JULY 2008


Ontario and Quebec get
new health ministers

Twin cabinet shakeups leave doctors uncertain about new directions

On June 20, George Smith-erman's reign as health minister of Ontario came to an abrupt end. Five days later, Quebec Health Minister Dr Philippe Couillard resigned his cabinet post and announced he was leaving the legislature entirely.

Although it seems the timing was purely coincidental, when the two men responsible for the healthcare of nearly two-thirds of Canadians both leave their jobs all of a sudden, you have to ask yourself: what gives?

New Ontario Health Minister David Caplan

In late June, as Mr Smitherman faced growing public criticism over his handling of the ongoing Clostridium difficile outbreaks in the province's hospitals, Premier Dalton McGuinty moved him to a new combined Energy and Infrastructure "super-ministry."

David Caplan has been selected to fill Mr Smitherman's sizeable shoes. Mr Caplan is largely an unknown quantity. He's best known to physicians and healthcare experts by way of his pedigree: his mother, Elinor Caplan, served as On-tario's health minister from 1987 to 1990.

Many healthcare analysts are already familiar with at least one of his policies, however. As infrastructure minister (now part of Mr Smitherman's portfolio), he has played a central role over the past five years in establishing hospitals funded by public-private partnerships (P3s). Mr Caplan's appointment, says Natalie Mehra, the director of the left-wing Ontario Health Coalition (OHC), is "a weird message from the McGuinty government." The OHC had hoped the Liberals would stop short at privatizing clinical services in hospitals, but with Mr Caplan at the helm they fear it might be full steam ahead.

But of greater concern to the opposition parties, apparently, are two other private issues: Mr Caplan's excess weight and his erstwhile smoking habit (a spokesperson says he has now butted out). The opposition leaders publicly poked fun at Mr Caplan's waistline after he was appointed — and they stand by their name-calling. "He has not exhibited the personal habits that keep you healthy," NDP health critic France G�linas told NRM, saying her training as a physiotherapist qualifies her to comment on the matter.

Premier Jean Charest's cabinet shuffle in Quebec has been far less controversial than Ontario's, though speculation abounds on the rationale behind Dr Couillard's resignation. One theory says Dr Couillard — hugely popular in Quebec — had climbed as high as he could in provincial politics and wants a new challenge. Another theory: he may return to neurosurgery to make more cash to feed his large family. (In an interview with NRM last December, Dr Couillard advised doctors to consider the pay cut before going into politics. "The advice I would give is that they should look at it very carefully with their accountant — in my case I didn't do this.")

New Quebec Health Minister Yves Bolduc

Replacing Dr Couillard as health minister is rural GP and hospital administrator Yves Bolduc, who ran as a Liberal candidate and lost in last year's election. Both the GPs' and specialists' unions agree that Dr Couillard's reforms — towards better access to care and fewer restrictions on doctors' private-healthcare initiatives — should be part of Dr Bolduc's plans. "I'm expecting continuity," Quebec Federation of Medical Specialists president Dr Ga�tan Barrette told NRM. "I hope we won't see drastic changes."

The departures of two fairly popular health ministers can only mean that the Canadian healthcare system remains an intractable problem, said columnist Chantal H�bert on the CBC News At Issue panel in late June. Quebec's and Ontario's unresolved difficulties — rising costs, wait times, the family physician shortage and infectious disease control, among others — will now fall to Mr Caplan and Dr Bolduc to grapple with, as Mr Smitherman's explosive personality bursts onto the nuclear-power, gambling and liquor scene in Ontario and Dr Couillard finally takes a vacation after years of tumult and turmoil in the National Assembly. He told reporters, "I'm going to go fishing a lot this summer."



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