THE INTERVIEW: Dr Robert Ouellet, the CMA’s new president

At next week’s annual meeting in Montreal, the Canadian Medical Association will welcome a new president and for the second year in a row he will be a doctor who sees many of his patients outside the public system, leading critics to accuse the organization of pushing for ‘two-tier medicine.’ But the new president, Dr Robert Ouellet, the co-owner of five private radiology clinics in the Montreal area, is undeterred: he says his mandate is nothing less than to come up with a plan by the end of the year to totally remodel the Canadian healthcare system.

In a recent conversation with our reporter Graham Lanktree, Dr Ouellet laid out his agenda for the coming year, explained his comic book allegiances and discussed his need for speed.


You recently wrote in the CMAJ, “I don’t want to change the world, but at least, to have some little influence and to show that there are some solutions that we have, that are working.” What specifically would you like to accomplish with your influence?

Well, we have to look at what’s going on elsewhere because there are experiences in other countries -- I’m talking about the UK -- where they were at the same level as us with wait times five years ago but they’ve succeeded in getting rid of them. We’re a rich country and have wait times of nine months for surgery or more for hip replacement! We cannot accept that. I cannot accept that.

What do you propose?

There have been enough studies, so no more studies. I want to look at what’s been done elsewhere in Scandinavian countries, in Australia, and if we use the same solutions they’ve been using we’ll have the same results. One solution that [outgoing CMA president] Dr Brian Day started talking about this year is patient-focused funding. We have to change the way our hospitals are funded. Not to have global funding, but to have funding focused on the services they give.

So you don’t think a greater role for private clinics is the solution?

No, no. It’s one part of the solution, I’m not putting it aside, but it’s not the solution. We have to look at everything, be open-minded and not just say ‘OK, we have to be only public, public, public or only private.’ This isn’t an issue in other countries, even socialist Scandinavian ones. Sweden has a private system which is small, but it’s there. In Canada people say it’s not possible to have both systems at the same time. I don’t mean to replace the public system with a private one. We still need universal coverage for everyone. We’re just talking about having some complementary services from the private system and to have competition... The CMA has resources, and this year I will try to use those to create a proposal for a new healthcare system. We need action!

Should we be more open to private insurance for care that is publicly insured?

Yes, yes. We have to guarantee to the population that they will have treatment in the proper time. If someone wants to go a little faster, and they want to pay for that, I don’t have a problem with it.

Aren’t you worried about US-style problems creeping into the Canadian system with the emergence of private insurance?

No. One thing we have to do in Canada right now -- and it’s really the time to do it to avoid the problems that they have in other countries like the United States -- is regulate the private sector. Right now all we’re doing is saying ‘Oh, it doesn’t exist. We don’t want to go that way.’ And that stance lets the private sector develop in a wild fashion. Right now Bill 95 introduced in Quebec -- concerning ownership of radiology clinics -- is a good start. It says radiologists must have at least 50% of the ownership of clinics in the province. If we give that to big corporations we will have the same problems as the US. Now is the time to regulate because private care is still not very big, but it will grow.

What’s the biggest concern facing Canada’s physicians today?

They ask for tests for their patients and their patients have to wait. They must see patients again and again because they deteriorate while they’re waiting for surgery. The system isn’t working well, and this is one thing doctors don’t like it at all.

When it comes to licensing foreign-trained doctors in Canada, there’s a perception that the medical profession is acting like a cartel by putting the priority on protecting their own. How can we staunch the doctor shortage and allay concerns about quality of care?

It’s the Colleges [of Physicians and Surgeons] that don’t want to have those doctors, or are putting up so many rules that it takes too much time. That’s too bad, because we need those doctors. At the same time we want doctors that are competent, but I believe we’ve had some Canadians that have done their studies elsewhere, like the US, and when they come back they have to redo their exam and redo everything. That’s not proper.

You’ve talked about your plan to “build bridges between the Franco and Anglo-Canadian medical communities.” Do Quebec’s physicians have a different view of healthcare from the rest of the country?

Well, Quebec is always different. I think that we have good things in Quebec and good things in the rest of Canada, and I will try to bring them together. In Alberta right now they’re doing a great job instituting EMR [electronic medical records], and one of my goals is to tell the rest of Canada about Quebec’s plan for pharma coverage. I want to give the rest of the country a drug plan to cover them, because drugs are part of the treatment.

Why haven’t a majority of Quebec physicians joined the CMA?

There are factors. One, it’s not compulsory, and two you have to pay a fee. Of course you also have the problem in Quebec that some doctors will not like to have a connection with a federal organization because of their political thinking.

A little bit about the American election: whose healthcare platform is better, McCain’s or Obama’s?

Obama is probably more Canadian because he’s open to a universal system. That’s what we have in Canada and that’s what we want to keep.


5 things you didn’t know about… Dr Robert Ouellet

He’s unlikely to gain Spiderman-like superhero abilities because of all the radiation he’s absorbed Well, now we’re doing ultrasounds and CT scans and aren’t in the room with the patient anymore. Of course, 30 years ago we had to be in there with the patient wearing some lead apron. But this is being done less and less and the machines are much better. No, I’m not afraid of glowing in the dark.

His comic book heroes It would be Asterix & Obelix for sure.

Racing runs in his blood One thing I really like, which I don’t think is well known in the rest of Canada, is Formula One racing. I usually try to go when it’s on here in Montreal. My son is an engineer and he worked for three years at the Renault F1 factory in Oxford.

He wishes he could have seen Paul McCartney play on the Plains of Abraham for Quebec City’s 400th anniversary I think I would have liked to be there, but not to wait four or five hours to get in or wait for the restroom. What I’m not really proud of are the comments that come from the MPs who said that McCartney shouldn’t be there because he’s British.

English is not his mother tongue So I have been practicing. But I have to practice a little bit more since I’ll be giving a speech at the CMA meeting here in Montreal. I will have to get used to making speeches in English more this year.

Interview conducted by Graham Lanktree
Photo: Liam Maloney

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