Wednesday, August 29, 2012

When The New Guy Seems Like the Old Guy

Francois Legault, the leader of the CAQ, the new party that proclaims to be different from Quebec's older parties, seems to be cut from the same cloth. Why do I say this?  Because he is promising to restrict the exodus of doctors produced by Quebec's medical schools (mostly aimed at McGill).  The funny thing is that Charest of the Liberals has been accusing Legault of being a closet separatist, when the real concern should be that Legault would run the province like any other PQ government--into the ground with over-reaction and coercion and one size-fits all solutions.

Is there a Doctor exodus from Quebec? Probably.  Do I know of McGill-produced doctors who have moved out of Quebec?  Certainly.  One might ask why some leave.  It might be about pay, but it also might be about how poorly administrated the health care system is in Quebec.  I remember early in my time in Quebec lots of discussion of doctors being compelled, rather than persuaded, to serve outside of Montreal and especially in the less populated parts of the province.  Again, coercion, not incentives.  The Soviet style decision-making about how many pediatric oncologists a hospital needs can be a bit of a turn off.

The thing that is most annoying and most typical is that this kind of policy assumes that people do not have choices and will not react.  Certainly, they will do so.  How so?  Well, the most obvious thing is that McGill (and others, I guess) would receive fewer applications as students anticipate and choose to go elsewhere rather than McGill.  Why is that a problem if people intend to leave?  Well, this selects out people who may not intend to leave but want the freedom to do so if they change their minds or get a good offer.  Perhaps the CAQ would argue that we don't need those people.  Well, if you reduce the pool of applications, you will almost certainly reduce the quality, causing a lowering of standards.  This is problematic because advocates of educational reforms almost always forget a key reality--students learn from each other.  So, if you reduce the size of the pool of applicants, you will probably reduce the quality of the educational experience.  I don't know about you, but I prefer that folks doing the doctoring to be not only really smart but also really well educated.  And the quality of the education depends critically on those who are school with the doctors that stick around.

There are other dynamics as well.  Students may come to McGill intending to leave but then fall in love with Montreal and Quebec and stay.  But you will not get those students if they know ahead of time that they cannot leave.  Further, McGill and similar schools, while public schools, do not just exist to help Quebec.  They produce public goods--a better educated medical community in Quebec AND beyond.  They also may help produce research while they are in Quebec or even after they leave that helps out Quebec.  If Quebec punishes those who try to leave and work in the rest of Canada, perhaps Canada might react by considering whether to fund McGill's medical schools.  Ah, yes, some of the med school funding is federal, not provincial.  Ooops. 

Lastly, McGill should be a point of pride in Quebec despite is Anglophone-ness as it has a reputation around the world as one of the finest schools.  Quebec politicians should keep in mind that when they come up with policies that would diminish McGill, they are also diminishing Quebec in the world.

But, of course, it is far easier for Quebec politicians to come up with coercive policies--to threaten doctors, to restrict choice--than it is to develop policies that require some imagination, some creativity, ways to appeal to aspiring doctors to keep them around so that they can help fix a broken health care system.  So, the CAQ, as the "new" party in town seems a lot like the old ones.  The quick reference to the "Notwithstanding Clause" should set off alarm bells.

Talk about restricting choice--this election gives Quebeckers a lousy set of alternatives.

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