Dear readers, there is hope for our healthcare system! As you read, there is no shortage of solutions to improve access to family doctors.
This is what emerges from the abundant mail received after the publication of our editorial on the broken promises of our health system1.
Basically, you are suggesting a return to the relentless law of supply and demand. Is there a shortage of doctors? “Increase the supply significantly, that is to say the number of students in general medicine,” writes Michel.
This makes sense, especially as the aging of the population hits on several fronts: more complex cases increase the workload of doctors… more of whom are retiring. This is a significant trend, since a quarter (23%) of family doctors are over 60 years old.
This is how the number of family doctors in the public network fell last year, for the first time in more than 20 years. Quebec lost 48 general practitioners, out of a total of 9,904.
It would be necessary to add 1,500 family doctors to have the same number of front-line doctors per capita as the other Canadian provinces, according to calculations by the Federation of General Practitioners of Quebec (FMOQ).
And Canada, as a whole, has fewer doctors (2.8 per 1000 inhabitants) than the average for OECD countries (3.7 per 1000). Obviously, there is some catching up to do.
Good news, the Coalition Avenir Québec (CAQ) announced last July the admission of 660 additional doctors over four years, thus respecting an electoral promise.
The problem is that students prefer specialties to family medicine. For 10 years, some 600 places for training general practitioners have remained empty in Quebec.
On Tuesday, leaders of four Ontario universities joined together to urgently call for significant reforms to convince tomorrow’s doctors to choose family medicine over specialties.
Their call for help deserves to resonate as far as Quebec, where the problem is even more acute.
Should we place more quotas on specialties to force students to go into family medicine? Maybe. But students risk waiting until the following year, rather than opting for a career choice that does not correspond to their aspirations. Last year, more than 60 people in Quebec took a sabbatical, double the number a few years ago.
It must be said that the pay gap is considerable. Particularly well treated when compared with OECD countries2a Quebec medical specialist pocketed gross remuneration of $419,616 in 2022. This is 57% more than a general practitioner ($266,620), who often has significant office expenses3.
The diagnosis of a family doctor from Estrie is simple: “The abysmal gap between the remuneration of a specialist and a family doctor will contribute to maintaining the existing shortage. »
This shortage is exacerbated by the exodus of doctors to the private system. This is no longer marginal: 487 family doctors are disengaged from the RAMQ, almost 5% of the total number.
The worst thing is that more and more young doctors are working directly in the private sector after obtaining their diploma. It’s annoying when we know that training a family doctor costs taxpayers more than $70,000 per year.
Several readers, including doctors, want Quebec to tighten the screws.
“I think it would be good for new graduate doctors to spend at least five years in a general medicine clinic before moving to the private sector,” writes Diane, who noted, during a recent consultation, that two newly qualified doctors had gone private. ” Anything ! », she protests.
Another avenue: prohibit private doctors from charging higher prices than those in the public sector, as in British Columbia.
But beyond the new constraints, we must also restore the image of family medicine.
“I find that the government is having a field day on the backs of family doctors, a handy scapegoat,” writes a 62-year-old omni who feels like he is doing his fair share. “I look after 1,700 patients and I welcomed around 300 patients referred by the GAP last year. In addition to three hours of paperwork per day, I see 80 patients in consultation every week. »
Less paperwork. More support. These are good remedies to unclog family doctors. More experts can do more: physiotherapists, nurses, social workers, psychologists…
But for Évelyne, “medical specialists must be part of the solution and be more present on the ground”. “Where are they hiding? », asks the 65-year-old nurse who has observed, over the past 20 years, that general practitioners must multiply tests and procedures before being able to obtain a consultation with a specialist.
Elsewhere in Canada, we found another solution: physician assistants, a profession that does not exist in Quebec, except on military bases. “The results must be good since one province after another decides to take the plunge,” says Valérie.
In fact, everyone must do their part to improve access to the front line… including the patient. It is aberrant that nearly 298,500 patients did not show up for their appointment, over 30 months, according to data compiled by the FMOQ from April 2021 to September 2023.
“Health care may be free, but people who don’t show up should pay $100, for example,” says Wayne. In reality, doctors already have the right to impose fees, but this remains delicate, especially if the patient is less well off.
But we must be aware that “no shows” waste doctors’ precious time. Health is everyone’s responsibility.
1. Read our editorial “The broken promises of our health system”
2. Consult data on health systems from OECD countries
3. Consult the data from the Régie de l’assurance santé du Québec
reference: www.lapresse.ca