Yes, they are coming back to Ontario. They’ve been up and down this road before, but this time, they don’t expect to return home anytime soon. The married couple work at the Jewish General Hospital and say they can’t see a way forward in Quebec for themselves and their two boys, ages three and one. So two different Toronto emergency departments prepare for their arrival, with jobs waiting for them. “It was a really tough decision,” said Dr Daria Denisova, 34. Her husband, Dr Philip Stasiak, 37, said it was taken “with a heavy heart”. “I love Montreal. It’s the city I grew up in and to leave it again for the second time, it’s disappointing,” Stasiak said. They are leaving at a time when the health care system is fragile.
Montreal alone has 18,399 health care workers, according to the government’s July 4 health care system dashboard. But after all their anguish, it became clear to the doctors that compared to the hospital system they remember in Toronto, Montreal’s harsh, rigid working conditions are incompatible with raising a healthy family. They say these conditions are a natural consequence of government rules that limit hiring. And if they still had doubts about following the well-worn path on the 401 a second time, Quebec’s new language law, commonly known as Bill 96, sealed the deal. Doctors have no problem communicating with patients in French or English. They are trilingual: Denissova also speaks Russian, Stasiak speaks Polish. But they are somewhat concerned that the law aimed at protecting the French language could affect patient care and make an already crowded workplace even more burdensome. “It’s very murky. What will the real consequences of this be? Is it political posturing? How will the laws be enforced?” Stasiak thought. “No one really knows.” He expects that in the English-defined hospital where he works, he could continue to use his best judgment, but the unknowns still stir. It will be felt in “my interactions with patients, is it my interactions with my colleagues, when I talk to a consultant or a nurse or someone else from an allied health profession? What about my charting?” “We’re completely bilingual, but the thing is, there are so many acronyms in medicine… and to describe it to someone else who needs to convey this information… wouldn’t it be better to keep it that way?” Stasiak suggested. “I don’t like dictating who I have to speak to in English or French to begin with,” Denisova said, when what matters most is communicating effectively with patients. “It’s infuriating that this is even a debate,” he added. “Should people show their fitness certificates when you go to hospital for treatment?” They are not alone in their concerns. Other medical groups, notably the Quebec College of Physicians, have been sounding the alarm over Bill 96 for months. In an email to CTV News on Monday, the Quebec College of Physicians reiterated that the organization “will remain vigilant” regarding Bill 96 as “the reform could have an impact on the doctor-patient relationship.” “I just didn’t want to live in a place where I no longer felt like I represented my views and values,” Denisova said.

THREE PRIORITIES: FAMILY, FRENCH RESPONSIBILITY AND FREEDOM OF CHOICE

However, the much bigger issue for young parents is how Bill 96 may limit their children’s academic options when they reach CEGEP age and have attended French primary and secondary schools as they did as children.
“We want them to have the freedom to choose between ‘You know what?  I want to go to an English CEGEP or a French CEGEP,’ which is the choice we had made,” Stasiak said.
But they fear changes to the language law could make that impossible.
Bill 96 caps English-language CEGEP enrollment levels and is expected to make colleges increasingly difficult for francophone and non-native students to enter as their growth stalls at 2019 levels.
Given the restrictions, the couple want to ensure their children don’t spend their early years studying French in a province that could later close the door on their future success.
“They are freezing English CEGEP enrollments and giving priority to students coming from English schools – and that’s it now,” Denissova said.  “What will it be in ten to 15 years?”

The only possible solution would be to send the boys to private English schools in Montreal that offer a grade 12 option so they can bypass CEGEP entirely and graduate with an Ontario Secondary School Diploma. But then, French fluency would kick in, the pair noted. It’s 22, unless they leave Quebec. “I think the biggest irony is that now we’re going back to Toronto, we’re going to send them to a private French school,” Denisova said. “We want them to speak French perfectly … but not at the expense of their future freedom and future choices and career opportunities,” he said. Dr. Philip Stasiak and Dr. Daria Denissova, shown with their eldest son, are leaving Quebec to ensure that their children have more freedom in their education.

EMERGENCY COLLEAGUES “UNDERSTAND”

The strangeness of their story full circle isn’t lost on the couple, and it’s hard to believe they’re leaving home again.
They left for Ontario the first time because they couldn’t get practice permits in Montreal after completing their fellowships at McGill University’s teaching hospitals.
The government determines how many doctors a region or hospital can hire, using a licensing system known as PREMs/PEMs (Plan régional d’effectifs médicaux) – and they weren’t available to them.
So, for five years, they worked in emergency rooms in Toronto.
“Then, once we had our first child, we decided, you know, it would be really nice to come back. I miss the French. I miss Montreal as a city. We’ll be closer to our parents,” Stasiak said.
Those elements of Montreal were wonderful: the grandparents, the house, the neighborhood.  After about a year, however, reality set in.
“It hit me that, oh my gosh, this is such a rough work environment and also there was Bill 96 that was all over the news, so all of that started to dawn on me,” Denissova said.
He wondered if they could handle the workload, multiple shifts and shifts 30 to 50 percent longer than in Toronto, he estimated, and stay healthy for the next 20-plus years if they continued on the same path.
The environment, they said, has nothing to do with how their particular hospital is run, something Denissova noticed when she took a few ER shifts at a different Montreal hospital to help her understand the problems she was facing.
Both young doctors said the “heavy” workload has a lot to do with the province’s licensing system.
“Because of the PREM system, working conditions are much more difficult, work is much less flexible in terms of hours, shifts,” said Denisova.
In that assessment, he has an ally in a veteran Montreal general practitioner who just took the health ministry to court over the PREM system and how it is being used to distribute – or not distribute – family doctors in Montreal .
“It doesn’t make sense to have hiring restrictions,” said Dr. Mark Roper, “when we have such a shortage of staff, a shortage of emergency physicians, it doesn’t make sense, right?”
He points out that having more family doctors in Montreal would reduce pressure on swamped emergency rooms because they would see more patients in their offices and do ER rotations.
“We would certainly welcome and benefit from more doctors,” said Denisova, disheartened to see doctors who are decades older still being overworked as much as she is.
Nor do they envision ever having a flexible work schedule that would allow them to better care for their children and get them to and from daycare and school – unless various aspects of the system are dramatically changed.
“That’s true,” said Roper.  “The PREM system and the PEM system, which are more human resources controls for hospitals, force department heads to use only full-time doctors and part-time doctors are having a hard time.”
They are so short-staffed, Denisova said.  It would put too much pressure on the rest of the team if she was allowed to cut back on her hours for a few years – something she will now be able to do in Toronto.
“Pretty much as soon as I spoke to the department in Toronto where I worked before, they said, ‘Yes, of course, we’ll be happy to take you as many shifts as you want to work.’
“”If you want to work less hard for a few years of your life because you have younger children, we can accommodate whatever you want.” So the contrast was striking,” Denisova said.
Quebec’s PREM system sent them back.
Telling the Jewish General ER’s colleagues about their decision was “tough,” Stasiak said.  “These are people that we’ve trained with, that we know, they’re our friends, I feel like we’re letting them down even a little bit, and they’re also disappointed.”
“But everyone is very understanding. They understand it because they see the conditions,” he said.
“We have to do what’s best for us, for our family,” even if it means leaving others behind.