Bill 10 limiting the use of independent labour in the Quebec healthcare system was sanctioned on April 20, 2023. Media in general are keen to use narratives to catch eyeballs and I want to take the opportunity today to give you some perspective on the pros and cons of Bill 10 for the healthcare system as well as for our industry in general.
Main features of Bill 10
Although sanctioned on April 20, 2023, Bill 10 is not yet officially in force. Detailed regulations must still be published in the Gazette officielle du Québec and therefore the date of entry into force of Bill 10 is unknown.
The minister’s declared objective is to regulate the use of placement agencies and the law, when it is adopted, will grant the Minister of Health the power to frame the use of agencies through regulations, which are still in preparation. The implementation of this bill would eventually prohibit the use of placement agencies in certain territories and adjoining areas by 2026 and in the meantime give the government levers to regulate the use of placement agencies. By regulation, the Minister grants himself a discretionary power that allows him to establish exceptions to use agencies.
The main elements contained in Bill 10 are:
- Supervision of the use of placement agencies by health establishments.
- Imposition of maximum hourly rates to employment agencies that provide workforce.
- Imposition of administrative measures and regulatory offenses in the event of non-compliance with the law.
Financial Logic
Earlier this year the Association des Entreprises privées de personnels soignants du Québec (EPPSQ) retained Raymond Chabot Grant Thornton (RCGT) to analyze statistical data concerning the evolution of hours worked and costs for independent labour and measure the cost of using independent workers against the all-in cost of staff in the health and social services network.
According to RCGT’s study, independent workers were making an hourly wage of 21% to 26% lower than healthcare system workers historically, until the current government introduced the reform of the Act respecting labour standards. Today, due to the labour standards reform and labour shortage, the wage for hours worked by healthcare system workers is almost equal to that of independent health care system workers on average.
On a more granular scale, data shows a higher cost for independent workers in remote areas related to accommodation, travel and per diem for the human resources deployed, which significantly increases the all-in rate. On the contrary, independent workers deployed in urban centers, Bill 10’s main target, cost on average 12% less than healthcare system workers. In our opinion the cost cutting narrative used by the authorities doesn’t follow proper financial logic.
Operationalization of Bill 10
The independent workforce represents annually between 2.5% and 5.0% of employees in the Quebec health system. A proportion that can be considered marginal when compared to other provinces or other countries.
A large proportion of these independent professionals choose this mode of work for personal, family, or logistical reasons. The use of placement agencies allows them to practice their profession within their own constraints. Without that possibility, a large proportion of them would leave the system to work in other sectors (+/- 70% of independent health professionals according to an internal EPPSQ survey). In the North American context of a shortage of health workers, the priority must be to encourage Quebec health professionals to remain active in the network, regardless of the mode of work they chose.
Working conditions and flexibility are by far the most important considerations that leads medical personnel to find alternatives to the public network. In this context, operationalization of Bill 10 implies exhaustive negotiations with unions and professional associations regarding the modernisation of collective agreements with the objective to offer more flexibility and better working conditions to healthcare professionals. We salute the pursuit of this objective but anticipate the time frame for a resolution to be long.
Our view
We believe that Bill 10 and the current political exercise could eventually have a positive impact on our sector by setting a clear framework for agencies and independent workforce. Such a framework would improve the competitive landscape and favor those like us who are capable and willing to work within a well-defined environment for the long term.
The staffing agencies represent less than 5% of the healthcare system workforce, so they play a small but vital role in supporting the system. They provide the flexibility required to fill staffing gaps on-demand, and by doing so, help prevent service disruptions, at a very competitive cost. It is difficult to understand the government’s rational to voluntarily forego such flexibility. Premier Health of America is confident in its capacity to adapt to the changing political environment, and we are determined to continue helping people within the province of Quebec and elsewhere in Canada.
I hope this information gave you a good understanding of the situation.
All the Best,
Martin Legault
Chief executive Officer
