LESPÉCIALISTE 2010 NEGOTIATION PART 2. Une nouvelle ADRESSE LE MAGAZINE DE LA FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC P.

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1 LESPÉCIALISTE LE MAGAZINE DE LA FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC Vol. 12 no. 1 March NEGOTIATION PART 2 P. 8-9 Une nouvelle ADRESSE voir texte p.35

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5 Vol. 12 no. 1 March2010 P. 8-9 voir texte p.35 SUMMARY WORD FROM THE PRESIDENT 7 Stirring Things Up! 2010 NEGOTIATION PREVIEW - PART 2 8 The Medical Powerl IN THE NEWS 10 Get People Talking! 13 DID YOU KNOW COVER STORY DOSSIER Diabetes: Emergency Case! Status of Diabetes Waiting in the Wings Impacts in Cardiology Education Centres LESPÉCIALISTE LE MAGAZINE DE LA FÉDÉRATION DES MÉDECINS SPÉCIALISTES DU QUÉBEC 2010 NEGOCIATION PART 2 Une nouvelle ADRESSE CONTINUING PROFESSIONAL EDUCATION 28 MORE OB : Safety-Driven Delivery of Care IN THE WORLD OF MEDICINE 30 The Remote Monitoring of Pacemakers in 21st-Century Cardiology 31 GREAT NAMES IN QUEBEC MEDICINE Dr. Phil Gold and the Discovery that Revolutionized Our Knowledge of Cancer MEMBERS SERVICES 32 Commercial Benefits GROUPE FONDS DES PROFESSIONNELS SOGEMEC ASSURANCES MOT DU PRÉSIDENT 38 Une campagne qui dérange LESPÉCIALISTE Le Spécialiste is published 4 times per year by the Fédération des médecins spécialistes du Québec EDITORIAL COMMITTEE Dr. Bernard Bissonnette Dr. Raynald Ferland Dr. Diane Francœur Maître Sylvain Bellavance Nicole Pelletier, APR, director Patricia Kéroack, communications consultant DELEGATED PUBLISHER Nicole Pelletier, APR RESPONSIBLE FOR PUBLICATIONS Patricia Kéroack REVISION Angèle L Heureux PRODUCTION ASSISTANT Geneviève Roberge GRAPHIC DESIGNER Dominic Armand TRANSLATION Anne Trindall Annette Grimaïla PRINTING Transcontinental Interweb PUBLICITY France Cadieux Circulation 12,300 copies PUBLICATIONS MAIL Mailing Indicia LEGAL DEPOSIT 1st quarter 2010 Bibliothèque nationale du Québec ISSN The Fédération des médecins spécialistes du Québec represents the following specialties: Allergy and Clinical Immunology, Anesthesiology, Cardiac Surgery, Cardiology, Community Health, Dermatology, Diagnostic Radiology, Emergency Medicine, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology and Medical Oncology, Internal Medicine, Medical Biochemistry, Medical Genetics, Medical Microbiology and Infectious Diseases, Nephrology, Neurology, Neurology, Nuclear Medicine, Obstetrics and Gynecology, Ophthalmology, Orthopedics, Otorhinolaryngology, Pathology, Pediatrics, Physiatry, Plastic Surgery, Pneumology, Psychiatry, Radiation Oncology, Rheumatology and Urology. TO JOIN US EDITION Telephone: Fax: communications@fmsq.org PUBLICITY Telephone: Fax: fcadieux@fmsq.org Fédération des médecins spécialistes du Québec 2, Complexe Desjardins, porte 3000 C.P. 216, succ. Desjardins, Montréal Québec H5B 1G8 Telephone : All pharmaceutical product advertisement's have been approved by the Pharmaceutical Advertising Advisory Board (PAAB). CCAB audits the medical specialists and residents database (10,676 copies auditedfordecember2009) The FMSQ also distributes around 1,000 copies to Researchers and Professors of the 4 Medical Faculties in Quebec, as well as managers and leaders of the Québec healthcare system. The authors of signed articles are sole responsible for the opinions expressed therein. THIS EDITION S ADVERTISERS: Pfizer... 2 and 36 Hydro Québec... 3 La Personnelle... 4 Groupe Fonds des professionnels... 6 Cardiologie interventionnelle Club Voyages Berri Congrès Santé Respiratoire Bayer ASSS du Bas-Saint-Laurent.. 22 Banque Royale Sogemec Assurances Valeant Canada and 40 Solutions Cliniques L E S P É C I A L I S T E V O L. 1 2 n o. 1 M a r c h

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7 WORD FROM THE PRESIDENT Dr. GAÉTAN BARRETTE Stirring Things Up! By now you must have seen our TV campaign and perhaps even visited the Internet microsite expertisehasaprice.com (lexpertiseaunprix.com) a different style of campaign, even somewhat daring, and one designed to arouse public debate. Mission accomplished! We obviously knew that not everyone would agree with us and that has been confirmed! But, as a celebrated author once said, it s not because things are difficult that we don t dare. It also came as no surprise that the road construction and generic drug lobbies, as well as some others, pressured us to withdraw our spots. But, like it or not, killing the messenger does not kill the message! The suggestions we make are all documented and a number have been presented by others long before us, but have gone unheeded. We wonder why It is easy enough to hold discussions on the economic depression we are suffering. It is also easy to criticize, judge and condemn our campaign, just as it is simple to claim that the FMSQ is only entitled to speak on health matters. But that s the whole point! Health accounts for 45% of the Quebec budget. An unavoidable expenditure. And physicians, specialists though they may be, are also taxpayers. We are continuing our action. The reasoning is simple: add the voice of medical specialists to all those raised over previous weeks, months, years, hoping that the Charest government might finally make some decisions and act to improve the financial health of Quebec. But not just any decisions, and not just anyhow! Quebec is in the red: we know that. But there is money in Quebec, and we are demonstrating that fact! WE POSTULATE THAT IF IT WERE TO ASSUME THE NECESSARY LEADERSHIP ROLE, THE GOVERNMENT COULD SOLVE ITS DEBT PROBLEMS AND FACE THE FUTURE WITH A CERTAIN DEGREE OF ECONOMIC SERENITY. We postulate that if it were to assume the necessary leadership role, the government could solve its debt problems and face the future with a certain degree of economic serenity. Better still, it would have ample funds to pay an equitable amount for professional expertise in the Public Service AND doctors. It has to be realized that, in Quebec, systematic, significant differences exist versus the main indices used for comparison purposes as far as those with professional expertise who are paid within the public sector are concerned. We are not the ones saying that: it s the Institut de la statistique du Québec, among others. This state of affairs applies just as much to nurses, teachers, engineers, occupational therapists, legal aid lawyers, Crown prosecutors... and doctors. The day is fast approaching when we will file our demands with the government in connection with the renewal of our Agreement. The outcry can already be anticipated particularly from (rightthinking) people who will not take the time to talk to us, to delve into matters, to understand, since their national sport is to chronicle. Good for them! However, it will always be up to you to defend your interests by readying your forces. In addition, to help convince you that there is money in Quebec and that the problem lies not in the lack of it but in our governments failure to make decisions, I suggest you read the second document put out by the Advisory Committee on the Economy and Public Finances (Comité consultatif sur l économie et les finances publiques) report, which is available on the Web and which clearly demonstrates that money is definitely available! Lastly, we have to underline that we are in a highly pivotal period. In addition torecoveryfromthecurrent depression, hereas elsewhere there is the whole debate on controlling government expenses and, in the health field, maintaining a strong but efficient public system. We are involved in this debate, as is right and proper. And the timing is good. In fact, while aiming for an appropriate level of payment for our services we believe it is time for medical specialists to be involved at all levels of the health network, including its administration. We favour a model based on the principle of joint management. Hence the need to provide for appropriate remuneration in order to attract the best candidates. Then, there is the digitization of clinical records, the organization of care, and so forth. In other words, we have much to do. You can rest assured that we are ready! We believe that you are, too. Always remember that our situation is the result of small cutbacks accumulated over the years. Starting a new round of negotiations from behind the eight ball is out of the question particularly when everywhere else in Canada physicians are reaching agreements similar to their previous ones! Yours, in union! LS L E S P É C I A L I S T E V O L. 1 2 n o. 1 M a r c h

8 Maître Sylvain Bellavance DIRECTOR LEGAL AFFAIRS 2010 NEGOTIATION PREVIEW The Medical Power You will have noted that, since the beginning of February, the media newspapers, radio / television public affairs programs have been taking an active interest in medical specialists negotiating demands. The negotiating process is therefore under way, even though the Federation s official demands with regard to the renewal of our Master Agreement have still not been filed with the Ministère de la Santé et des Services sociaux (MSSS). You will also have seen that, as usual, the ideas expressed by the media reflect the various social tendencies. Some strongly criticize medical specialists; others acknowledge the validity of their claims while insisting that no level down should be made in Quebec. I would like to discuss three aspects of the debate that has begun, and which will only grow more heated during the coming months. 1. The Remuneration Gap Some people have understood the nature of the negotiations that will soon be beginning for medical specialists, whereas others are under the impression that physicians have already had the increases they deserve and that nothing should be heard from them for some time. Let s clarify this issue, once again. The government has acknowledged that the gap in remuneration between doctors in Quebec and their colleagues in the other provinces was 50-55% at April 1, The Agreement provides for a reduction of this shortfall over a period of 8 years, i.e., between April 1, 2008 and March 31, Adjustment of the April 1, 2007 remuneration gap does not in any way call into question the need to negotiate the increases which should apply as of April 1, The MSSS clearly understood this point in the last Agreement by signing a clause which explicitly states that the adjustment has absolutely no effect on the other items up for negotiation, including the renewal of the Master Agreement in 2010 and following years. Since 2008, medical specialists have received slightly more than 10% of the adjustment negotiated. Consequently, the gap in remuneration (50-55% at April 1, 2007) is still more than 40% at the present time. Other fee increases will come into effect this year as per the 2007 Agreement, but they have no bearing on the negotiations which are now starting and the increases applicable under the renewed Agreement. ONCE AGAIN, LET US MAKE IT QUITE CLEAR: THE 2007 AGREEMENT REDUCES THE GAP IN REMUNERATION FROM THE 2007 LEVEL OF 50-55% TO AROUND 15% IN Once again, let us make it quite clear: The 2007 Agreement reduces the gap in remuneration from the 2007 level of % to around 15% in However if, during the upcoming negotiations, medical specialists were not to obtain increases similar to those granted in the other provinces, the effect of the 2007 Agreement would quite simply be nullified and the gap in remuneration would remain at its present level of more than 40% or even revert to the previous 50-55%. 2. Medical Power Some people have strongly criticized the fact that medical specialists command substantial powers of negotiation, without analyzing the validity of the demands made. Once again, I would like to set the record straight. Power represents the very essence of the negotiating process. As certain authors in the field have written le pouvoir de négociation est l essence de la négociation (the negotiating power is the very essence of the negotiation process). This reality has nothing negative in itself. History shows that physicians have only rarely been able to insist on and support some of their claims. Some say it does not belong to doctors to do so. Reacting firmly to government decisions has been stronger here in Quebec compared to other provinces in the last few years. Would this be a shudder in our Judeo-Christian values? Over the years, I have often seen medical specialists hesitate to mention their remuneration. They feel embarrassed about defending demands for an increase, particularly since they already receive a good income. Politicians and bureaucrats have used this very same reasoning to impose certain working conditions or remuneration on physicians, assuming that no protest would be forthcoming. Physicians therefore have a choice of two evils: they either agree to working conditions or remuneration which is inferior to that of others, or appear to be blackmailers. I believe, however, that there is another option: they should present their demands and the latter s validity should be analyzed objectively. 1 Rojot, Jacques (1994). La Négociation. Paris, Librairie Vuibert. 8 L E S P É C I A L I S T E V O L. 1 2 n o. 1 M a r c h

9 Physicians are independent workers. I sincerely believe that this particular fact, as well as their professional freedom, is essential to a quality healthcare system. The same applies to their medical power. It stands as a rampart against political dictates. Medical power must apply at all times and at all levels, as has been proven over the past few years. This power should first come into play with regard to conditions of practice, and a refusal to accept government decisions like those imposed in 1990 and following years which harmed the health system. It should be exerted when departments, services, hospitals, outpatients clinics are closed down, operating time is reduced and quotas imposed, etc. Quebec physicians should act more promptly in resisting such decisions; using their power can only have beneficial results. It is also vital that medical power is exerted during the negotiating process, particularly because the strength of the respective parties is unequal, with the government having full powers on its side as well as the ability to act as both stakeholder and decision-maker. Medical specialists do not want to have to use their negotiating power. Since passage of the Canada Health Act, recourse to arbitration has formed part of negotiations between physicians and governments. This process exists in several Canadian provinces. I would really like to hear the opinion of our detractors on the subject of setting up an independent arbitration process for Quebec physicians; a process that would be binding on government should there be a failure to reach an agreement through negotiation. Until then, doctors have the right to negotiate. Medical specialists are demanding remuneration that is competitive with that of their colleagues in the other provinces. This is totally legitimate. All workers in Quebec earn less than those in other Canadian provinces, mainly because the cost of living is lower in Quebec. Medical specialists also accept this situation. However, their situation is unique and the gap in their remuneration is larger than others. All they are seeking is to restore the balance, and they cannot be blamed for doing that. If medical specialists earn more than other workers (and I insist here, this is normal for the work they do), it doesn t justify they should reject the equity principle. 3. The Current Publicity Campaign At a time when society in general is discussing ways to improve public finances, medical specialists are also adding to the debate by suggesting various measures which deserve consideration. They are doing this in reaction to the public debate which is trying to place us before a fait accompli and to convince Quebecers that they will have to make difficult choices. Actually, nothing guarantees that the government should continue financing the rising costs of health sector. This is reminiscent of 1995 and following years. But medical specialists will not agree to again live through the upheavals that affected our health system during that period and that resulted in a reduction of the public s access to care. If the Federation had been content to present its demands and to ask that the rise in health system costs be maintained, it would have been described as irresponsible given the present economic situation. It is more than surprising that it is being reproached for the part it is playing in the debate. In conclusion, keep your heads high and your powder dry. Not only are your demands reasonable and fair, there are various ways in which they can be achieved. LS Paul G. Brunet of the Council for the Protection of Patients Misquoted Following an article in the Journal de Québec on Thursday, February 11, 2010, entitled Les patients seraient victimes d intimidation (Patients reported to be victims of intimidation), together with a further article on Friday, February 12, 2010 in the Journal 24 heures, and in response to a formal notice received from lawyers for the FMSQ, the Council for the Protection of Patients (CPM) issued a public retraction to the Federation and its President, Dr. Gaétan Barrette. A few (translated) extracts follow: When Mr. Brunet, President of the Council for the Protection of Patients, responded to a reporter's question on Wednesday, February 10, 2010 concerning the class action suit filed by some patients, it was reported that the Federation's lawyers were using every legal means to discourage witnesses who might be called in the case concerning the alleged strike of medical specialists in 2002 and ( ) If the Federation or Dr. Barrette were insulted by that report or by facts which, while reported, were not stated by the Council or its President, the Council for the Protection of Patients and its President, Mr. Paul G. Brunet, deeply regret the situation and sincerely apologize. They also formally demand that the media which incorrectly reported these comments or which used Dr Barrette's photograph for the report, without authorization specifically the Journal de Québec and the Journal 24 heures apologize and issue a retraction. L E S P É C I A L I S T E V O L. 1 2 n o. 1 M a r c h

10 Engourdissement politique Enflure des structures Irritation populationnelle EXAMEN PHYSIQUE (SIGNES) Inflammation du déficit IN THE NEWS Text by Patricia Kéroack and Nicole Pelletier Get People Talking! Since last fall, the Charest government has carefully started setting the stage by touching on the difficulties caused by the economic crisis, the lack of available resources, predictable budget cuts, etc. It has also announced loud and clear that the Province's coffers are empty. This message clearly shows the government s colours for the upcoming round of negotiations with the entire public sector, whose contracts all expire at the end of March The government also set up numerous meetings and consultations with experts to support or to obtain support for its position. This was the case with the 2010 Economic Summit an event that melted away like snow in March, when a few dozen carefully chosen partners (but not the FMSQ), met for 5 or 6 hours to talk about Quebec's economic future. Furthermore, anticipating that the government would not change its position, the FMSQ decided to launch a major campaign to inform the general public. One of the aims was to suggest possible approaches to replenishing the Province's coffers. Since January 31, the FMSQ has been suggesting economic measures that the government could take without directly increasing the tax burden on ordinary Quebecers. It must be emphasized that many of the ideas had already been suggested or mentioned by other parties, including the Auditor General of Québec and the Montreal Economic Institute: not just anybody. The estimated value of these proposals, were they to be put into effect, would not only fix the government's budgetary deficit, but would also pay for the expertise of all the professionals working in the public sector who find themselves paid below par for their professions. Hence the title for our campaign: "Expertise has a price." Please note that our entire strategy was developed internally and is the result of the close collaboration between the President and the Public Affairs and Communications team. Certain specialized tasks, including producing the media messages, placing the ads and obtaining public relations support were outsourced to carefully chosen agencies. L économie du Québec ne va pas bien? Pourtant on ne parle pas de santé à la Rencontre économique 2010!?! ANNÉE MOIS JOUR NOM DU PATIENT Gouvernement du Québec TYPE DE VISITE Réévaluation (état chronique) FICHE DU PATIENT HISTOIRE DE LA MALADIE ACTUELLE (SYMPTÔMES) Prise de poids de la dette The absent are not always wrong! Deploring its exclusion from the Summit and to highlight the absence of representatives from the health sector which accounts for more than 45% of Quebec's budget the Federation found ways to ensure its point of view was known. Firstly, a full page ad (see htm) was conceived and placed in several major dailies in Quebec, on October 21. Then, a special edition of the magazine Le Spécialiste was given out to participants at the event, a good number of whom were government ministers. You can consult this issue on the FMSQ's site at Essoufflement et fatigue générale TESTS ET INVESTIGATIONS ANTÉRIEURS - TRAITEMENTS PROPOSÉS Rapport Gobeil sur la révision des fonctions et des organisations gouvernementales, 1986 Rapport Fortier sur la privatisation des sociétés d'état, 1986 Rapport Scowen sur la déréglementation, 1986 Rapport Rochon sur les services de santé et les services sociaux, 1988 Rapport Facal sur l'examen des organismes gouvernementaux, 1997 Rapport Clair sur les services de santé et les services sociaux, 2000 Rapport Bédard sur les finances et la fiscalité locales, 2000 Rapport Brunet sur le rôle de l'état québécois dans le capital de risque, 2003 Rapport Ménard sur la pérennité du système de santé et de services sociaux, 2005 Rapport Montmarquette sur la tarification des services publics, 2008 Rapport Fortin sur l'investissement des entreprises, 2008 Rapport Castonguay sur le financement du système de santé, 2008 DIAGNOSTICS Fracture nette de la confiance Trouble envahissant du développement économique Amnésie parlementaire PLAN DE TRAITEMENT Hypertrophie des organes décisionnels Hémorragie budgétaire Hypertension Tous les traitements proposés au patient n ont pas été suivis tels que prescrits COMPLICATIONS INÉVITABLES Dossier suffisamment documenté, aucune nouvelle analyse requise Patient doit cesser de consulter et agir!!! Un message de la Fédération des médecins spécialistes du Québec Quoi de neuf en imagerie cardiovasculaire? La thérapie cellulaire peut-elle aider vos patients? La révolution des remplacements valvulaires percutanés : aujourd hui et demain. Opportunité d'éducation médicale à la fine pointe des développements cliniques Dr Jean-François Tanguay - Dr Serge Doucet 1 0 L E S P É C I A L I S T E V O L. 1 2 n o. 1 M a r c h

11 The campaign The FMSQ decided to demonstrate that there is in fact money available, but that political decisions are needed when it comes to making choices. Why did we decide to go down this path? POINT NO. 1: The economy and Quebec's finances The FMSQ maintains that it is possible to solve the problem of public finances. Moreover, if Quebec wants to retain professionals working in the public sector (all university graduates dentists, architects, legal aid lawyers, nurses, teachers, etc.), it must recognize their expertise and pay them accordingly. In order to raise Quebecers awareness and encourage both discussion and involvement, the campaign denounces waste, unused resources, laws and regulations that are not properly enforced, new avenues for financing and so on. The Expertise Has A Price campaign consists of a series of 15-second TV teasers and 30-second commercials. Since it is impossible to say everything in a short advertising message, the audience is invited to visit the campaign's site where more information is available on the measures we suggest. POINT NO. 2: Better understanding of the 35 medical specialties At the same time as the campaign on the economy is running, a public relations campaign entitled Passionnés pour la vie ( A Passion for Life ) has been created to introduce the various medical specialties. The FMSQ has chosen a little-used television format the short program which lasts 60 seconds and during which a medical specialist talks of his or her passion for a particular specialty. Physicians (real ones) from each medical specialty were recruited for the filming and agreed to give their points of view. These short programs are to be aired at a set time since they are part of a channel's regular programming. The series will be presented (in French) from Monday to Friday, at 10:12p.m. during Le Téléjournal (Radio-Canada), at 9:12 p.m. during Le Téléjournal (RDI), at 12:10 p.m. during RDI en direct (RDI), and around 7:36 a.m. during RDI Matin (RDI). It will continue until next November, with a break in the summer. LS As expected, the ads drew a great many comments as soon as they were aired. Political analysts, broadcasters, columnists and the public gave their views on the contents and their relevance. Some groups targeted by our campaign came out in support and themselves denounced instances of waste; some asked for more information or disputed our arguments. Our president, Dr. Barrette, gave a number of interviews and made a very strong impact on February 7, as a guest on the television program Tout le monde en parle. In the final analysis, you can say something good or say something bad. What counts is that you say something. Dr. Thérèse Côté-Boileau presenting pediatrics. L E S P É C I A L I S T E V O L. 1 2 n o. 1 M a r c h

12 IN THE NEWS (SUITE) A Barometer than Speaks for Itself! Reacting to news of the earthquake that devastated Haiti on January 12, the FMSQ reacted rapidly and made donations totalling $30,000 to Doctors of the World - Canada and Doctors Without Borders. Through its website, the Federation also organized a fund-raising campaign among its members, FMSQ employees and those in affiliated associations. To date, more than $200,000 has been collected and given to Doctors Without Borders, Doctors of the World - Canada and the Centre for International Studies and Cooperation (CISC) to help meet the urgent humanitarian and health needs of the Haitian people at this time of great suffering. Do you or do you not trust...? 1 Firefighters 97% 2 Nurses 96% 3 Doctors 91% 4 Farmers 90% 5 Teachers 86% 6 Mail delivery employees 85% 7 Notaries 78% 8 Electricians 76% The FMSQ Bags the Bag! The famous oversize hand - bag belonging to the former Minister of Finance of Quebec, Madame Monique Jérôme- 9 Artists 10 Police Officers 11 Engineers 12 Plumbers 13 Judges 73% 72% 71% 66% 65% Forget, is now in the hands 14 Taxi drivers 63% of the FMSQ. The handbag was auctioned off during 15 Pollsters 60% the 2009 Grande guignolée des médias (the media s 16 Journalists 17 Bankers 44% 40% major food drive). Dr. Gaétan 18 Church Representatives 40% Barrette, the President of the FMSQ, bid $2,000. When 19 Economists 37% placing his bid, Dr. Barrette challenged all other union organizations (and, more specifically, the FMOQ) to bid more and win the prize. On December 10, Dr. Barrette finally took possession of the handbag during Radio-Canada s morning radio show 20 Lawyers 21 Construction Contractors 22 Business People 23 Real Estate Agents 29% 29% 29% 28% C'est bien meilleur le matin, adding a further $6,500 to 24 New Car Salespeople 26% bring the Federation's total contribution to $8,500 (or the equivalent of one dollar per member) to the very worthy 25 Financial Consultants 26% cause of the Grande Guignolée. According to the ex-minister, the bag has several secret compartments. As we approach 26 Senior Public Servants 27 Unionists 22% 22% the 2010 round of negotiations, maybe a few dollars might 28 Publicists 19% have escaped the sharp eye of the person who also held 29 Politicians 8% the position of President of the Treasury Board!? There are bound to be more references to the handbag during the coming period. 30 Used Car Salespeople January 2010, 1,500 people polled, +/- 2.8% 6% Source: Léger Marketing - Journal de Montréal Pollster Jean-Marc Léger of Léger Marketing recently updated his barometer of professions in Quebec. This barometer shows today's main trends on how professionals in Quebec are appre - ciated and trusted. According to the author, professions that help people are all in the upper third in our survey. More liberal professions, like notaries, judges, engineers, bankers or economists, long admired in Quebec, are in the second third. And all the gripers politicians, union members, sales people, business people and lawyers are battling it out in the lower third. Doctors rank third, imme diately after firefighters and nurses. Our politicians come in 29th place, at the bottom of the popularity ranking. LS Pour un service unique et personnalisé! Consultez les CONSEILLERS-SPÉCIALISTES de votre agence partenaire. Un seul appel vous convaincra! Congrès - Événements Loisirs - Affaires 920, boul. de Maisonneuve Est, Montréal BERRI-UQAM Promotion super réservez-tôt 40 e jusqu au 31 mars De plus, réservez votre circuit avant le le 31 mai 2010 et courez la chance de voyager gratuitement! Escapade à Londres départ du 16/05 au 23/05 à partir de 2356$ Grand Tour d Autriche départ du 14/05 au 28/05 Option jeux de la passion à Oberammergau à partir de 4156$ Plusieurs autres départs disponibles. Informez-vous! Corse Sardaigne départ du 18/05 au 01/06 à partir de 4156$ Espagne Portugal départ du 18/05 au 02/06 à partir de 4256$ Départ de Montréal. Les prix sont par personne en occupation double et incluent toutes les taxes de vente, les taxes et les autres frais. Pour le détail des inclusions des programmes, veuillez consulter les brochures Les prix sont en vigueur au moment de l impression. Titulaire d un permis du Québec. md/mc Marque déposée/de commerce d AIR MILES International Trading B.V., employée en vertu d une licence par LoyaltyOne, Inc. et Transat Distribution Canada Inc. Prix excluant le 3,50$/1000$ du fonds d indemnisation des clients des agents de voyages détaillants. 1 2 L E S P É C I A L I S T E V O L. 1 2 n o. 1 M a r c h