Quebec’s Psychologists in Crisis

Poor Public Sector wages and overwork are driving many into private practice – a trend they say is killing mental health care access 

By Peggy Curran, The Gazette April 25, 2011   
Concordia master’s student Jessica Senn is one of hundreds across the province caught in the middle of a labour dispute that has clinical psychologists
refusing to train incoming students. Senn was lucky enough to secure a position in Ontario.  

Need to see a psychologist at a Quebec hospital, clinic or school?

Be prepared to wait, up to a year or two, depending on what’s wrong with you – or how willing and able to fork out the $100 to $150 an hour it costs to
go private.

Psychologists from across the province who work in the public sector say low wages and overwork are killing access to mental health care in the province.

Whether you are a parent or teacher who needs an assessment for a child with autism, have an elderly parent with anxiety issues or are yourself going through a rough patch and need counselling, psychology departments in Quebec’s public system are so overworked and understaffed they may not be able to see you for awhile.

Perhaps not until you arrive at the hospital in crisis.

“There is the spillover into the emergency rooms,” says Rachel Green, a neuropsychologist and psychologist at the Douglas Hospital.

“People you can’t see in a timely manner when they are not at a critical level, they become critical, they go through emergency rooms and they block them up, block up the beds.”

“Or the police stations and the justice system,” adds Peggy O’Byrne, professional chief of psychology at the Douglas Hospital.

It’s not that there is a shortage of qualified professionals. There are as many trained psychologists in Quebec as there are in the rest of the country
combined. Increasingly, though, they are walking away from hospitals and clinics – or else dividing their time between the public system and private practice, where they earn five times as much money, set their hours and choose their patients.

“The issue of attraction and retention is a colossal one,” says Yves Beaulieu, a child psychologist and professional practice leader for psychology at the
Montreal Children’s Hospital. “A large part of our work is actually that – maintaining active qualified manpower to service the population.

“And we cannot do that anymore – recruit and maintain people.”

As a result, Beaulieu said, waiting lists have been climbing, “skyrocketing for some ages and specific populations. And the cost of that to society is absolutely huge.”

“We are going to disappear completely from the public sector because it’s just not tenable,” Green says of deteriorating working conditions for psychologists and longer waiting times for patients.

“It’s a big danger,” said Alain Ptito, director of the psychology department at the McGill University Health Centre.

The problem is not limited to Montreal.

At the regional health centre in northern Quebec, for instance, there are always one or two postings for psychologists that don’t get filled. The waiting
time to see a psychologist there is now six months, up from two, says psychologist Michelle St. Pierre.

A high school in Gatineau hasn’t had a psychologist for several months. No one has even applied because wage scales and working conditions are so bad.

On Wednesday, representatives of public-sector psychologists have been called to a meeting with officials from the Quebec department of health and social services in a bid to resolve their differences.

It’s their second encounter since the coalition representing more than 1,000 psychologists in the public sector turned up the heat by saying they would
no longer supervise graduate students who need hospital training before they can practise – compounding the chronic staffing shortage.

Nathalie Dinh, the chief of psychology and co-ordinator of psychological services at St. Mary’s Hospital, said it took a lot for psychologists to take such
a drastic step. She said they did so only after 18 months of trying to get Quebec to heed their appeals for an overhaul of salary scales. Since 2006, Quebec has required psychologists to have a doctorate, educational requirements that aren’t reflected in their wages.

The starting salary for a psychologist working in the public sector is $20 an hour.

“This is the deep dark secret,” says Dinh. “And the ceiling is hovering around $38 something. This is after 10 years. This has never been published because it is not in the interests of the government to say just how badly psychologists are being treated.”

“The salary we have to offer these people that we are trying to recruit is very low,” says Beaulieu, who calls it the 30-30-30 formula.

“It takes nine years to train a psychologist. By the time they finish their doctorate, they are in their 30s. They have delayed having a family, they have
delayed buying a house.

“So they come to us at 30 with $30,000 in debt because they don’t get any money during any of the practical training and they don’t get money during their stages. So they are heavily indebted. And we turn around and offer them a salary in the 30s as an enticement,” Beaulieu said. “They look at us and they say this is not something which is feasible for them.”

“We are the only jurisdiction in North America that does not pay our interns for a full year of full-time clinical work. Zero,” says Zeev Rosberger.

The director of the psychology division at Jewish General Hospital, Rosberger says that after more than 30 years on the job and even with a small premium for running the department, he still earns $10,000 less than a nurse with a master’s degree.

Quebec psychologists have complained to the government that they wanted to be recognized as doctors and have their jobs reclassified to better reflect the role they play in first-line assessment and treatment. In December, the Treasury Board threw them a small bone – an extra $1.67 an hour.

“Here I am trying to bring people into the system and keep them, and I am supposed to say, ‘I am happy to tell you I can offer you $1.67 more than my previous offer,’ ” Beaulieu said.

Even the government recognizes there is a problem – one that won’t go away soon. A working paper prepared for the health and social services department in 2009 predicts that the shortage of psychologists in the public sector will get worse before it gets better.

Analyst Charles Madet said in 2008, Quebec was already short 128 psychologists, with another 297 expected to retire in the next five years. And with roughly half of the psychologists currently working in the system women in their prime child-bearing years, Madet said Quebec needs to factor maternity leaves into its staffing calculations.

Martin Bourque, a member of the coalition who works as a psychologist at a regional health centre on the South Shore, recalls the situation at a clinic
he worked at a few years ago where, for four years, there were two psychologists in a region of 150,000 people.

“We tried to get a third and couldn’t find one. We finally managed to recruit one, but she didn’t stay long before going on maternity leave. Our waiting
list climbed to six or nine months. During her leave, she wasn’t replaced, so the waiting list went up to almost a year,” Bourque said.

“With a year’s wait, a patient’s condition can deteriorate a lot. There is great pressure on us because we try to see patients as quickly as possible.

“At the same time, we have extremely complex cases to treat – people with multiple problems, personality disorders, addictions, depression – and they require time to evaluate and to treat.”

Next: If the public system founders, what happens to the poor?

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