I obtained a medical degree in Europe and have lived in Quebec for over 30 years. Problems of access to health care are subjects of particular interest to me. As I pursued my career in the exclusive field of research, however, I never had my diploma validated to carry out clinical activities in North America.
I can therefore only speak as a citizen, despite everything having the benefit of a certain professional experience.
I can only be sorry for the chronically deficient situation of primary care medicine. Although our health care system was very recently hit hard by the COVID-19 pandemic, the problems are unfortunately not new, and have in fact lasted for so long that the population has come to regard them as inevitable. . This is not the case, however: Quebecers are generally unaware of how much better access to health care can be in other countries, other provinces or other states, and how it is in fact possible to organize differently.
What a family ?
Before addressing the systemic issues, I would like to speak out against the use of the term “family physician”. What a family ? My wife and I are followed by different general practitioners and we have inquired about the possibility of having access to the same doctor. The response was: “It is not possible. “
This one anecdote illustrates the absurdity of the system, and I will only refer in the following lines to “general practitioners”.
The lack of flexibility and imagination in the search for solutions is undoubtedly part of the problem. For example, general practitioners often refer to their obligations to provide services in emergency departments to explain their availability problems. But this system is a very Quebec invention: outside Quebec, it is mainly emergency physicians who work in emergency rooms, which allows general practitioners to devote the necessary time to their patients in the office.
The next step
While it shouldn’t be too difficult for the various stakeholders to list the system’s malfunctions and the problems to be addressed, it seems particularly difficult to take the next step.
With regard to professional medical organizations, we have the unfortunate impression that they are more interested in defending their interests, privileges, monopolies and prerogatives than in finding solutions. Who can remember a plan devised by the federations of physicians to solve the organizational problems of health? We get the impression that professional medical federations are driving the change truck with both feet on the brakes.
On the government side, we may be surprised that the problem seems, for him, to be limited to reducing the registration lists. But even if all Quebecers were registered, would the problem be resolved? If we are not satisfied with the human and / or professional qualities of our doctor, how can we consider the problem to be resolved if we have no possibility of changing doctors or no “realistic” possibility of lodging a complaint with a professional body? ?
It reminds me of a system where our access to a hairdresser would be governed by a mandatory registration system. Why do we tolerate for our health what would seem unacceptable to us for a simple haircut?
Solutions abound: increased integration of specialized nurse practitioners for routine care and follow-ups; relaxation of the monopolies still exercised by physicians in the control of the auxiliary health professions; changes in the organization of health care and the way doctors are paid; development of pathways for the recognition of the skills of foreign graduates and their integration …
Media
The media could play a valuable role in this debate, by examining how things are going abroad, by asking why certain solutions whose effectiveness seems to be demonstrated are subject to resistance from various Quebec stakeholders and by asking accounts to responsible persons.