Family medicine | A hundred doctors could postpone their retirement

(Quebec) Thanks to a new agreement with Quebec and their professional order, family doctors can now take gradual retirement. Their union anticipates that around a hundred of them could postpone their departure in the short term.

In a context of shortage, the Federation of General Practitioners of Quebec (FMOQ) welcomes the publication on Friday of a new Support Guide for family doctors who would like to plan a gradual departure towards retirement. The document is the result of a project launched two years ago by the union, the College of Physicians and the Ministry of Health and Social Services (MSSS).

“It was a request from doctors to be able to slow down over a few years”, expresses the director of the FMOQ, the D^D Anne-Louise Boucher. She cites the case of general practitioners who are getting older or others who have had health problems and who “still want to contribute, provide care to patients”. However, “reducing their pace was complex,” she explains.

A quarter (24%) of the approximately 10,000 general practitioners who billed in the Quebec public plan in 2022-2023 are 60 years of age and over. More precisely, around 7,600 doctors provide care. Of this number, 1,150 are over 65 years old. They have nearly 900,000 patients registered, including 450,000 qualified as “vulnerable”.

With the new program, the FMOQ anticipates that around a hundred family doctors could opt for gradual retirement rather than leaving the service completely, which could limit the number of orphan patients.

“Faced with the difficulty of really slowing down, doctors, excuse the expression, but pulled on the plug two, three, four years earlier than they would have liked. So, it’s a gain for the population,” illustrates the D^D Butcher in interview.

The agreement notably allows for relaxations in the current process for ending the therapeutic relationship between a patient and his doctor. The Code of Ethics provides in particular that “the doctor who has examined, investigated or treated a patient is responsible for ensuring the medical follow-up required by the patient’s condition following his intervention, unless he has ensured that another doctor, another professional or another authorized person can do it in his place.”

However, it was becoming increasingly difficult for doctors to transfer their patients to colleagues. For the first time this year, the arrival of new doctors did not compensate for the number of departures.

GAP

The creation of the famous First Line Access Counter (GAP) changed the situation, according to the FMOQ. This centralized window, launched by Minister Christian Dubé in 2022, allows orphan patients to be cared for by a family medicine group (GMF) rather than by a family doctor.

“It’s the safety net we were missing […] it was a void that the Colleges of Physicians and doctors did not like,” illustrates the D^D Butcher. The FMOQ is now planning a mechanism for transferring patients to the new platform for doctors at the end of their career.

The accompanying guide nevertheless asks general practitioners to prioritize other options. The GAP is “not ideal”, we recognize.

The doctor must first encourage the transfer of his patients to colleagues in the same practice environment, to colleagues in his GMF or in his territory. He must also transfer patients with follow-up needs at varying intensities to “respect the capacities” of colleagues. He must also ensure that members of the same family, as well as patients and their caregivers, are kept together.

“For patients who are unstable, who have just started an investigation for cancer, who are off work, actively adjusting medication… These are patients who we will not transfer, who we will keep at their disposal. our name”, also qualifies the D^D Butcher. Each doctor must also “paint the portrait of his patient base” before starting to reduce his registration list.

Patients transferred to the GAP must be in stable condition, not the subject of an ongoing investigation, nor request medical follow-up within a short period of time, we write.

The FMOQ also admits that its standoff with the Minister of Health could have effects on its progressive retirement program due to the “uncertainty” caused by the end of the agreement on access to the GAP. The union fiercely opposes Christian Dubé’s decision to eliminate an annual bonus of $120 paid for each patient registered with a GMF through the GAP.

This premium represents an annual bill of more than $100 million. However, Quebec claims that half of the registered patients did not have an appointment. Data contested by the union.

According to the FMOQ, the government’s choice could jeopardize the existence of the window. “The GAP is here to stay,” assured the minister.