The media often talks about workers' and student unions, but rarely about professional corporations. In a study published late in 2015, we asked ourselves if they we functioning properly, i.e. if they were aptly fulfilling their mission to protect the public. We realized that there were a number of important problems.
Let's go ahead and state from the get go that our findings did not please everyone. Reacting to our publication, the College of Physicians and Surgeons, one of Quebec's 46 professional corporations (and certainly not the least), published a press release in which it defended itself from having been complacent regarding the ancillary fees that some doctors charge to Quebec patients. We were astounded to read in their reply that the College of Physicians considered that its own annual reports were not a reliable information source from which to conduct our study..! This stance did tend to confirm our doubts on the self-regulating capabilities of professional corporations…
The College of Physicians did not appreciate when we reminded our readers that, after having changed its code of ethics on January 1st, 2015 in order to prohibit ancillary fees, it dragged its feet in the face of its members' massive violations of said code. It preferred instead to sometimes negotiate compensations with the plaintiffs and other times to pass the buck to the government, and therefore it manifestly never attempted to stop this nonetheless prohibited practice. The College decided instead to wait while, in the meantime, between one and two million dollars were being extracted from patients… per week! Maybe doctors urgently needed some money?
We addressed the issue in our study. The College of Physicians replied that it has been treating it with the utmost "seriousness". Good thing. The public itself takes healthcare access very seriously. We've noticed that, recently, part of the population is growing increasingly annoyed by the fact that, despite there being a third-party-payer system (i.e. the state pays physicians within a public regime) —which has in time allowed a number of doctors to reap very high salaries, and even to build up bona fide fortunes—, physicians are feeling confident enough to charge ancillary fees, sometimes in a completely scandalous manner. Clearly doctors knew that it was highly unlikely that their professional corporation would give them a slap on the hand. In its press release, the College does not deny having processed complaints piecemeal rather than having taken the initiative to address the root of the problem.
At a time when not a week goes by without seeing medical doctors' compensation make the headlines for the wrong reasons (their compensation has, it's worth remembering, increased 60% in the last six years), the College should exercise more caution when accusing others of lacking credibility.
The problem with ancillary fees is that it's only one among a number of failings within Quebec's professional system, leading us to question the ability of professional corporations overall to defend the public. In fact, the tension between the mission to protect the public and the promotion of a profession too often drifts into corporatism.
Why else has the province's association of professional engineers, the Ordre des ingénieurs du Québec, completely failed —for nearly 15 years(!)— to protect the public from the "culture" of collusion, corruption, and illegal funding that prevailed in public contracting in the construction industry?
Is it really the mission to protect the public that led social workers' professional corporation to demand (and to be granted) exclusivity in preparing mandates in case of incapacity at a time of both growing needs in the field and saturation in the public sector, driving citizens into the arms of private social workers' companies?
The energy that corporations put into allowing professionals to incorporate is in and of itself suspicious. The euphemism used is "modernizing professions". The practice essentially makes it possible to avoid paying taxes. Recently, tax leakage for the state was evaluated at $150 million for the incorporation of medical doctors only. How much is it for all the others also entitled to incorporation?
The administration of professional corporations will certainly need to be rethought if we wish to put them in a better position to protect the public. Few people are aware of it, but representatives of the public sit on each corporation's board. Aside from the fact that they are assigned based on a list of names, we ignore how they are selected (which is a separate issue) and we wonder if their small number allows them to ensure proper oversight.
In short, if we want to truly break with the corporatist reflexes that leads certain professional corporations to value and to promote a profession rather than to defend the public to the bitter end, we need to rely less on self-regulation and to increase controls by the Professions Board (therefore by the state) and by citizens, perhaps even by citizen organizations.
Guillaume Hébert is a researcher with IRIS, a Montreal-based progressive think tank.