Montreal will welcome fewer new family physicians than expected in 2023. The duty learned that the Minister of Health and Social Services Christian Dubé has requested that “adjustments” be made in the distribution of positions between the regions. Result: Montreal, the North Shore and Abitibi-Témiscamingue lose doctors, to the benefit of Laval and Lanaudière.
The Association of General Practitioners of Montreal (AMOM) is indignant at this decision and strongly denounces it. “On the ground, it does not pass pantout! said its president, the Dr Michael Vachon. We do not understand why Montreal patients are seeing their access to health care diminish more and more, year after year. We think that the minister absolutely does not understand what is happening in Montreal. »
The Montreal region will be entitled next year to 85 new family doctors rather than 89, according to a document from the Ministry of Health and Social Services (MSSS) obtained by The duty and which details the regional medical staffing plans (PREM) for 2023.
The Côte-Nord will reap 14 positions rather than 16 and Abitibi-Témiscamingue, 9 instead of 11. Two regions gain from the change: Laval (21 instead of 15) and Lanaudière (18 rather than 16).
The head of the regional department of general medicine in Montreal, Dr.D Ariane Murray, deplores these “unilateral” modifications. “It is certain that the cut of 4 positions this year hurts less than that of 30 last year, she admits. But that makes that in three years, we are in total at least 44 positions. Given our numbers in relative decline, it hurts. »
Last summer, Minister Christian Dubé transferred to the 450 some thirty positions intended for Montreal. The operation was decried, in particular by the Federation of General Practitioners of Quebec. Its president, Dr.r Marc-André Amyot, described as “completely arbitrary” this decision based “on the color of the electoral map”. Christian Dubé defended himself, arguing that this intervention had been “difficult” but necessary.
Asked about the “adjustments” made for 2023, the office of the Minister of Health indicates that it was necessary to “adjust the PREMs according to the needs of the population” and demographic growth “in the years to come” in order to put implement Christian Dubé’s health plan. His press secretary, Marjaurie Côté-Boileau, took the opportunity to fire an arrow at the Liberal Party of Quebec.
“Unfortunately, the Minister realized, when he arrived at Health, that the Liberal government was granting PREMs randomly,” she said in a written statement. For our part, we do not hesitate to correct the situation and manage according to the needs of Quebecers, in all regions. »
The MSSS specifies that it has made “minor changes” to “accelerate the correction of the differences between comparable regions” with regard to the number of doctors per 100,000 inhabitants. This ratio is 94 and 98 respectively in Lanaudière and Laval, compared to 114 in Montreal, 153 in Abitibi-Témiscamingue and 173 on the North Shore (see box).
AMOM finds it difficult to explain, in the context, why the Capitale-Nationale does not suffer any job cuts in 2023. The Quebec region currently has 126 physicians per 100,000 inhabitants. And according to the ministry’s forecasts, this ratio will rise to 139 in 2026. Montreal will go from 114 to 117 taking into account the adjustments made in 2023.
For the Dr Vachon, the indicator of the ratio of doctors per 100,000 inhabitants does not hold water. “If we wanted to compare oranges with oranges, all family doctors would have to do the same job in all regions of Quebec,” he said. So have equal practices. »
The head of the Abitibi-Témiscamingue Regional Department of General Medicine, Dr.r Jean-Yves Boutet, points out that his region “does not even have 150,000 inhabitants” and that the territory is vast. Small teams carry services in hospitals at arm’s length and have to call on emergency doctors.
He believes that the government is not sending the right message to the doctors in place. “At some point, we will not be able to continue to ask these doctors for 110% all the time, all the time, all the time, he thinks. They want to have relief and reinforcement. »
According to the MSSS, the withdrawal of positions in Côte-Nord and Abitibi-Témiscamingue will have “little impact” since the two regions still have positions to fill from PREM 2022. They will be able to fill them by 15 January, it says. As for Montreal, the effect will be “negligible”, it is estimated, given the fact that the region “is being allocated the most positions”.
One post cut is one too many, according to the DD Murray. “A patient from Montreal who goes on RVSQ [Rendez-vous santé Québec] today with his postal code and trying to find a walk-in beach, he can’t find one, ”she laments.
The PREM system, which aims to fairly distribute medical resources in Quebec, is not unanimous. A Montreal physician, Dr.r Mark Roper is also contesting in court the workforce distribution plan which, according to him, maintains inequalities between regions in terms of access to family doctors.
The Dr Amyot believes that the problem is not so much the method of calculating PREMs, but the lack of medical staff. In 2023, 412 positions for new doctors will be granted, which is about thirty less than last year, according to the MSSS. “Montreal and all the regions say ‘I don’t have enough’ and it’s true, says the Dr Amyot. We share the shortage. »
According to him, Montreal is however in a “special situation”, in particular because of the number of patients without a family doctor and the medical deserts there. Many Montreal doctors will also be retiring in the years to come. The third is over 60 years old, he recalls. However, in the distribution of its workforce, the MSSS only aims to replace 75% of physicians retiring.