Philippe Boyer could continue as a family doctor for a few more years. But a pernicious illness pushed him to take an early retirement.
What is this evil? There’s nothing medical about it. I quote his email: “The heaviness of the system and the omnipresent and sprawling bureaucracy. »
I invited Philippe Boyer to coffee one recent morning. He spoke to me about his life, his love of medicine, his father who was a family doctor until the age of 75, his beginnings in 1985, his years in the emergency room until 2009 and the privileged contact with his patients from the Prairies Family Medicine Group (GMF), in metropolitan Joliette.
What pushed him to advance his retirement by a few years, to 63, was the paperwork: “I’m not that old. Until five years ago, I saw myself continuing until 65, 70 years old. »
This grievance from the doctor (who keeps his title, for the moment) is not isolated: some of his colleagues estimate that just for private insurer forms, a quarter of their time is spent there.1.
He mentions the forms to fill out, of all kinds. A good part of his days could be spent filling out forms for his patients. For insurance companies, for human resources services, for state bodies.
The Ministry of Revenue has a form so that citizens losing their independence can receive a tax credit. This form has 16 pages… And on one of these pages, we counted, there are 40 questions. It didn’t exist in 1985.
Philippe Boyer, doctor
I summarize the absurdity: an organ of the State (the Revenue) crushes a doctor paid by the State (the Dr Boyer) with paperwork, while the health system (state responsibility) has difficulty ensuring access to the front line (family doctors).
The doctor continues about the CRDS (service request dispatch centers), the interface for seeing a specialist. Dermatologist, orthopedist, ophthalmologist, etc. : to see a specialist doctor, you must go through the regional CRDS.
“When you refer a patient to a specialist via the CRDS,” Philippe Boyer explains to me, “it’s difficult. If there is a small box incorrectly filled out in the form, it can take four, five, six months before someone calls you back to tell you that a box was filled out incorrectly… I have seen patients who waited four years for an appointment with a specialist who never came: the request had not been processed. »
Of course, there is no way of knowing where the CRDS appointment request is at. And the Dr Boyer gives me another example of the absurdity linked to CRDS: “I remember a teenager who had to see a physiatrist. So, since she was a minor, a pediatric physiatrist. She waited so long that she had time to become an adult before getting a date. But as she was an adult, I had to make a new request to the CRDS so that she could see an adult physiatrist…”
Philippe Boyer began practicing medicine in 1985, as if it were his destiny. Father, family doctor, two uncles, doctors. He loved the contact with patients.
For him, the trouble in the network began when the government of Lucien Bouchard2 launched the zero deficit operation at the end of the 1990s.
They encouraged family doctors to take early retirement. Before, you didn’t see that, people looking for family doctors. They did the same thing with the nurses. We started to run out of people. I identify the beginning of the problems there.
Philippe Boyer, doctor
I ask the Dr Boyer if there was a tipping point, a very specific moment when he decided to bring forward his retirement.
Answer: “Yes. There’s a patient I’ve had for a long time who left a message at the office. He was treated by a podiatrist who gave him a one-month sick leave notice…”
I’m hitting the pause button here for some context. A podiatrist is not a doctor. He is a foot specialist who completed four years of university studies to become a podiatrist and member of the Order of Podiatrists, a professional order recognized by the State.
Allow the obvious: a podiatrist knows the foot more intimately than a family doctor.
No problem, the human resources department of this patient’s employer (the punch is coming) still required that a doctor, or rather, in the eyes of the bureaucracy, a Doctor, sign the work stoppage himself… Even if the Dr Boyer knows less about the foot than the podiatrist.
“So I decided to call HR,” the D told me.r Boyer, to tell them that it made no sense for me, a doctor, to be the only one who could sign this work stoppage, while a podiatrist, who knows more about feet than me , decrees that the patient must stop working for one month…”
The doctor tells me about his conversation with human resources:
“We’re splitting up here!”
“That’s how it works, ministerial directive, doctor…”
Ministerial directive? here is the punch : this patient who had foot pain was an employee of the CISSS de Lanaudière!
“It’s so stupid,” says the doctor. It is the overburdened network that contributes to overloading its own doctors with forms that do not have to be completed by doctors. Not everything has to go through a doctor’s paper. Until recently, specialized nurse practitioners (NPs) could not sign CNESST forms…”
Tuesday, I sent to the Dr Boy this news3 : a bill aims to end the requirement for patients by insurance companies to provide a medical prescription from a doctor to obtain reimbursement. Furthermore, the frequency of follow-up appointments, when a patient is injured or ill, will be determined by the doctor: the employer or insurer will no longer be able to impose this frequency (often unnecessarily high).
The Minister of Health and Social Services, Christian Dubé, believes that this measure will make it possible to free up 500,000 more appointments with general practitioners annually.
Response from Philippe Boyer: “It’s a step in the right direction, but I don’t think it will generate 500,000 appointments…”
By the way, doctor, you haven’t thought about continuing to practice medicine part-time?
Answer: “Yes. But even part-time, I would face the same bureaucratic burden…”
1. Read an article from Radio-Canada
2. Read “Massive retirements: has the state’s objective been achieved? »
3. Read “Insurance Companies: Bill Will End Requirement for Certain Medical Notes”
reference: www.lapresse.ca