The Legault government is changing its approach in its negotiations with general practitioners. Instead of forcing doctors to take care of at least 1,000 patients and to work more, the Minister of Health and Social Services, Christian Dubé, now insists that they make themselves available, through family medicine groups. (GMF), in order to offer a consultation within 36 hours to anyone who needs it.
Christian Dubé presented Bill 11, which requires general practitioners to participate in computerized appointment scheduling systems, such as Rendez-vous santé, of the public network, or Bonjour santé, a private service. FMGs will have to reserve time slots so that their doctors see, in addition to the people they have taken care of, people who do not have family doctors. Typically, a doctor will have to occupy 7% to 10% of his working time to receive in so-called “walk-in” consultation – although this is an appointment system. Already 450 of the 600 GMFs offer this service and Christian Dubé promises that all of these clinics will have followed suit within a few months.
Another “flagship measure” of the bill: the Minister will be able to share detailed information on the activity of physicians that comes to him from the Régie l’assurance maladie du Québec (RAMQ) with the CISSS and CIUSSS in each of the regions of Quebec. , more precisely with their regional Department of general medicine.
A few weeks ago, in what appeared to be the prelude to a standoff with the Federation of General Practitioners of Quebec (FMOQ), François Legault had denounced these doctors who were not working hard enough. At the end of October, The duty revealed that 15% of family physicians in Quebec treated less than 500 patients, while 40% of 10,000 general practitioners had less than 1,000 patients on their list.
However, the government realized that there was a lack of data to provide a detailed analysis of the phenomenon since many doctors have a mixed practice, working both in their office and in the hospital. In addition, the characteristics of the people treated and the intensity of the care they require vary. The FMOQ had also decried the disclosure of these raw figures.
During the 2018 election campaign, the Coalition futur Quebec promised that at the end of its four-year mandate, all Quebecers would have a family doctor and that they could obtain a consultation within 36 hours of requesting it. The first element of this commitment is beyond reach. The minister revealed that according to his assessment, there are not 800,000 Quebeckers who do not have family doctors – double the number three years ago – but 1.5 million.
The Minister rules out the possibility of bringing into force the penalties provided for in Law 20, the work of Dr Gaétan Barrette when he was Liberal Minister of Health. These penalties amounted to 30% of the total remuneration of physicians if the FMOQ, as it turned out, did not meet the objectives in terms of access.
“I think the environment has changed,” said Christian Dubé. Many young doctors no longer accept to take on as many patients as their elders who are now retiring. He takes note of this reality.
The minister called his bill an “outstretched hand”. No more threatening these young doctors. His bill is about management, not coercion, he said.
But don’t be mistaken. This is only one step. What Bill 11 allows is to obtain precise data on the activity of each FMG and each of their physicians, data that will be used to negotiate a new agreement with the FMOQ.
The bill is not innocent: it makes it possible to impose by regulation a “percentage of time slots of availability” during the day, in the evening or on weekends. “The health system has been managed blindly,” said the minister. And information is the sinews of war.
The critic of Quebec solidaire in matters of health, Vincent Marissal, perceived “a hint of Big Brother” in Bill 11, the minister arrogating to himself the right to know the schedule of doctors at work. This is a lot of solicitude on the part of the left training for self-employed workers, now incorporated, whose full remuneration, varying from $ 400,000 to $ 500,000 per year for a 40-hour week, is paid by the state. At that price, Quebeckers have the right to expect results.