The health system is sick. We all agree. There are thousands and thousands of patients waiting for family doctors and we would all like this reality to be different. However, it would not be wise to use the strong method by requiring us, family doctors, to take more patients under penalty of sanctions through the application of Bill 20. [Loi favorisant l’accès aux services de médecine de famille et de médecine spécialisée]. The objective of ensuring that every Quebecer has a family doctor is desirable, but the coercive solution that you are recommending, Mr. Minister of Health, is a dangerous and counterproductive gamble.
Stop decrying the daily work of family doctors as insufficient when around me, I see instead that most of my colleagues are exhausted, out of breath, stunned by the heaviness of the professional load while being shaken by the attitude of the Ministry of Health towards them. His criticism is harsh, but his support is insufficient.
Isn’t it time to speak loudly — and positively — about the efforts made by groups of family doctors who, since the agreement between the Federation of General Practitioners of Quebec and the Legault government in May 2022, have taken into account charges more than 507,000 Quebecers and registered more than 900,000 new patients, including many vulnerable patients?
When I started my practice, more than 40 years ago, we did not have all these administrative pitfalls to deal with and our work was primarily devoted to patient care.
What are you doing, Mr. Dubé, to put a stop to this bureaucratic frenzy, this all-consuming paperwork? The situation of family doctors is very precarious. Many medical students in Quebec prefer specialties to family medicine because of the increasingly heavy constraints associated with it. Since the Barrette era, in 2015, general practitioners have been thrown out to pasture on public forums. This denigration, which you in turn maintain, contributes to a loss of interest in this practice.
Hundreds of family medicine residency positions have not been filled for 10 years. In addition, around a quarter of general practitioners and specialist doctors will retire by 2030. The sad state of the health system is far from being solely the responsibility of family doctors. However, we are regularly vilified and even threatened with sanctions on a recurring basis. But it is so much more profitable, electorally speaking, to hit the nail on the head on family doctors than taking responsibility for the ill-advised political choices implemented over the decades.
One after another, the various governments are absolving themselves of all responsibility for certain decisions that have perpetuated the chronic shortage of doctors. For example, in July 1997, six months after the launch of the voluntary departure program which made it possible to retire from age 50, nearly 19,000 health employees opted for early retirement, including almost 4,000 nurses and 1,500 doctors. In the early 1980s, the then Ministry of Social Affairs decided to reduce the growth of the medical workforce, in particular by reducing admissions to medicine and limiting the entry of foreign doctors, despite the feminization and aging of the workforce. .
These are just two examples of political decisions which have had and still have unfortunate consequences on the precarious state of our network. There are more and more family doctors practicing privately in Quebec. To date, there are more than 500 general practitioners disaffiliated with the Régie de l’assurance santé du Québec. Why do you think ?
An alienating bureaucracy
Furthermore, who is responsible for having created a bureaucratic monster which is imposed on us and which considerably increases our work as doctors? The desire of the Ministry of Health to control the work of doctors by developing administrative requirements of all kinds has become elephantine. Office work represents two to four hours a day wasted filling out forms of all kinds. For example, the Service Request Dispatch Center (CRDS), which involves a range of examinations to be carried out before the patient is seen in a specialty, often very long delays in treatment by specialists using a ventripotent system and not very efficient, forms sometimes counting up to 16 pages for a single patient such as that for the certificate for the federal disability tax credit, codes and exception forms for hundreds of medications, forms from the CNESST or the SAAQ, etc.
These means of control exercised by the Ministry of Health through undue administrative requirements, including alienating bureaucracy, are unacceptable. That’s enough ! Such a spirit is incompatible with the ability to calmly and efficiently exercise the clinical practice of medicine.
We should not forget that we are dealing with increasingly vulnerable, aging patients with multiple physical pathologies and an increase in mental health problems. Specialized services are insufficient and delays continue to lengthen, placing on the shoulders of the family doctor the management of thousands of patients who continue to suffer while waiting to have access to the necessary resources.
I am distressed to see the situation deteriorating even though I had the privilege of experiencing a time when we could practice our profession effectively and with more efficient autonomy and free from this procession of administrative tasks. I am also sorry to see young colleagues leaving the medical profession after three, five or ten years, completely demotivated. I am also no longer surprised to see colleagues now considering early retirement because the working climate has become so difficult.
Despite the importance of the task before us, which is complex and heavy with an aging population and where mental health is increasingly compromised, the approach chosen by the ministry remains coercion towards family doctors. . In these conditions, do not be surprised, Mr. Dubé, if family medicine becomes a profession in danger of extinction.
*The full list of doctors who support this letter is online here.