Quebec Health Minister Christian Dubé claims he wants to force family doctors to care for 13,000 vulnerable patients. However, this figure does not mean much, according to three heads of regional departments of general medicine (DRMG) interviewed by The duty. These doctors, responsible for coordinating medical services in their region, are calling for a major cleaning of the family doctor access counters (GAMF) to have a real picture of the needs.
” THE [chiffre de] 13,000 vulnerable patients means nothing, says the head of the Montreal DRMG, the DD Ariane Murray. The counter data that is reliable is the total number of patients waiting. » Not the number of vulnerable patients. “There, we currently have some, in Montreal and elsewhere, who have had time to give birth and who have had their baby for three or four months. »
When a patient registers with the GAMF, Quebec assigns them a “priority rating” based on their situation or health problems. Those who are most vulnerable fall into categories “a” and “b”: they suffer from active cancer; receive palliative care; have suicidal thoughts or a psychotic disorder; are suffering from HIV-AIDS; are pregnant; were hospitalized in the last month for a chronic problem, etc. For these patients, registration with a family doctor is considered “urgent” or “pressing”. Support must be completed in less than two weeks.
According to the Ministry of Health and Social Services (MSSS), 13,083 vulnerable patients were waiting at the GAMF as of January 31 (see box). Among them, 2,600 have a family doctor who will retire. The average waiting time is 548 days for those whose “priority rating” is “a” and 928 days for those in “b”, according to the MSSS.
The DD Murray says he shares Minister Christian Dubé’s objective of caring for the most vulnerable. But she believes that the criteria determining vulnerability — put in place when the counters were launched around fifteen years ago and appearing in the draft regulation tabled by the minister on Wednesday — are “totally outdated” and must be reviewed.
According to her, pregnant women should no longer be given “priority a rating”. For two years, future mothers have had access to the “My Pregnancy” service, an online tool that allows them to request obstetric monitoring and obtain it from the first trimester. “They are already taken care of differently,” she argues. The same goes for people suffering from an incurable illness at the end of life. The DD Murray sees “no point” in a family doctor being assigned to a patient “followed by a palliative care team at home and who will die in two months.” “I apologize, but there is no relevance,” she said.
A “political” announcement
The head of the DRMG of Outaouais, Dr Marcel Guilbault deplores that Christian Dubé did not consult the DRMGs before announcing his intention to force family doctors to take care of the 13,000 vulnerable patients. The minister could have had a better portrait of the people waiting, according to him. “It’s a political announcement,” he said. It’s an easy message for the population to understand: 13,000 patients moaning in pain, and the doctors are not taking care of them. But that’s not reality. »
The Dr Guilbault explains that vulnerable patients are automatically registered with the GAMF, because their family doctor has notified the Régie de l’assurance santé du Québec (RAMQ) of their retirement within two years. He adds that cleaning up the waiting lists is “not always done” due to a lack of staff. “Our counter is someone part-time who takes care of it, [à raison de] two days a week,” he explains.
The head of the DRMG of the Côte-Nord, Dr Roger Dubé thinks that the number of vulnerable patients waiting is lower than 13,000. “The figure still gives an order of magnitude,” he says. There are several thousand “a” and “b” patients in Quebec who are not taken care of and who deserve to be. » According to him, a family doctor does not, however, bring “great added value” to a patient with breast cancer during the “acute” phase of care. She is followed by a surgeon, an oncologist and a radiation oncologist, he recalls. “It’s certain that, subsequently, for annual follow-ups, someone will be needed. »
This is a political announcement. It’s an easy message for the population to understand: 13,000 patients moaning in pain, and the doctors are not taking care of them. But that’s not reality.
In the office of the Minister of Health, we insist that “there are 13,000 patients classified as being vulnerable at the window for access to a family doctor”. “Now we must rise above administrative debates like this,” they say. There are vulnerable patients waiting and who are not taken care of, it is for them that we work. »
The cabinet indicates that the minister has had meetings with the DRMGs regarding waiting lists. He reminds that “all partners” can make their comments on the draft regulation during the 45-day consultation period. The Federation of General Practitioners of Quebec (FMOQ) put the Minister of Health on notice in mid-February, judging that it had not been sufficiently consulted before the application of the draft regulation.