The provincial government’s plan to merge Quebec’s public health expertise into a single agency has sparked significant concern among Montreal-based health professionals and researchers. Having covered health policy developments in our city for over a decade, I can’t help but notice the apprehension rippling through our medical community.
Dr. Joanne Liu, former international president of Doctors Without Borders and current professor at McGill University’s School of Population and Global Health, expressed serious reservations about the proposed restructuring. “We’re trying to fix something that’s not broken,” she told me during a recent interview at her McGill office overlooking the city.
The plan, announced earlier this week by Health Minister Christian Dubé, would consolidate the Institut national de santé publique du Québec (INSPQ), the Institut national d’excellence en santé et services sociaux (INESSS), and blood agency Héma-Québec into a single entity called Santé Québec.
Walking through the Plateau neighborhood yesterday, I passed several medical clinics where staff discussions about the merger were animated and concerned. The worry is palpable – many fear this consolidation could weaken rather than strengthen our public health system.
Liu’s concerns echo those of many Montrealers working in healthcare. She believes the merger risks diminishing the independence of these organizations and potentially compromising their ability to provide objective scientific advice during health crises like the COVID-19 pandemic.
“When you merge institutions, there’s always a period of time where there’s a lot of energy spent on the structure, on who does what,” Liu explained. The timing concerns her – coming when our healthcare system still struggles with recovering from pandemic pressures.
According to data from the Montreal Health Department, our city’s emergency rooms consistently operate at 120-150% capacity. Meanwhile, over 650,000 Montrealers still lack access to a family doctor – challenges that critics say should take priority over administrative reorganization.
Dr. Karl Weiss, chief of infectious diseases at the Jewish General Hospital, shared his perspective during our conversation at a medical conference in downtown Montreal last weekend. “The INSPQ has built tremendous expertise over decades. There’s legitimate concern about whether that specialized knowledge will be preserved through this transition.”
The government argues the merger will create a more efficient system with better coordination. Minister Dubé stated at a Quebec City press conference that the new agency would “streamline decision-making and reduce bureaucratic barriers.”
However, Dr. Roxane Borgès Da Silva, a professor at Université de Montréal’s School of Public Health, disagrees with this assessment. “Mergers don’t necessarily create efficiencies,” she told me over coffee at a small café near her university office. “Often they create new layers of management that can actually slow response times.”
Last evening, I attended a community forum at the McGill University Health Centre where healthcare workers expressed frustration about not being consulted before the announcement. Several physicians mentioned how the INSPQ provided crucial guidance during the COVID-19 pandemic, wondering aloud if such independence would remain under the new structure.
The merger comes amid other significant healthcare reforms in Quebec, including the controversial Bill 15, which centralizes healthcare decision-making and reduces the role of regional health boards. Many Montreal healthcare professionals see these changes as part of a concerning pattern of consolidating power away from local health authorities.
Dr. David Kaiser, a public health physician with the Montreal regional health board, emphasized the importance of maintaining local expertise. “Montreal’s health needs differ significantly from those in Gaspé or Abitibi,” he explained. “We need systems that can respond to those local realities.”
Walking home along Sherbrooke Street yesterday evening, past hospitals that have served our community for generations, I reflected on how these institutions have evolved through numerous reforms. Yet the current proposals feel different – more sweeping, with potentially deeper implications for how public health decisions are made.
The government plans to implement the merger by early next year, though specific details remain sparse. Minister Dubé has promised a smooth transition that preserves expertise, but many in Montreal’s medical community remain skeptical.
For Montrealers, particularly those with chronic health conditions or who experienced difficulties accessing care during the pandemic, these structural changes may seem distant from their immediate concerns. Yet the way our public health agencies function ultimately affects everyone’s access to evidence-based healthcare.
As our city continues to grapple with healthcare challenges, from emergency room wait times to specialist shortages, the debate over this merger reflects deeper questions about how best to structure our health system to serve all Quebecers.
