News and analysis · Nouvelles et analyses

CMAJ 1999;160:1545-7

• Residents' strike averted in Quebec
• Reduce the risk of SIDS
• Plush room for new moms raises cash for hospital
• We have a winner!
• Huge variations in access to home care
• Pulse: MDs second on honesty scale, lawyers and politicians lag
• Bangladeshi university wins CMAJ subscriptions
• Hunger strikers protest First Nations health care

After 4 years without a contract and 6 years without a salary increase, 2000 medical residents in Quebec have voted to accept a new contract that will bring their salaries and tuition fees in line with those in other provinces. The late-April vote narrowly averted a general strike.

The agreement between the Fédération des Médecins Résidents du Québec (FMRQ) and Quebec's Ministry of Health and Social Services was reached Apr. 17, 2 days before rotating strikes were to begin. Negotiations had been under way for 3 years but had been stalled by the ministry for the past 18 months. Until the agreement was signed, Quebec residents had been among the lowest paid in the country.

One of the most contentious issues was tuition fees. Quebec's residents pay some of the highest fees in North America — $3007 annually — for the privilege of taking residency training at the province's 4 medical schools. Dr. Jean-François Cailhier, the FMRQ president, says it is "unthinkable that medical residents should have to pay tuition fees for providing care to the public for 72 hours a week."

Under the new agreement residents will pay only $700 a year. The $2300 difference between the amount paid last year and the amount stipulated in the new agreement will be reimbursed to residents by the provincial government. Many residents are angry that the agreement is not retroactive.

Dr. Shayna Zelcer, a 27-year-old pediatric resident at McGill University, says "it's pretty unfair that we were asked to pay tuition fees. We have 2 hours of formal teaching a week, yet we're paying full tuition. We're not functioning as students — we're licensed physicians who provide medical services in hospitals. My husband and I had to get loans, and a friend had to sell her car to pay her fees." Zelcer, who is from Toronto, says it is common knowledge that lower salaries, higher tuition fees and the highest taxes in Canada discourage residents from coming to Quebec to fulfil their residency requirements.

The residents' association also won a salary increase. "We were at the tail-end, among the lowest paid in the country," says Cailhier. Residents have been granted the same increases as the rest of the public service (2% for the period from 1996 to 1998 and 5% spread from 1999 to 2002), and this will rank them fourth or fifth in Canada.

Dr. Derek Puddester, president of the Canadian Association of Internes and Residents, is pleased by the outcome in Quebec. "I think that what the FMRQ did was very courageous and thoughtful. The bottom line is that the federation was willing to represent and advocate for its members." — © Susan Pinker, Montreal

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www.hc-sc.gc.ca/hppb/childhood-youth.

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New mothers just out of labour and delivery are lining up to stay in a room that looks more like a hotel suite than a hospital room. Today, just months after opening the "Victorian Room," officials at the McMaster University Medical Centre in Hamilton are so pleased with the results that they may redecorate a second bedroom. And the fact that the bedroom brings in some extra cash for nurse training and development is a bonus that has everyone smiling.

Sue Smith, the director of obstetrics and gynecology, first saw a specially decorated ward room at an American hospital. When a grateful Hamilton-area woman said she wanted to donate a gift to the hospital as a memorial to her husband and to recognize the care her daughter and 2 grandsons had received, the room became reality.

The burgundy-coloured bedroom, with double bed, comfortable chairs, en suite bathroom and a television, costs $50 daily for a patient with private coverage. "We've tried to keep it in line with what it would cost for a nice arrangement of flowers or a gift basket," Smith says. "We think its a nice gift for people to give to a friend or relative."

The creative use of the room is just another example of new ideas flooding into hospitals because of government cutbacks. "It's important to staff morale and expertise that they keep constantly up to date," says Smith. "It's kind of neat because you are achieving the ends you have to [achieve] for the sake of dollars, and at the same time the patient is very happy with the way you've achieved it. It's a nice compromise."

Because the birthing process is something mothers cannot book ahead, the room cannot be booked early either. "We let mothers-to-be know about it early and when they come into labour and delivery, they can fill out a card requesting use of the room," Smith says. It's available on a first-come, first-served basis.

The room's success has Smith and hospital officials eyeing other possibilities. "I can see a special room for our short-stay people," Smith mused. — © Ken Kilpatrick

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Congratulations to Dr. Ian Hopkins of Edmonton, winner of our first OSLER contest (see Osler marks first birthday with contest. CMAJ 1999;160[6]:873). He will receive the book This is our Work: the Legacy of Sir William Osler, by Ted Grant. This is an appropriate year for the contest, since 1999 marks both the first birthday of the CMA's immensely popular OSLER (Ovid Search: Link to Electronic Resources) service and the 150th anniversary of Sir William Osler's birth. In just 1 year, the member-only service has attracted 4500 registered users, or almost 10% of all CMA members.

In our contest, we asked users to provide the Unique Identifier number attached to the only article in the MEDLINE database written about 2 famous physicians — Osler and Sir Arthur Conan Doyle. The correct answer was this reference: Key JD, Rodin AE. William Osler and Arthur Conan Doyle versus the antivivisectionists: some lessons from history for today. Mayo Clin Proc 1984;59(3):189-96; 84166571.

To find it, select MEDLINE 1966­99. Type William Osler into the Keyword Box, hit enter, and then tick it where it appears at the bottom of the list of mapped terms. This creates one set of references that mention William Osler in the title or abstract. Repeat the process with the name Arthur Conan Doyle. Combine the sets by typing 1 and 2 into the Keyword Box, and you will have the winning citation.

Hopkins, an anesthetist, was delighted to have his name pulled from a large pile of entries. "I still use OSLER frequently, and find it very helpful in my work."

Details about another OSLER challenge will appear in an On_the_Net column later this year, but be warned: the next search will be more demanding. — Deidre Green, OSLER support librarian, CMA

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Governments need to inject $700 million into home care services to ensure equal access for every Canadian, a University of Toronto study indicates. Peter Coyte, codirector of the university's new Home Care Evaluation and Research Centre, found that all provinces except Newfoundland need significantly more funding to match Ontario's home-care spending. Quebec, for instance, would have to double its funding, and Alberta and BC would require a 50% increase. Even though the $700-million projection represents a 30% increase in total home-care funding, it would still account for less than 1% of total health expenditures.

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Pulse: MDs second on honesty scale, lawyers and politicians lag

The University of Science and Technology in Chittagong, Bangladesh, has been awarded 3-year subscriptions to CMAJ and its sister publication, the Canadian Journal of Surgery (see CMAJ 1999;160:63-4 [full text]). It was nominated by Winnipeg orthopedic surgeon Fariduddin Shariff, who visited the city in 1997; the country's physician-to-patient ratio is about 1:5000.

(Dr. Fariduddin Shariff photo)

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Four First Nations chiefs in northwest Ontario began a hunger strike in April to protest the poor level of health care in their region. To turn up the pressure, they invited the World Health Organization (WHO) to tour the area.

The Sioux Lookout Zone Hospital, which is administered federally to provide health care to the area's predominantly native population, was virtually closed earlier this year due to a severe shortage of physicians and nurses. The zone hospital serves about 15 000 people in the Sioux Lookout area, some 400 km northwest of Thunder Bay. Residents of the area now must travel hundreds of kilometres, to places like Dryden or Thunder Bay, to receive basic services.

Allan Rock, the federal minister, set up a working group of government and native officials to solve the hospital's problems, and its final report is due July 30. Meanwhile, area residents have taken matters into their own hands.

"[We want to] bring them [WHO] up to see the conditions and view firsthand how First Nations are treated," said regional chief Tom Bressette in a recent interview. Canada has twice been rebuked by the UN for shoddy treatment of aboriginal peoples. The Sioux Lookout chiefs hope the threat of another black eye on the international stage will inspire government officials to solve the shortage.

Attracting professionals could prove challenging. The town's remoteness is illustrated by a recent nursing job posting: "Candidates must be willing to travel over rough roads for long distances, to fly by small plane or helicopter, or to travel by boat, [perhaps] in inclement weather." — © Michael OReilly

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© 1999 Canadian Medical Association (unless otherwise indicated)