Family medicine remains a young specialty, complex, poorly known, little recognized, in a world where specialism reigns supreme. Although it has existed and evolved for almost 60 years, supported by science and desired by the population, family medicine has been more defined by other specialties and other professionals. She must now define herself and embrace her role as a front-line conductor, not a concertmaster or virtuoso with rare skills.
In the context of the shortage of family doctors that we are experiencing, some miserabilists are asking that patients deemed “non-vulnerable” be deprived of any registration with a main service provider (family doctor, pharmacist, nurse practitioner specializing in primary care, nurse, social worker, etc.) and any longitudinal follow-up. However, this would take away from these professionals and patients, who hope to benefit one day, what matters most for their health.
There is indeed a high added value in terms of health outcomes, scientifically well demonstrated and never denied in almost 50 years, to the continuity of monitoring by the same person, yes, even among young people in good health. In the absence of relevant data or an organizational consensus leading to a national policy to support family medicine, it is the doctors’ unions that define and negotiate what the service offering for this specialty should be. Despite their claim to thus resolve the acute lack of front-line services, the unions legitimately give priority to the interests of their members and not to those of the population.
These corporate maneuvers often have the perverse effect of pushing family doctors towards a reduction of their field of competence to one-off and technical interventions, like those practiced by other specialties, without them benefiting from the privileges of these other specialties. For example, family doctors’ access to specialized consultations is channeled and regulated by a centralized arbitration system from which other specialties are subtracted: the service request distribution centers, the CRDS. Thus, a cardiologist obtains the opinion of his pulmonologist colleague directly and without particular prioritization, not family doctors.
This two-tiered access to which family doctors are subject is echoed in the dichotomous access that is emerging in Quebec: care provided to those “registered with a family doctor” versus that provided to those “left behind.” , registered at the Family Doctor Access Center… or not. However, according to the College of Family Physicians of Canada, which determines the standards for the specialty, family medicine is community-based and its responsibility must extend without discrimination to the entire local population it serves.
I hope that it no longer does anything but be scandalized (rightly!) by this segregation and fully embraces its role in health by relying on better information, an important place in governance and authentic support, to make population an ally of the valuable work of family doctors.
Get out of demagoguery
However, promoting family medicine today gives the impression that we are trying to convince a child to swallow cod liver oil by claiming that it is tasty… However, without regard to “catastrophic disinterest” hammered home for 20 years, well before the “Barrette 2014-2018 era” (my master’s thesis reported on this in 2010), registrations at the College of Physicians of Quebec show that family medicine remains (by far!) the specialty the most chosen, in relative and absolute terms: 532 positions in family medicine in the government decree (even with 55 positions left vacant, 477 people chose it), compared to 149 for internal medicine (positions all filled), which ranked second among the most popular specialties in 2023.
An even more surprising reality is that family medicine remains among the lowest paying specialties, having long shared the floor with public health colleagues, according to 2022 data from the Régie de l’assurance santé du Québec, and most devalued in the media. If family medicine was as valuable and rare as it is made out to be, according to the law of supply and demand, shouldn’t it be among the highest paid?
Likewise, a specialty as important for the Quebec health system, as in all successful systems in the West, should find a special place in the Santé Québec agency. However, we seem to have made very little room for the front line in the governance of this new superstructure.
It is therefore becoming urgent to move away from demagoguery and high-sounding speeches promoting family medicine. Let us help it to assert its specificity, its principles and its methods of intervention, to no longer let people believe that it carries the burden of humanity on its shoulders and let us offer it remuneration consistent with that of other branches and with the monumental expectations imposed on him.
Of course, this real promotion will have to rely on exemplary family doctors, who work hard, of course, but above all better and as a team, taking full responsibility for their fundamental commitments, not for the fate of the entire world.
In the era of kindness and balance, it will be necessary to support them and equip them, not mistreat them or criticize them, at least, not without having informed them of their real performance or clear expectations of them, by based not on impressions and hearsay, but on solid, user-friendly and concerted data. Data about the patients they follow — including what happens to them in the hospital! —, but also everyone they don’t follow!
Finally, let’s take advantage of the current negotiations to stop selling family medicine. Instead, let students choose of their own free will a specialty that attracts them because it is inspiring, respected, supported, exciting, esteemed and accomplished in a healthy, contemporary and stimulating environment. Let us no longer wait for the next good reason to do so and invite Quebec family doctors to take their place in a happy interprofessional environment, full of enlightening and relevant data. Let’s lead them to understand that they are no longer alone in carrying the population’s well-being on their shoulders and that we really care about their invaluable contribution to the health of the population.
Otherwise, let’s all hurry up and negotiate a nice little family doctor before there are none left.