More and more dermatologists are leaving the public health network to practice privately. Around forty have the status of “non-participant”, compared to 25 five years ago, according to data obtained from the Régie de l’assurance santé du Québec (RAMQ). The government says it is concerned about the “disaffiliation” of these doctors. More than 100,000 consultations are pending in dermatology, nearly 60% of which are late.
Quebec has 200 dermatologist doctors, according to the association that represents them. Among these specialists, around 20% chose the private sector. This proportion was 13% in 2018-2019.
The Association of Specialist Dermatologists of Quebec (AMSDQ) explains these departures to the private sector by the desire of some to “offer non-medically required services”, such as aesthetic treatments. “Others left the public system because they could no longer tolerate the administrative burden and the network’s lack of resources,” says its president, the DD Catherine Besner Morin. She points out that “in the majority of regions”, dermatologists do not have the “resources they need”, such as premises and nursing and administrative staff.
The Ministry of Health and Social Services (MSSS) indicates that “the disaffiliation of doctors from the public network is a concern of the MSSS, regardless of their specialty.” Quebec argues that “significant efforts are being made” to “make the public network more attractive to staff” and improve access to care.
Since the COVID pandemic, the number of pending consultations has exploded in dermatology: it went from 63,319 on January 4, 2020 to 107,801 on August 12, 2023, according to the latest data from the MSSS. This is the longest waiting list among medical specialties.
Josée Vézina had to wait five months before seeing a public network dermatologist in August for a problem with pimples which started on her hands and now extends to her entire body (including her head). “It’s like eczema, but ten times worse,” summarizes the 59-year-old woman. It hurts. Want, don’t, we scratch. We want to tear our skin off. And aesthetically, it’s not very beautiful. »
Josée Vézina is satisfied with the care she finally received from her dermatologist. But she finds it “flat” to have to go to Alma to consult him. “I’m from Chicoutimi,” she said. From our house to Alma, I have 45 km to go. »
Faced with long waiting times, more and more Quebecers are deciding to turn to a private clinic. Dermago, which offers dermatology services online, has seen demand “triple” since its launch five years ago, says its co-founder, dermatologist Marc-André Doré. The company has just opened a physical clinic in Saint-Augustin-de-Desmaures in the Quebec region.
“There are really people who will say “I have a bruise on my back, I’ve been waiting for two years [au réseau public]I’m tired, it’s bleeding, it annoys me” and then, they go [nous] consult,” explains the Dr Golden. Others decide to call Dermago more quickly, having been informed of the long delays by their family doctor, he adds. The fee for a virtual consultation is $199 and the fee for an in-person appointment is $299.
Thousands of cases resolved via teledermatology
The MSSS, the AMSDQ and the Federation of Specialist Physicians of Quebec are banking on teledermatology to reduce waiting lists in the public network. A virtual care platform, launched in July 2022, allows family doctors to consult a dermatologist so that the latter can make a diagnosis and determine a treatment. The general practitioner monitors the patient.
According to the MSSS, several thousand Quebecers have benefited from this teledermatology service over the past year. The platform was able to “respond” to 3,016 consultation requests out of the 3,953 received, specifies the ministry. “Only 24% of requests required a referral for an in-person consultation following the virtual consultation,” we wrote in an email.
The DD Besner Morin emphasizes that its members “work tirelessly” to find ways to improve access to dermatology in Quebec. However, she believes that “it is the government which dictates the entire rules of the game” and that it has “all the cards” to offer “interesting working conditions” to dermatologists. “If there is an action to be taken to convince doctors to remain in the public network, it can be done,” she thinks.