A model that is no longer viable

We hear from family doctors that they cannot be found, that they no longer want to work, that they leave the public sector for the private sector, that they complain of not earning enough, that they prefer aesthetic medicine ( more profitable)…

One thing is certain, we observe a lot of frustration and bitterness towards family doctors in Quebec. The shortage of around 1,200 doctors and the difficult access to the front line are not improving things.

For their part, family doctors are vague. They are overwhelmed by administrative tasks, they would like to be more autonomous, they feel underpaid and, above all, they have the impression of being the scapegoats for everything that is going wrong in the Quebec health system.

Throughout the interviews conducted for this file, I realized that family medicine had changed. That the students perhaps shun it less than we think. And that our fantasy of the family doctor present in his office 24/7 is indeed that: a fantasy.

“The image of the family doctor as we describe him today is folkloric,” the D tells me.^r Cédric Lacombe, president of the Federation of Resident Physicians of Quebec (FMRQ). We seem to have forgotten that this image was based on a family model where the doctor was a man who worked crazy weeks while his wife took care of the children at home. This model is no longer viable. »

Today, young doctors aspire to a better quality of life and want to see their children grow up. Who can blame them?

The D^r Lacombe understands the criticism of family doctors, but says there is no scientific evidence to support the idea that each individual should have “their” doctor. “What is necessary,” he says, “is for there to be a well-identified single entry point to access a basket of services. »

It is not a question of replacing the family doctor, the president of the FMRQ assures me, but of reorganizing the health system so that “the patient’s trajectory” is more fluid.

A harmful political discourse

When I ask the president of the FMRQ why medical students avoid family medicine, he first refutes this observation.

“It’s a super interesting and flexible specialty over the course of a career, which other specialties cannot boast of being,” he answers.

But, because there is a but, the Charest and Couillard governments – and more especially the passage of Gaétan Barrette to the Ministry of Health – have caused a lot of harm.

For a handful of doctors

The question of the “shortage” of family doctors raises eyebrows in every medical school dean I have spoken to. I am reminded that every year, around half of medical students, all universities combined, choose this specialty. “A few years ago, we had the opposite view, we were worried about the lack of specialist doctors,” notes Dominique Dorion, dean of the faculty of medicine and health sciences at the University of Sherbrooke. Then, the emergency rooms became overcrowded and we realized that we lacked doctors on the front line. I would bet that in 10 years, there will be a shortage of oncologists and geriatricians. And the shortage of family doctors will be behind us. »

According to the Ministry of Health and Social Services, by taking into account the contribution of other health professionals such as nurse practitioners specializing in primary care and pharmacists in patient care, it will be possible to achieve the balance between the offer of services and the number of doctors required in 2030-2031.

Nevertheless, pressure remains strong on universities to train more family doctors. A decree sets the proportion of places reserved for this specialty at 55%. As the number of admissions to medicine has increased each year since 2020 (we should start to see the effect of these increases from 2026), it happens that not all places in family medicine are filled. “We are talking about a handful of students,” insists Dean Dorion of the University of Sherbrooke.

Is it catastrophic, as Marc-André Amyot, president of the Federation of General Practitioners of Quebec, suggested?

Not according to the D^r Dorion, from the University of Sherbrooke. “What discourages students the most,” he believes, “is the inappropriate speech of politicians and unionists. Family medicine has many good years ahead of it, but it has changed profoundly. It has become more professional, the practice has improved. It is a complex medicine that is now practiced in collaboration with other health professionals. But we must stop targeting the 4 or 5% who have not chosen family medicine. »

A diversified practice

There is much criticism of the fact that family doctors spend too much time in the hospital, which reduces their availability in clinics. Should we bring them all back to their offices?

“It would be a bad idea,” believes the D^r René Wittmer, family doctor and clinical assistant professor. “We try to find what we can to attract the next generation to family medicine and I believe that the diversity of practice resonates with them,” he says.

The family doctor 2.0

While waiting for the author of the series STATMarie-Andrée Labbé, imagines a character of a super friendly family doctor (which could greatly help the image of general practitioners in Quebec!), a committee is working to revalorize this lovesick specialty.

The National Consultation Table on the Promotion of Family Medicine brings together senior leaders from all medical organizations, including the Conference of Deans of Quebec Medical Faculties and the Federation of Student Doctors of Quebec.

The recent decision to no longer require a doctor’s form for an absence of a few days is one of the recommendations of this Table. Just like the idea of ​​moving forward family medicine internships to expose students to this specialty more quickly during their studies.

“In total, we identified 120 problems to resolve,” explains the D^r Pascal Renaud, president of the Association of General Practitioners of Quebec, who actively participates in the work of the committee.

Like everyone I spoke to for this report, D^r Renaud insists on the evolution of family medicine in Quebec. “What sets family medicine apart today is its versatility,” he says. This is even more true for regional doctors. I am a family physician and my only practice is in the emergency room. I have colleagues who only provide long-term care in CHSLDs. The majority of deliveries are carried out by family doctors in Quebec. This is what the population must understand. »

Another aspect of family medicine that is overlooked by students and the general public is how much a doctor’s practice can change over the years. “I started doing emergency work, I did obstetrics, and today, I do palliative care and CHSLD,” explains the D^D Danielle Daoust who also sits on the Revaluation Table. This flexibility has been very valuable in my life in adapting to the needs of my children. »

This versatility means that doctors are less available for office consultations. But it is also the greatest attraction of the practice among young people.

Among the major sources of irritation that everyone wants to tackle: the obligations to practice in the region or to take charge of certain tasks. “Everyone has a problem with that,” says Dr.^r Renaud. We pretend to think that if this were removed, there would be far fewer than 70 unfilled positions in family medicine. »

I have no doubt that Quebecers will eventually adapt to this new vision of the front line. As long as we explain things clearly to them. And that they can be seen by a health professional who will respond to their needs within a reasonable time frame. It’s not yet the case.

What do you think ? Participate in the dialogue