Dr. Michel Lallier
The Autopsy of a Frantic Autumn
My best wishes for a great start to 2007! allowing us to discuss these matters. Our situation was unique, and
while our discussions were continuing with the government, we noted
his is my very ﬁrst article in Le in December 2005 that special legislation had been passed regarding
Spécialiste as Vice President of public service employees which excluded medical specialists. That
the FMSQ. I would like to conduct meant that matters were postponed as far as we were concerned. I will
a personal autopsy of the events we all come back to that later on.
experienced last fall. It’s a difﬁcult – but most
enjoyable – task! At a time when autopsies are In January 2006, a round of negotiations began with a new proposal
becoming less frequent, I would like to use this from the FMSQ on Canadian parity. As mentioned previously, our
forum to analyze the causes and problems, solutions situation differed from that of the public service; we brought up the
and remedies we will be keeping in mind in the future. question of parity once again. I won’t go into details of the negotiations
First of all, a brief reminder of what happened. Everything began in and the actions taken but, in June 2006, the government decided to
2002 and, for this autopsy report to be accurate and complete, we have muzzle the FMSQ by means of a special Bill, No. 37. This ferocious
to go back that far if we want to identify the relevant points. In 2002, Bill dictated medical specialists’ pay and working conditions until
our negotiations mainly dealt with achieving Canadian parity and 2010. It ﬂouted and violated their rights, opening a wound that deepened
improving our practice conditions. Bill 142 then came along, covering as time went on. Physicians could not change their level of practice,
medical activities, the distribution and commitment of physicians. reduce it or become non-participants. They found themselves trapped
Armed only with our courage, our professional ﬁbre and, above all, the in an untenable situation.
will to maintain our professional independence, we started out on a
ﬁerce, long-drawn-out battle. Members’readiness to act was impressive. During the summer of 2006, we carefully assessed the options open to
In January 2003, we succeeded in having several Letters of Agreement us. Given the harsh and, above all, coercive nature of the legislation,
adopted, the three most important being Letter 142 (the repeal of Bill we had very little room for manoeuvre. In September 2006, the
142), Letter 145 (the creation of a committee to study our conditions Delegates’Assembly opted in favour of stronger, faster action, which
of practice) and Letter 146 (the creation of a committee to study the would still comply with the provisions of Bill 37.
gap between the remuneration received by medical specialists in Quebec
and the Canadian average). Implementation of these three Letters of Our game plan recommended the following ﬁve measures:
Agreement brought about a pause in our actions. 1. Contest Bill 37 before the courts;
2. Maintain the level of practice as required by the legislation – i.e.
The Remuneration Committee submitted its report after 18 months of
not doing any less, but not doing any more either;
intensive work. We all know its conclusions: the difference in medical
specialists’remuneration according to the FMSQ was 44%, whereas the 3. Stop all teaching activities for which little or no pay was received,
government found the gap to be 10 %. But the independent expert but maintain clinical teaching activities;
assessed the gap at 26 to 38%, leaning more towards the FMSQ. 4. Stop all forms of unpaid medico-administrative work;
Another victory! 5. Continue treating our patients in accordance with good practice.
After the committee’s report was issued, the FMSQ submitted a
demand for a 44% correction with regard to parity. As provided for in Unfortunately, Dr. Yves Dugré had to withdraw for health reasons, but
Letter of Agreement 146, this amount would be spread over four Dr. Louis Morazain, the FMSQ Vice President, immediately seized the
years, starting April 1, 2004. As the request did not include renewal of torch in an outstanding manner. I would like to draw particular attention
our Agreement, the 2% annual increase given to public service employees to this fact and thank him for all he did. We entered a more active phase
did not form part of our discussions. However, the FMSQ had submitted at that point (October 2006). Meetings with the government were
various other matters that required attention, such as parental leave, non-existent to all intents and purposes; the government systematically
on-call duty, teaching in university hospitals, end-of-career planning, refused to upgrade its offer (which was 0% as far as parity was
and so forth. Our negotiations therefore speciﬁcally concerned the concerned), basing itself solely on the amounts granted to public
situation of medical specialists, which differed from that of the public service employees (8% up to 2010), with an additional 5% for certain
service because we had already signed an agreement with the government speciﬁc measures.
8 LE SPÉCIALISTE · VOL. 9 no 1 · march 2007
It was at that point that the Federation totally changed its approach. the government wanted to act ruthlessly in view of what it perceived as
Our action became intensiﬁed. As Dr. Dugré had informed us of his illegal pressure tactics on the part of the FMSQ. The Minister asked
decision to quit for health reasons, we had to replace him in accordance the Conseil des services essentiels (CSE) to intervene and end FMSQ
with FMSQ bylaws. After numerous discussions, Drs. Morazain and members’“pressure tactics”. In November, the CSE studied the legality
Montreuil decided to resign for strategic reasons, thus making it of our actions. I would like to highlight the outstanding efforts of our
possible for a new team to pick up the torch once again and continue legal advisers, led by Maître Sylvain Bellavance, our Director of Legal
with negotiations. On November 16, the Delegates’Assembly unani- Affairs. After several days of hearings and deliberation, the decision
mously elected Drs. Gaétan Barrette, Raymond Hould and Daniel handed down was basically in our favour. The various associations
Doyle. This trio was to breathe new energy into the FMSQ. There was called by the CSE were also up to the task and I would mention, in
a ﬂurry of messages of encouragement, congratulations, personal particular, the incredible effort and commitment of the Association of
comments and suggestions from FMSQ members. A distinctly uneasy Obstetricians and Gynecologists of Quebec, its President and members
feeling was noted on the government side when confronted with this who had many calls made on their time during this period.
professional energy because, shortly before the arrival of the new
team, a 10% offer with regard to parity was placed on the negotiating The tone of the negotiations heightened each day; the tenacity of medical
table. Strengthened by members’ unequivocal support, we considered specialists became increasingly formidable from the government’s point
that the offer fell well short of our objective of 44%, and it was of view. The pressure consistently maintained by specialists and the
therefore refused. balance of power were clearly felt by the government. Just mere minutes
before a special meeting of members was held (more than 1,300 members
Many will say that November saw the beginning of the real trial of forsook parties and holiday preparations to be present on December
strength between the FMSQ and the government. The Federation’s 21); a ﬁnal offer was made by the Minister, one that was considered
objectives were set very high: we demanded a real offer with regard to reasonable and acceptable to Quebec medical specialists as a whole. The
Canadian parity, the repeal of Bill 37 and better working conditions. FMSQ presented the offer to members at the special meeting: mission
It appeared unlikely that the question of parity could be settled over accomplished! We had won. The real process of mediation began
the short-term. Medical specialists and the FMSQ placed little trust in in January. If no agreement is reached by the end of August 2007,
the government’s promise of good faith. Furthermore, the FMSQ was arbitration will be the ﬁnal step. We will all see what comes after.
continually astonished by the fact that the government made its offers
in public: the Minister only talked to the media and refused any form of In conclusion: in all humility, I consider that, together, we found both
direct contact with the FMSQ executive. Conscious of the government’s the cause of the problem and its remedy, which we will keep very
escalating tone and obstinate attitude, the FMSQ asked for an arbitrator carefully in mind for the future.
to settle a situation that was becoming increasingly virulent. No Quebec
government had ever agreed to arbitration, even though several other The cause of the problem lay mainly in our lack of conﬁdence that we
provinces in Canada had had recourse to this method. We wanted a could establish a true balance of power. We have seen what we can do:
true arbitration process that would be binding on both parties. At we have to believe and remain united to achieve our ends. The remedy
that point, this was the only way in which a real settlement could be is solidarity and unity. We have experienced what it can do: our
guaranteed. The government categorically refused to consider it. strength in numbers and our determination allowed us to achieve a
result that we sincerely hope will enable us to reach the reasonable
Meanwhile, the matter of professional liability insurance required objectives of our Federation as regards Canadian parity.
attention. Unless there was a rapid solution, specialists would ﬁnd
themselves faced with a totally ridiculous increase in premiums. The I trust that we have all learnt something from this difﬁcult period. No
specialty most affected by the absence of an agreement would have been future government will ever repeat such errors, and physicians will
Obstetrics/Gynecology. The media seized upon the story that no babies never again accept the unacceptable.
would be delivered as of January 1, 2007. The public’s concern
increased daily as medical specialists’defection was announced, mainly Following our President’s example, I will end with:
obstetricians and gynecologists. But, we maintained a solid, united Yours, in solidarity!
position. Faced with the spirited determination of medical specialists,
LE SPÉCIALISTE · VOL. 9 no 1 · march 2007 9
Jean-Marc Desrosiers, Adm.A.
Financial Security Advisor
Group Insurance & Pension Advisor
Association Group Insurance:
A Rare Opportunity
s a member of the FMSQ, you situation. This means that, before it is even made, your application has
have an advantage that few profes- already passed a crucial step in the rating process. In addition to knowing
sionals enjoy when the time comes the general and speciﬁc requirements of your profession, the analyst
for you to take out insurance – and that is assesses the insurer’s proﬁtability based not on a single application but
choice. You can choose a personal contract on a whole group. This gives him more latitude when making a decision.
with a ﬁnancial institution or belong to an
Finally, the advantage of a personalized rating is just one of the many
association group insurance program (AGI)
other beneﬁts you enjoy with an exclusive product, with coverage
sponsored by your Federation, to which
developed by and for group members. Beneﬁts include payments until
several thousand of your peers already belong.
age 70, a 45-day waiting period, 5% indexation, an HIV rider, improved
AGI (often called “group insurance”) is not simply a presumption of disability for surgeons, to name just a few. Further
collection of personal life, disability, accident or health details on these individual beneﬁts will be given in an upcoming issue.
insurance contracts. It is the result of a single contract between a
To help you make an informed choice, consult the experts at Sogemec
policyholder and a service provider, taken out on behalf of a group of
Assurances. They are the only ones who can offer you the FMSQ’s
legally designated persons1.
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Among the many beneﬁts membership in such a program brings you, plans from all Canadian insurance companies.
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Sogemec Assurances, Assurances, a team that works for you!
As a member of an AGI, you have the advantage of doing business with
an insurer who has been carefully selected by a committee of your Collection LE GUIDE ÉVOLUTIF TOME 1, 2004, Michel Ferland
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12 LE SPÉCIALISTE · VOL. 9 no 1 · march 2007
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ater damage is one of the most common reasons for an Fortunately, The Personal may be able to raise the
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LE SPÉCIALISTE · VOL. 9 no 1 · march 2007 13
Dr. François Brochet, Radio-oncologist
Chief, Radio Oncology Department, CSSS Chicoutimi
From Radium to Optimization
hile the term “brachytherapy”
is commonly used in English,
France (and, by extension,
French-speaking countries) prefer the
term “curiethérapie” in honour of Pierre
and Marie Curie who discovered radium in
Paris in 1898, two years after Becquerel
accidentally found that uranium emitted invisible
In 1901, Danlos used radium
for the first time to treat
lupus. In 1903, in St.
Petersburg, the cure of two
basal cell carcinoma that had
been treated using radium
was confirmed histologically and, in 1905, five people were pho-
tographed in Melbourne, Australia, in the process of manually
applying a tube of radium to their skin cancer. That same year, in the
United States, Abbé inserted the ﬁrst radium implants into a tumour.
At that time, powdered radium was placed in a rubber sleeve or in
a glass tube. Radiation protection never entered users’ thoughts.
Advertisements lauding the merits of a radioactive cream (Activa) to
slow skin ageing, or for atomic soda (Zoe) which had energy-inducing
virtues have even been found…
It was only in the 1920’s that a Frenchman, Jean Pierquin, developed
Pierre and Marie Curie
radium needles that could be implanted in tumours, more speciﬁcally
tumours of the breast, mouth, neck, etc. It was again a Frenchman, Bernard Pierquin (the son of Jean) who,
together with his team (D. Chassagne et A. DuTreix), established a
With the therapeutic use of radium, brachytherapy gradually developed dosimetric system (the Paris System); its principles are still used in the
throughout the world for the treatment of tumours. However, dosage 21st century, although manual calculations have been replaced by
calculations were empirical, and were ﬁrst based on a milligram-hour- computerized programs. The Gray (Gy) unit (1 joule/kilo) has become
radium unit and then the Curie, which corresponded to the dose emitted the new unit for measuring the dose received, following the Rad (100
by the radium and not that absorbed by tissue. erg/gram).
In 1941, Quinby drew up the first treatment table showing the At the same time, because of the unfortunate consequences experienced
relationship between the dose emitted and the dose received. It was not by radium users, radiation protection rules were developed in the
until the 1950’s however and the arrival of new artiﬁcial radioactive 1960’s. The ﬁrst afterloading machine was used in Stockholm in 1962.
isotopes like iridium and cesium (artiﬁcial radioactivity was discovered Then, in 1969, Bernard Pierquin and his team developed the
by the Curies’ daughter, Irène, and her husband Frédéric Joliot in Curietron. This equipment allowed the mechanical withdrawal of a
1934, but its development was delayed because of World War II) that a patient’s sources of radiation when caregivers or visitors entered the
start could be made on ﬁnally establishing measurement systems and room. (The walls were, of course, lead-lined.) Other machines
modern dosimetry. followed: the Selectron, Cathetron, Brachytron, etc.
14 LE SPÉCIALISTE · VOL. 9 no 1 · march 2007
In 1966, GammaMed, a German company, developed a source projector While many types of cancer can beneﬁt from brachytherapy with
containing only a tiny, single source of iridium, but its activity was regard to control and quality of life, it can also be used to treat certain
10,000 times higher than that of a standard iridium wire. High-dose- benign lesions like cheloid scars. If very low doses are delivered imme-
rate (HDR) brachytherapy was born, but it took until the 1990’s for it diately following surgical removal, the cure rate is 98%, with no side
to gradually replace low-dose-rate effects.
(LDR) brachytherapy and for
North Americans to ﬁnally show Brachytherapy has already entered the future with 3D dosimetric scans
slightly more interest in this mode or MRI’s, thus enabling optimal local control and fewer side effects.
of treatment, which they had
previously tended to ignore, aside It should be remembered that we are discussing highly localized radio-
from the uterovaginal application therapy, which obviously results in a considerable reduction in side
developed by Fletcher in Houston. effects when compared with high volume external irradiation.
However, indications must be carefully selected and the treatment team
When I arrived in Quebec in 1983, well-trained (physician, medical physicist, technician).
people looked askance when I
began to use brachytherapy for A number of scientiﬁc groups (the European Curietherapy Group
breast cancer, as I had learned to (GEC), the European Society for Therapeutic Radiology and Oncology
do in Paris and had already (ESTRO); the American Brachytherapy Society (ABS); etc.) organize
practised in various places. This experience allowed me, in the year congresses and courses on a regular basis in order to teach and foster
2000, to present and publish the most impressive North American the uniformity of modern brachytherapy.
series on brachytherapy in breast cancer, such as boost therapy of the
tumor bed following external radiotherapy: 820 cases after 10 years For my own part, I would like to express my wholehearted thanks to
and 94% local control regardless of the size of the tumour, and 97% those who, when I was taking my ﬁrst steps in radiation oncology,
for tumours up to 2 cm in diameter. opened my eyes to the wonderful world of brachytherapy: Monique
Perrot, Bernard Pierquin, Daniel Chassagne and Alain Gerbaulet.
The advent of high-dose-rate brachytherapy enabled the indications to
be expanded to cover tumours of internal organs (the bronchi and the
esophagus, for example) which, until that time, did not appear to
tolerate long-term therapy. BRACHYTHERAPY: A SHORT GLOSSARY
Other brachytherapy techniques were developed at the end of the 20th • Low-dose-rate (LDR): 0.4 to 2 Gy/hr., continuous
century, such as pulsed dose-rate (PDR) brachytherapy which is actually • High-dose-rate (HDR): > 12 Gy/hr., fractionated (3 to 10
low-dose-rate brachytherapy but in a hyperfractionated form involving sessions, or 1 to 2 per day depending on the indication)
multiple daily sessions. The use of permanent implants (iodine,
palladium) has progressed rapidly in prostate cancer. I would like to • Interstitial brachytherapy: brachytherapy performed inside
take the opportunity here to pay homage to the Canadian forerunner the tumour or tumour bed.
of this technique, our late colleague Jean Roy of Quebec City. • Intracavitary brachytherapy: In contact with the tumour or
Reviewing all the indications for brachytherapy today would be too
time-consuming, as its use is growing at a spectacular rate worldwide, • Permanent implant: Iodine or paladium “seeds”, implanted
alone or in combination with external radiotherapy or, again, together permanently in the affected organ. As the photon energy
with surgery (peroperative brachytherapy) emitted is very low with a short half-life, there are no radiation
• Temporary implants (LDR or HDR): Plastic (interstitial)
tubes or special (intracavitary) applicators placed in contact
with or inserted into the affected organ, followed by treatment
sessions in a shielded room with a source projector.
LE SPÉCIALISTE · VOL. 9 no 1 · march 2007 15
Dr Pierre Ferron, ENT Physician,
A Revolutionary in the World of
Deafness in Quebec
During his career, he has seen hundreds of people of all ages with severe hearing problems. Nothing could help
them recover their ability to hear, even partially. Nothing, that is, until he became interested in cochlear implants.
n 1984, Radio-Canada television presented a true Canadian “ﬁrst” Cochlear implants presented a worthwhile alternative for many of his
during its Science réalité series. A Quebec physician, Dr. Pierre patients. In certain cases, when hearing aids cannot help, cochlear
Ferron, performed an operation to implant a device that would implants allow them to distinguish noises that give structure to their
allow a 33-year-old man to hear sounds again. He had become deaf as surroundings. Others can hold telephone conversations. To attract the
a result of a hereditary illness. The operation consisted in embedding funding needed, Dr. Ferron created the Quebec Cochlear Implant
a bobbin and a tiny 12-wire cable in the skull; the wires were then Research Foundation. The donations received have allowed him to
inserted into the auditory nerve. Dr. Ferron certainly had to believe in continue his research work and establish the Quebec Cochlear Implant
this multielectrode cochlear implant if he allowed his initial operation Program. Today, he heads a 20-member multidisciplinary team of
to be seen on live television! 1 surgeons, researchers, audiologists, speech therapists and psychologists.
Dr. Ferron was a believer! Today, more than eight hundred patients Funding and research: a balancing act
in Quebec, children and adults, have successfully been ﬁtted with a Although the RAMQ pays the cost of cochlear implants today
cochlear implant. But where did he get his original idea from, the one (estimated at more than $30,000), it does not pay for new “research”
that today has enabled more than thirty thousand people worldwide to implants. Yet it is research that leads to improved techniques. In 1987,
hear once again? the operation was performed on a child for the ﬁrst time; in 1990, it
was performed on a child with congenital deafness and, in 2000, an
Dr. Ferron has always been touched and saddened by the distress expe- implant was given to a 24-week-old child, the youngest instance of
rienced by the deaf. He quickly realized that profound deafness can be cochlear implantation in the world.
a lifelong handicap and that it was a mistake to think that deaf people
lived in utter silence, since many of them suffer from tinnitus. It was this What does Dr. Ferron think about research in the future? “It will
ﬁnding that pushed him to ﬁnd a way to help his patients better cope undoubtedly be there. This science is in its infancy. It can only improve.
with their handicap. Reviewing the scientiﬁc literature, he discovered The day will come when we will probably implant a bionic ear in
that work was being done on the ﬁrst multielectrode or cochlear Quebec – i.e., one that is fully implantable. The challenges will be
implants. It was mainly being carried out in Paris by Dr. Claude-Henri different, both with regard to auditory programming and its function
Chouard, and also by Dr. William House in Los Angeles and in humans”.
Dr. Graeme M. Clark in Melbourne. “If others can do it, so can I,”he
told himself. Dr. Ferron’s team is working with large companies to develop future
technology. For more than twenty years now, the improvement and
In late 1982, Dr. Ferron decided to meet with his colleagues, study miniaturization of electronic components have presented a daily chal-
these innovative techniques thoroughly and ﬁnd out how useful they lenge. Work is currently being done on developing fully incorporated,
could be for his patients. A cochlear implant consists of an external/ non-invasive micro-implants that provide better performance and a
internal device that uses a microcomputer to transmit sound impulses wider range of applications.
to the auditory nerve and receive the processed signals.
If you were to ask Dr. Ferron what his proudest accomplishment is, he
With the support of Hôtel-Dieu de Québec management, he ﬁrst tested would say without hesitation that it is making people hear. “Seeing a
his patients to objectively measure their levels of hearing or hearing child and even an adult smile because they can now hear still touches
loss. Under general anesthesia, an electrocochleogram receives an me deeply. There can be no better reward than that”.
acoustic signal and accurately calculates hearing activity (uptake by
1 A clip of this telecast (in French) can be seen on the Radio-Canada archive
the auditory nerve). These tests then allow a precise diagnosis of the
hearing deﬁcit and the possibility of correcting it. “In addition, when site at: http://archives.radio-canada.ca/IDCC-0-10-1851-12403/vie_societe/
children present some residual hearing, we are able to develop hearing handicapes_services/
aids perfectly adapted to their individual needs”, says Dr. Ferron.
LE SPÉCIALISTE · VOL. 9 no 1 · march 2007 17
Dr. Gilles Hudon
Director, Health Policies and the Ofﬁce of Professional Development
Report on the Second Annual
he Second Annual MS-7 They have to deal with decision-makers, politicians and ﬁnanciers
Conference was held in Belgium who are concerned about and responsible for a balanced system. The
from November 10-14, 2006. The way the system is approached changes depending on whether the person
theme was The Funding of Specialized concerned is an economist, lawyer, politician or physician and whether
Medicine. The event brought together the ﬁeld is health, economics or physicians and societal ethics.
representatives of physicians’ professional
associations from Belgium, Canada, France, Health care has become a universal right. It has no price; it only has
Italy and Switzerland, together with members a cost. The ethical question is to know what price is to be paid. How
of the European Union of Medical Specialists much are developed societies prepared to pay for health care? The
(UEMS) representing medical specialists of the European politicians, decision-makers, are faced with impossible choices: what
Community. Participants were invited to meet at the Clinique level of care should be provided for the price to be paid? Not everything
Saint-Jean, a 350-bed private hospital located right in the centre of can be funded. Who will be left aside? Who will be helped? These
Brussels. The organization of this 2nd Annual Conference had been decisions have to be made almost callously. They are politically driven
entrusted to the Groupement des Unions Professionnelles Belges de and, in a democracy, politicians are elected! One can almost hear the
Médecins Spécialistes, whose President, Dr. Jean-Luc Demeere, an word “demagoguery” being whispered. As physicians, we prefer
anesthesiologist and Vice Presidents, Prof. Jacques A. Gruwez, a surgeon, “responsibility”, from the Latin respondere, i.e., to be answerable for
and Dr. Françoise Matthys, a psychiatrist, were the organizing hosts. one’s choices and decisions.
Because of the situation affecting the FMSQ in November 2006,
elected members of the Board of Directors were unable to travel to Schools of public health, universities, and faculties of economic studies
Europe. Dr. Gilles Hudon, Director, Health Policies and the Ofﬁce of suggest systems. Actuaries calculate risks, statisticians manipulate
Professional Development, was charged with representing the FMSQ. numbers, and insurers weight alternatives, compare systems and seek
their place or share in the distribution of roles in the system. What
What is the MS-7? about the patients? What about the caregivers? What about the
The idea of the MS-7 (Specialized Medicine-7) occurred to Dr. Yves physicians? What about the specialists? The purpose of meetings like
Dugré in 2005 while he was President of the Federation of Medical MS-7 is to enable medical specialists to exchange information. More
Specialists of Quebec; it was inspired by the G-7. “Ministers of Health than ever before, all physicians must be truly knowledgeable about
meet together to discuss health systems, but the main players are usually health economics and the law. A friendly exchange of views, as at the
not invited to join them! We therefore decided to hold our own meeting, MS-7, is a valuable tool in achieving this objective”.
so that we could take a proactive approach when the time came to give
our opinion on a speciﬁc subject”. Subjects discussed during the conference
For two-and-a-half days, presidents and representatives of professional
Dr. Dugré contacted several European colleagues about his idea, in unions, private hospital managers and the Minister of Health presented
particular Dr. Jean-Luc Demeere in Brussels. The idea was immediately their points of view, as well as the realities of negotiating with their
adopted and implemented. A few months later, in the fall of 2005, the individual governments: their successes and their failures. Seventeen
ﬁrst MS-7 meeting was held in Montreal and Quebec City.1 “We are not delegates from seven federations or unions represented tens of thousands
pretending to change the world of specialized medicine in Europe or of medical specialists (there are more than 20,000 in Belgium, 50,000
Quebec, but knowing what works and what doesn’t is crucial when in France and more than 100,000 in Italy).
talking about health systems,”stated Dr. Dugré in his opening address.
A total of twenty-one presentations were made on the conference’s
When welcoming participants, Dr. Jean-Luc Demeere deﬁned the concept theme, The Funding of Specialized Medicine. A host of charts giving
as follows: population and medical demographics, national budgets covering
health care budgets and the delivery of medical treatment were some of
“The MS-7 provides a forum where physicians who are responsible for
the issues presented and discussed. Interested readers can ﬁnd all the
professional organizations can discuss their experiences concerning
presentations on the Federation’s Web site at: www.fmsq.org.
the defence of their profession. They are all players in the health
sector, working with health policies and organizing patient care but,
ﬁrst and foremost, they are, and always will be, physicians.
18 LE SPÉCIALISTE · VOL. 9 no 1 · march 2007
A few points to be noted equally between the physicians and the government. That means that
Private medicine has developed much further in Europe than in Canada independent French medical specialists had 500 million Euros ($750
or Quebec. In Belgium, in particular, medical clinics (complete private million CAD) that could be allocated to their consulting fees. This
hospitals with several hundred beds) are prevalent. The initial investment concept was explored by the Ministère de la Santé du Québec and the
required to create new ones, however, is now becoming very difﬁcult FMSQ in the early 1990’s, but was not followed up. It might be
if not virtually impossible, ﬁrstly because they are all non-proﬁt worthwhile taking another look at it…
organizations and, secondly, they require a major commitment on the
part of the physicians working there, together with a considerable
investment in time and money. On the other hand, the hospitals make List of Presenters and Participants
Second MS-7 Annual Conference
it a point of honour to provide physicians with almost ideal working
Brussels, November 10-14, 2006
conditions. It was clear from the outset that the physical organization
of the clinics, the way in which patients were received, the quality of Dr. Jean-Luc Demeere, President (Anesthesiologist)
the equipment and the cleanliness of the premises were outstanding. Dr. Françoise Matthys, Vice President (Psychiatrist)
Prof. Jacques A. Gruwez, Vice President (Surgeon) GBS-Belgium
An interesting idea was put forward by France. Independent practice
Dr. Marc Moens, Secretary General (Clinical Biologist)
physicians (those not paid directly by the State) are committed to
controlling health care costs (“medicalized control”) with the intention Prof. Francis Heller, Assistant Secretary (French) (Internist)
of replacing a system which is purely a matter of accounting. After 20 Dr. Jacques De Toeuf, Vice President (Surgeon) ABSyM -Belgium
months, the savings generated by this rationalization undertaken by Dr. Rachel Bocher, President (Psychiatrist)
INPH - France
the physicians themselves and basically involving the improved use of Dr. Jean-Marc Badet, Vice President (ENT Physician)
medication and better-controlled patient sick leave, amounted to Dr. Jean-Luc Jurin, 1st Vice President (Psychiatrist) U.ME.SPE-France
around one billion Euros ($l,500 million CAD). The savings are divided
Dr. Bernard Maillet, Secretary General (Pathologist)
UEMS - Belgium
Dr. Vincent Lamy, Treasurer (Gastroenterologist)
MS-7 – 2006 A Few Acronyms Dr. Max Giger, President (Gastroenterologist) FMH-Switzerland
GBS – VBS : Groupement des Unions Professionnelles Belges Dr. Alfonso Negri, Gen. Secretary CME-ICAP (Pneumologist) FISM - Italy
de Médecins Spécialistes Dr. Gilles Hudon, Health Policies and Ofﬁce
FMSQ - Canada
http://www.gbs-vbs.org/ of Professional Development (Radiologist)
INPH : Intersyndicat National des Praticiens Hospitaliers Dr. Marc Van Campenhoudt, Associate Director,
European Clinics (Radiologist)
Dr. Catherine Doyen-Fonck, Minister for Children,
ABSyM : Association belge des syndicats médicaux Youth Assistance and Health, Government of Belgium
http://www.absym.be/ the French Community
U.ME.SPE : Union Nationale des Médecins Spécialistes confédérés
Note : L'U.ME.SPE groups together medical specialists’unions,
most of them in independent practice, within the Confédération Even though health care insurance legislation, physical organization,
des syndicats médicaux français (CSMF). the number of physicians and expenditures vary from country to country,
http://www.umespe.com/ some problems are common to all and some solutions appear well
worthwhile and could even be imported/exported from one country to
UEMS : Union Européenne des Médecins Spécialistes another. MS-7 meetings help make this possible.
FMH : Fédération des médecins Suisses Delegates to the second conference in Brussels congratulated their
http://www.fmh.ch/ww/de/pub/homepage.htm hosts on their impeccable organization and warm hospitality.
Everyone promised to ensure that these annual meetings continue.
FMSQ : Federation of Medical Specialists of Quebec
France will be the host country in 2007, Italy in 2008 and Switzerland
FISM : Federazione delle Società Medico-Scientiﬁche Italiane
Boudreault, M. MS-7 : un franc succès. Le Spécialiste, 2005 ; 7(4):9.
LE SPÉCIALISTE · VOL. 9 no 1 · march 2007 19
The World of
Dr. Marie Gourdeau
Microbiologist and Infectious Disease Specialist
Chair, Committee on Nosocomial Infections in Quebec (CNIQ)
Probiotics and Clostridium difﬁcile-
associated diarrhea (CDAD)
In late 2006, a pharmaceutical advertisement praised the merits of probiotics in the treatment of
Clostridium difﬁcile-associated diarrhea, backed by supporting scientiﬁc evidence. So far, the merits
attributed to the use of probiotics far outstrip scientiﬁc studies on the subject. But, before diving into the massive
use of probiotics, we should make sure of their true beneﬁts. At the request of a number of colleagues and in my
capacity as Chair of the Committee on Nosocomial Infections in Quebec (CNIQ), I thought it important to look at these claims.
Following is a review of the literature on the current status of research into the use of probiotics in CDAD.
he emergence of a more virulent strain of Clostridium difﬁcile 4. The manufacture of probiotic products is not regulated and quality
has renewed interest in the use of probiotics in gastrointestinal control may be inadequate;
disease. Since the publication of the Guidelines on the prevention
5. New cases of invasive probiotic infections have been described
and control of nosocomial Clostridium difﬁcile-associated diarrhea
(CDAD) in Quebec (INSPQ February 20051), numerous articles have
discussed the role of probiotics in the treatment and prevention of 6. The use of probiotics should be considered in patients presenting
antibiotic-associated diarrhea as well as CDAD. In most cases, these one or more recurrences of CDAD;
have appeared in journals (Aslam S 20052, Bouza 2005, Dendukuri 7. New, well-designed studies with large numbers of patients are
20053, Huebner ES 2006, Johnston 20064, Katz JA 20065, Penner R necessary before the universal use of probiotics in the treatment and
20056, Sartor 2005, Wiesen P 2006), have formed the subject of prevention of antibiotic associated diarrhea and CDAD can be
meta-analysis (Johnston 2006, McFarland LV 20067, Sazawal 2006, recommended.
Szajewska 20068) or fundamental studies on the mechanism of action
of probiotics. Only one of the meta-analysis contains a speciﬁc section on the prevention
and treatment of CDAD (McFarland LV 20067). According to the
The quality and methodology of the studies, the choice of probiotic, author, this meta-analysis suggests that the administration of probiotics
the deﬁnition of the diarrhea and the choice of the endpoints measured can signiﬁcantly reduce antibiotic-associated diarrhea. However, only
varies a great deal. This limits the ability to compare them and the Saccharomyces boulardii is effective against CDAD. in the CDAD
conclusions cannot be extrapolated to cover all probiotics. In particular, section, the author considers six randomized, double-blind studies
the number of patients recruited is low. Despite these weaknesses, however, with a placebo as comparator for the treatment or prevention of
a review of the publications suggests that: CDAD (total: 354 patients). Five studies dealt with the treatment of
CDAD (216 patients) and one related to prevention by administering
1. The use of probiotics lessens the risk of diarrhea associated with antibiotics (138 patients). The study on the prevention of antibiotic-
antibiotics; associated diarrhea identiﬁed 30 cases of diarrhea, of which 5 out of
2. The use of probiotics lessens the risk of acute diarrhea in children; 15 were attributable to CDAD in the placebo group versus 2 out of 15
in the probiotic group.
3. The choice of probiotic, time of administration (beginning antibi-
otics before or after the patient’s diarrhea commences) and the
(continued on the next page)
existence or otherwise of patient subgroups in whom beneﬁts are
easier to see, are questions that have not yet been answered;
LE SPÉCIALISTE · VOL. 9 no 1 · march 2007 21
The author of the meta-analysis also conducted two of the ﬁve studies 2
Aslam S, Hamill RJ, Musher DM. Treatment of Clostridium difficile-
in which a probiotic was used to treat CDAD (Saccharomyces boulardii associated disease: old therapies and new strategies. Lancet Infect Dis
2005; 5: 549–57.
in both studies). These two studies alone accounted for 156 of the 216
patients treated with a probiotic or placebo. Only the ﬁrst study Dendukuri N, Costa V, McGregor M, Brophy JM. Probiotic therapy for the
achieved statistically signiﬁcant results (McFarland LV 199413). In this prevention and treatment of Clostridium difficile-associated diarrhea:
a systematic review. CMAJ 2005;173(2):167-70.
study, the beneﬁcial effect was found almost exclusively in the patient
subgroup that had recurring CDAD (60 patients: rate of recurrence : Johnston BC, Supina Al, Vohra S, Probiotics for pediatric antibiotic-
associated diarrhea: a meta-analysis of randomized placebo-controlled
64.7% in the placebo group versus 34.6% in the S. boulardii group;
trials. CMAJ 2006;175(4):377-83.
P= 0,04). The second study covered only patients with recurring 5
CDAD (32 patients) (Surawicz, McFarland et al. 200015). A decrease in Katz JA, Probiotics for the Prevention of Antibiotic-associated Diarrhea
and Clostridium difﬁcile Diarrhea. J Clin Gastroenterol 2006;40:249–255
recurrence was only observed in the subgroup receiving high doses of
vancomycin (2g per day) – i.e., 3 out of 18 patients in the S. boulardii Penner R, Fedorak RN, Madsen KL. Probiotics and nutraceuticals: non-
medicinal treatments of gastrointestinal diseases. Current Opinion in
group versus 7 out of 14 in the placebo group; placebo-probiotic Pharmacology 2005, 5:596–603.
difference in risk 33.0 (CI – 0.3 to 62.0). The other three studies 7
Lynne V. McFarland, Meta-Analysis of Probiotics for the Prevention of
covered, respectively, 25 patients with a ﬁrst episode or recurrence
Antibiotic Associated Diarrhea and the Treatment of Clostridium difﬁcile
(Pochapin 200012); 20 patients with recurrence (Wultt 200311) and 15 Disease. Am J Gastroenterol 2006;101:812–822.
patients with recurrence (Lawrence 200510); there was no follow-up 8
Szajewska H, Ruszczyn M, Radzikowski H. Probiotics In The Prevention of
with the ﬁrst two studies. Antibiotic-Associated Diarrhea in Children: A Meta-Analysis of Randomized
Controlled Trials J Pediatr 2006;149:367-72.
This meta-analysis therefore has several limitations. The studies had 9
Surawicz CM,et al. The Search for a Better Treatment for Recurrent
different variables: the choice of probiotic and the dose used, the indi- Clostridium difﬁcile Disease: Use of High-Dose Vancomycin Combined with
cation, the prevention or treatment of a ﬁrst episode or recurrence, the Saccharomyces boulardii. Clinical Infectious Diseases 2000; 31:1012–7
length of follow-up (none in three of the studies) and the number of 10
Lawrence SJ, Korzenik JR, Mundy LM. Probiotics for recurrent Clostridium
patients recruited. Based on this meta-analysis, no new conclusions can difﬁcile disease. Journal of Medical Microbiology. 2005 (10) 905-6.
be drawn regarding the use of probiotics in the treatment of CDAD 11
Wullt, M., Johansson Hagsla¨ tt, M.-L. & Odenholt, I. (2003). Lactobacillus
since the 2005 Guidelines. Only patients with a history of at least one plantarum, 299v for the treatment of recurrent Clostridium difﬁcile-associated
episode of CDAD may beneﬁt from the use of Saccharomyces boulardii diarrhoea: a double-blind, placebo-controlled trial. Scand J Infect Dis 35,
combined with vancomycin. 365–367.
Pochapin, M. (2000). The effect of probiotics on Clostridium difﬁcile diarrhea.
The enthusiasm for probiotics has exceeded the scientiﬁc knowledge Am J Gastroenterol 95, S11–S13.
available. It would be premature to recommend their use for purposes 13
McFarland, L. V., Surawicz, C. M., Greenberg, R. N. & 10 other authors
of primary prevention. Further studies on a larger number of patients (1994). A randomized placebo-controlled trial of Saccharomyces boulardii
are required before the role of probiotics can be clearly established. in combination with standard antibiotics for Clostridium difﬁcile disease.
JAMA 271, 1913–1918.
References : Munoz P, Bouza E, Cuenca-Estrella M, et al. Saccharomyces cerevisiae
fungemia: An emerging infectious disease. Clin Infect Dis 2005;40:1625–34.
Institut national de santé publique du Québec. Prévention et contrôle des la 15
diarrhée nosocomiale associée au Clostridium difﬁcile au Québec : lignes Surawicz CM, McFarland LV, Greenberg RN, et al. The search for a better
directrices pour les établissements de soins. 3e éd. Québec: INSPQ; 2005. treatment for recurrent Clostridium difﬁcile disease: Use of high-dose
Disponible: http://www.rrsss16.gouv.qc.ca/santepublique/protection/ vancomycin combined with Saccharomyces boulardii. Clin Infect Dis
22 LE SPÉCIALISTE · VOL. 9 no 1 · march 2007
François Landry, CFA
Private Wealth Management Chief
Groupe Fonds des Professionnels
Overview of 2006 and outlook for 2007
Economic Context Canadian Stock Market
U.S. economic growth slowed considerably In 2006, the S&P/TSX index recorded a total return of 17.3%.
in 2006, dropping from an annualized rate Income Trust Index, which represent about 10% of the overall
of 5.6% in the ﬁrst quarter to 2.2% in the S&P/TSX Composite Index, showed a negative return of –2.8%. On
third. The American economy is now October 31, 2006 the federal government’s decision to tax trust
running below its potential. Residential companies’corporate income as of 2011 caused the trust index to fall
construction and the real estate market by 11.4%. As already mentioned, we have always been cautious with
should continue to slow GDP growth regard to income funds because of their high valuation.
significantly during the coming quarters.
Given the present economic slowdown in the United States and the
However, consumer spending continues to grow
complacency of markets in general, we have to maintain a prudent,
at a relatively stable rate. We expect a softening of
conservative strategy. However, Canadian market values are reasonable
the American economy because employment and major
given current interest rates. The growth of corporate proﬁts is strong,
capital investment by corporations will continue to feed a moderate
although it will slow this year. We anticipate a moderate upswing in the
expansion of the economy.
Canadian Stock Exchange. The risk lies in the behaviour of cyclical
Despite the downward trend of Organisation for Economic Co-operation sectors (energy, mines and metals and gold stocks) which represent
and Development (OECD) advanced indicators, the metals index has 45% of the S&P/TSX index.
deﬁed gravity. The price of nickel jumped by 155% in 2006, and zinc
The U.S. Stock Market
increased by 126%. We are seeing the price of metals take the opposite
The rate of return for the U.S. market in Canadian dollars was 16.2 %.
direction to petroleum products. Some players are very active on the
This was realized in the second half of the year, thanks to the Fed’s
base metal term market; these speculative investments have, in part,
decision not to increase the prime rate in July and to a fall in gas prices.
fed the spectacular increase in the price of certain materials. Major
The American market is also trading at a reasonable level. There is a
investments in China require impressive quantities of base metals, and
positive inﬂuence on proﬁt growth because of the massive buy-back of
developing economies are more important today. The manufacturing
corporate stocks, which contribute 3% to 4% to proﬁt growth. The
sector is no longer such a major component of the U.S. economy, as
U.S. stock market should do well in 2007 because it is less cyclical and
production activities have now been transferred elsewhere. The United
is concentrated in the health and consumer sectors.
States has become a service economy...
International Stock Markets
This means that previous economic indicators are perhaps not as efﬁcient
Contrary to all expectations, 2006 was an exceptional year for Europe.
in predicting world economic growth, which will obviously slow some-
Economic growth exceeded forecasts and corporate proﬁts were revised
what in 2007, but will still remain strong when compared with previous
upwards. European companies took advantage of a weaker currency at
the beginning of the year, which beneﬁted exports. Repeating this
Fixed Income Securities Market situation will be harder in 2007. After a phenomenal year in 2005,
Interest rates have dropped since July, after the U.S. Federal Reserve (the Japan’s performance was stable in 2006. However, fundamental factors
Fed) decided not to increase its prime rate. This status quo contrasted related to Chinese and Asian expansion remain intact. There is little
with previous decisions – i.e., 17 consecutive increases in the prime rate risk that the Japanese market will fall and, in addition, the yen is
resulting in a cumulative increase of 4.25% since 2003. The Bank of undervalued against principal currencies. It should be remembered
Canada made the same decision in June. Investors quickly concluded that that 50% of the world’s population lives in Asia, which is very promising
the Fed’s next step would be to initiate a decrease in rates. We have for the future growth of consumer spending.
therefore witnessed a strong performance in the bond market over the last
Private Wealth Management Team
six months of the year. The Scotia Universal Index recorded a return of
François Landry, CFA, Wealth Management Chief
5.6% from July 1 to December 31, 2006, as opposed to the negative return
Éric Bernard, CFA
of –1.45% from January 1 to June 30, 2006.
Nicolas Bednarek, CFA
The ﬁxed income securities market has already anticipated a drop of Paul Delâge, M.Sc.
50 basis points on the rate of federal funds; the bond market therefore Stéphane Gagnon, CFA
seems to be fairly priced. Short-term rates (under 5 years) should Michel St-Laurent, CFA
decrease during the year. However, other maturities should remain
fairly stable overall in 2007. The inﬂation rate is low and should hold
24 LE SPÉCIALISTE · VOL. 9 no 1 · march 2007
Medical Foundations (Part 2)
n our December issue, we began introducing you to the medical ASSOCIATION OF RADIOLOGISTS OF QUEBEC
foundations and grant programs offered by the various associations The Foundation of the Association of Radiologists of Quebec was
afﬁliated with the FMSQ. We intended to do this in two parts. created in 1996 by Association members.
However, our research has revealed that there are far more foundations
and grants than we thought! We will therefore be adding a third Mission and priorities
installment in another issue. We would also like to take this opportunity The Foundation’s mission is to promote and fund research and the
to ask members to let us know about other initiatives of this type. creation of teaching tools for medical imaging in Quebec. The
Foundation’s priorities are to fund young researchers who are starting
In this article, you will ﬁnd information from three associations: the their careers and to encourage original research projects on imaging
Association des médecins microbiologistes infectiologues du Québec techniques. The Foundation also awards grants for teaching projects.
(AMMIQ), the Association of Radiologists of Quebec (ARQ) and the
Association des médecins psychiatres du Québec (AMPQ). Under a Memorandum of Understanding and collaboration between
the Foundation and the Fonds de la recherche en santé du Québec (FRSQ),
ASSOCIATION DES MÉDECINS radiology research projects are evaluated by the FRSQ. Educational
MICROBIOLOGISTES INFECTIOLOGUES projects are studied by the Foundation’s Evaluation Committee, which
DU QUÉBEC is composed of members of the Scientiﬁc Committee of the Société
The AMMIQ has been awarding grants to Association members since canadienne-française de radiologie (SCFR) further to an agreement
2001 as a contribution to continuing medical education (CME). with this latter organization.
Two CME grants of $2,500 each are available to Association members. A new program for young researchers has recently been developed. The
They are awarded each year to members attending the Association’s 3-year program targets radiologists who graduated during the previous
semi-annual and annual meetings. The grants are drawn by lot. eight years. The project is ﬁnanced on a 50/50 basis by the ARQ
Foundation and the FRSQ. Grants to young researchers can be
President: Dr. Jean-François Paradis, microbiologist/infectiologist renewed once for a further three years if an application is made to this
Contact : Mrs. Charlotte Lavoie, Director effect.
Internet Site: www.ammiq.org
Eligibility: Members of the Association des médecins microbiologistes President: Dr. Frédéric Desjardins, radiologist
infectiologues must provide a certiﬁcate of attendance at a CME activity Contact: Mrs. Lisette Pipon, Director
and supporting documents (air ticket, hotel bill, etc.). Grant recipients Internet Site: www.arq.qc.ca/index.php?page=45
are not eligible during the two years following the award. For more Eligibility: Radiologists wishing to apply for funding under the joint
information, please contact Mrs. Lavoie. FRSQ-FARQ program can ﬁnd the necessary explanations and forms on
the FRSQ Internet site at: http://www.frsq.gouv.qc.ca. Application forms
Address: for other funding from the Foundation can be found at
2, Complexe Desjardins, Suite 3000, P.O Box. 216, Succ. Desjardins
Montreal, QC H5B 1G8 Address:
Association of Radiologists of Quebec Foundation
2, Complexe Desjardins, Suite 3000, P.O. Box 216, Succ. Desjardins
Montreal, QC H5B 1G8
(continued on the next page)
LE SPÉCIALISTE · VOL. 9 no 1 · march 2007 25
ASSOCIATION DES MÉDECINS PSYCHIATRES Annual Achievement Prize: A $2,000 grant to acknowledge important
DU QUÉBEC work performed by a psychiatrist during the year in question. This may
The Association des médecins psychiatres du Québec awards a number be a book or publication in a scientiﬁc journal, setting up a clinic, a
of grants during its annual congress. These are given to members, new centre or department, appointment to an important position or
individuals or organizations who have been nominated by Association an innovation related to the practice of psychiatry. (This prize is
members. subsidized by Wyeth Pharmaceuticals).
Details President: Dr. Brian G. Bexton, psychiatrist
The Heinz E. Lehmann Prize for Excellence in Psychiatry: A grant Contact: Mrs. Line Martel, Assistant
of $5,000 made to a psychiatrist who, through the quality of his/her Internet Site: www.ampq.org
activities, has made the greatest contribution during his/her career to Eligibility: Application forms for all the grants are available by tele-
the advancement and spread of the profession. phoning the Association des médecins psychiatres du Québec. A Selection
Committee studies the submissions and forwards its recommendations
The Jacques Voyer Prize for Humanitarianism: A grant of $3,000 to the Board of Directors.
awarded to an individual or organization that has demonstrated a human-
itarian attitude towards people with mental or associated conditions. Address:
Professional Development Prize: A grant of $2,000 awarded to a group 2 Complexe Desjardins
of organizers in which at least one Quebec psychiatrist is involved and East Tower, 30th ﬂoor
which has carried out an innovative professional development activity, Montreal, QC H5B 1G8
such as the organization of a congress, the creation of a new educational Tel. : 514 350-5128
tool or any initiative connected with education and professional Fax: 514 350-5198
development in the ﬁeld of psychiatry.
Residents’ Annual Prize: Grants of $1,000 are awarded to two
residents to mark the best review and best completed research that
form part of a residency project.
Don’t miss the next issue of Le Spécialiste, which will
contain a full article on the Royal College of Physicians
and Surgeons of Canada’s professional development
26 LE SPÉCIALISTE · VOL. 9 no 1 · march 2007
Did you know… ?
Public Affairs: A Very Busy Team!
Public Affairs and Communications published a table listing its activities in Le Spécialiste of March 2003. The crisis that occurred in 2002
brought many demands on its time from all quarters. Following is a list of the results for 2006… and negotiations aren’t even through yet!
It is interesting to note that the FMSQ has now truly entered the electronic era!
The Public Affairs team makes it a point to offer a high standard of communications to members of the FMSQ.
ACTIVITIES 2002 2005 2006
Requests from media 1196 468 1835
Interviews given 691 115 774
Press conferences given 21 3 20
Press releases issued 30 9 10
Meetings/discussions with editorialists 7 22 26
Mentions in electronic and written media 2828 196 5660
References made to associations 137 136 124
Requests for consultation 29 24 42
Miscellaneous requests 355 350 729
Web requests 0 116 1331
Letters to the Editor 0 2 2
FMSQ Nego 1 0 23
FMSQ Brieﬂy 0 1 10
Le Spécialiste revue 4 4 4
Mailings to members 23 16 65
Advertisements Advertising campaigns: Advertising campaigns: Advertising campaigns:
9 3 25
(dailies, weeklies, radio, TV) (radio and dailies) plus (dailies)
an awareness campaign
(outdoor signs, radio)
Brochures 1 0 2
Posters 0 0 1
Mass meetings 7 1 5
LE SPÉCIALISTE · VOL. 9 no 1 · march 2007 27
Did you know… ?
Changing the Guard at the Groupe
Fonds des professionnels (GFDP)
The Groupe Fonds des professionnels has a new President and CEO, Mr. Frédéric Bélanger. He
succeeds Mr. Jacques M. Gagnon, who has retired after 10 years as the Group’s President.
Mr. Bélanger joined the GFDP in 1997 and has held several positions, including that of General
Manager of the Fonds d’investissement subsidiary, Vice Président of the Gestion privée subsidiary and
Corporate Secretary for the Group as a whole.
Changes at the FMSQ One Hundred Years of Pride!
Dominique Drouin has relin- The Sainte-Justine University
quished her position of Director, Hospital Centre celebrates its
Public Affairs and Communications, centennial in 2007. A scientific
which she held for the last eight program and events for the general
years. She intends to open her own
public will last all year long. You
special events consulting firm.
She was involved in the ﬁnal round can ﬁnd the complete schedule of
of negotiations right up to the last activities on the Hospital’s web site
minute, as the memorandum of at:
understanding was obtained on the
eve of her departure from the http://www.chu-sainte-justine.org/
FMSQ. We all send her our very 100//
Nicole Pelletier, ARP best wishes for every success in
her many personal projects.
Nicole Pelletier is now the new Director, Public Affairs and
Communications. She has been a communications manager with
such major organizations as Héma-Québec and the Ordre des
ingénieurs du Québec, and so comes to the FMSQ with a solid In the next issue
background in communications from which we can all beneﬁt. The Board of Directors ends its term of ofﬁce at the end of
March. Details of the new Board will be given in the next issue
of Le Spécialiste.
2nd Golf Tournament on behalf
of the Quebec Physicians Assistance Program (PAMQ)
Once again, it’s time to register for the golf tournament which will be held on July 30, 2007 at Le Mirage Golf
Club, Terrebonne. The registration form is available from the Federation’s Internet site (www.fmsq.org). All
proﬁts will go to the PAMQ, a program that assists all physicians trying to cope with various types of problems
(stress, substance abuse, addiction or dependence, bereavement, loneliness, etc.). Your participation is very important.
Come and enjoy a pleasant day in company with your peers and give a helping hand to the PAMQ.
28 LE SPÉCIALISTE · VOL. 9 no 1 · march 2007