwives who are active in the health care system across Quebec and 89 per cent of midwives caring for pregnant women in Montreal, heeded the call, according to INSPQ data.
The Regroupement Les Sages-femmes du Quebec (RSFQ), a professional association disputes those figures, however.
A spokesperson told CTV News they’re higher than reported and that close to 90 per cent of midwives are properly vaccinated province-wide. That rises to 100 per cent for midwives in Montreal, they said.
The fact that anyone who works in the health field, particularly those with a science background, would reject the opportunity to be vaccinated, continues to confound those who are vaccinated and who work alongside them.
Kovitch, on leave from her medical practice due to a rare multi-system disease, is in a unique position to see the situation from both the doctor and the patient’s point of view. She said, imposing the vaccine mandate was the right decision.
"Because of the choices and actions of a small group of people, we are now in a very difficult predicament, and the government has been forced to choose between suboptimal strategies," she said.
Doctors always have had to conform to strict standards when it comes to their behaviour and the care they provide, she explained.
"Unnecessarily exposing vulnerable patients to a very serious illness is simply another form of malpractice and should be subject to the same consequences," said Kovitch.
As a a patient who is immunosuppressed and at very high risk of COVID-19 complications she "recognizes and accepts that it might delay" some aspects of her care, she said.
But she has no desire to move up any medical appointments scheduled after Oct. 15, secure in the knowledge that after that date she won’t be “put in danger by the very people who are supposed to be safeguarding my health.”
De Serres said he can’t predict how the system will respond in ten days, but he said he is surprised to see “that there would be physicians, or nurses who, who do not believe that the vaccine is safe and effective, and don't want to take it....I would expect being in the medical practice, they would get the vaccine.”
But, as with any large group there are some among them who have certain beliefs “that may not be totally concordant with what science says,” the epidemiologist concluded.
In this way, they are just like anyone else who has resisted the call to be part of the solution and so far remain unswayed by a provincial vaccination mandate that will be costly in more ways than one.