The Minister of Health and Social Services, Christian Dubé, has just signed a new agreement in principle with the Fédération des médecins omnipraticiens du Québec (FMOQ) aimed primarily at taking charge, by March 31, 2023, of 500,000 Quebecers who do not have a family doctor, a little more than half of the people languishing on the list of the Window for access to a family doctor (GAMF).
By his own admission, Christian Dubé is not a follower of the stick, and he is once again wielding the carrot, that is to say by offering financial incentives and relying on the voluntary participation of doctors , that he intends to achieve his objectives.
If we asked those who are skeptical to stand up, there wouldn’t be many people sitting down. The last attempt of its kind, the result of an agreement reached in June 2019 under the aegis of Danielle McCann, ended in failure. The number of Quebecers looking for a family doctor has only increased since then.
The 500,000 lucky ones are among the most vulnerable. In addition, the agreement provides that the 7 million Quebecers registered in a Family Medicine Group (FMG) or a clinic will be able to see a doctor in a timely manner if they request it.
As for those who do not have a doctor, they will be able to register with the first-line access window (GAP) and obtain services through a health professional other than a doctor in a first time. It should be noted that, if the minister’s plan works, people who still do not have a family doctor will generally be younger and will not suffer from a chronic illness.
Why would Christian Dubé succeed where his predecessors broke their teeth? That’s the question, but we’ll get to it soon. The Minister argues that he is adopting a new approach based on improving the conditions of practice thanks to a better organization based on interdisciplinarity.
Finish the ” bashing doctors for Christian Dubé. The CAQ government will stop accusing certain doctors of not working enough, as François Legault did no later than last fall. The Minister accepts that young doctors, often women, take on fewer patients than older doctors and that they value work-family balance. For its part, the FMOQ, represented by a new president, Dr.r Marc-André Amyot is opening up to interdisciplinarity: more of the acts that doctors reserved for themselves will be taken on by other health professionals, in particular specialized nurse practitioners. In doing so, the FMOQ will be less able to justify its inaction by the lack of physicians, an easy excuse repeated ad nauseam.
With this agreement, the Minister is pursuing his ambition to change the nature of care. It will be the work of the entire GMF team, not that of a single doctor. Support for people who lose their doctor because he is retiring will be provided by the GMF.
This new organization depends on an exhaustive collection of information on the activity and practices of each of the physicians, of each of the FMGs, in each of the regions of Quebec. The Minister presented two bills concerning data collection, Bill 19 and especially Bill 11, which directly affects general practitioners and which must be adopted very soon by elected officials. “What can be measured can be improved,” says Christian Dubé.
To implement the agreement, the minister has several hundred million at his disposal, an amount that has not been spent from the total compensation envelope that falls to the FMOQ. The agreement in principle, which includes “no penalty or obligation”, specifies the FMOQ in a document sent to its members, will be submitted to them for approval before the end of May. According to the Dr Amyot, the agreement will certainly improve access to care, but it will also allow family doctors “to evolve in a stimulating work environment, less burdensome and where everything will no longer rest solely on their shoulders”.
However, the FMOQ is still fiercely opposed to Bill 11: it fears that the collection of data will lead to the application of coercive measures. However, it is normal and essential that the paying State, which pays 3 billion per year to general practitioners whose average remuneration is some $300,000 per head of pipe annually, can know what they are doing at work. That’s the lesser of it. After all, it is a question of ensuring that the population has full access to the care for which it pays dearly and to which it is entitled.