If 90.7% of Quebecers are known to have access to a family doctor, as the official portrait tells us, how is it that seeing this doctor in the flesh remains an obstacle course? It’s a question that puzzles citizens and haunts politicians. They are trying — with challenges and difficulties — to resolve this incessant problem. As the government prepares to negotiate with family doctors their remuneration and conditions of practice, the specter of real accessibility to a doctor will once again fill the discussions. Negotiation after negotiation, this question of access is linked to that of the complex remuneration of doctors, which will have to be resolved one day.
Liberal MP André Fortin, opposition critic on health, managed a moment of grace a week ago during the study of the Ministry of Health’s appropriations. Literally putting himself in the shoes of a patient looking for an appointment with his family doctor, he demonstrated live, in front of the Minister of Health, Christian Dubé, that his three attempts ended in a failure. On the Rendez-vous santé Québec access platform, on the GAP (first line access counter) and on the Clic Santé portal, he was told that, unfortunately, no appointment could be made for him. assigned.
With elegance, Minister Dubé immediately conceded that he had just witnessed one of the “biggest challenges” of the Quebec health system. A facade efficiency, therefore, as evidenced by the figures to which the Coalition Avenir Québec (CAQ) relies?
The Press unveiled its most recent emergency ranking on Monday, which reveals that, despite improvements here and there, the overall portrait of waiting and accessibility in Quebec’s emergencies has darkened since the last compilation carried out before the pandemic. This is where citizens who have encountered a lack of services three times rather than once, like MP André Fortin, end up: in the emergency room.
Under the “Access to the first line” tab, the dashboard following the evolution of the performance of the health and social services network nevertheless reveals a system which, apparently, presents good performance, on the side of the accessibility to a family doctor. Officially, 90.7% of the Quebec population has access to a front-line service, either by a family doctor or by a group of doctors, according to the collective access formula negotiated in 2022. This is the famous GAP , which we can say is an absolute success, because it has made it possible to considerably reduce the number of orphan patients. In reality, however, we have clearly seen that the figures do not tell the whole story and hide a persistent problem of access to said doctors. Just because you have been assigned one of these rare gems does not mean you will be able to easily see it.
Officially, 913,951 patients are registered with the GAP. And Minister Christian Dubé wants to understand how many appointments were made available for them, because there was to be, according to the letter of agreement, one appointment per patient per year.
According to information revealed in the media, half of these appointments were not given – something with which the general practitioners’ union does not agree. However, this would partly explain the gap that exists between theory and the field. The Minister of Health will need the upcoming implementation of a regulation to have access to the answer, because, at the moment, he says he is not able to obtain these figures. It remains absurd that ministries as important as Education and Health remain in the dark regarding data so crucial to their reforms.
Like all games between Quebec and doctors, this one promises to be tough. Minister Dubé has already sent a powerful message of dissatisfaction and doubt by returning the issue of phantom appointments to doctors. They are protesting the abrupt end of a $120 bonus linked to the collective management of GAP, because they believe that staff essential to the success of the first line will have to be let go without this bonus.
And the sick citizen in all this? We cannot suspect anyone of bad faith when dealing with sick patients, but, despite all the colossal efforts made by the CAQ in providing access to the first line, the recurring embarrassment of dysfunctional fee-for-service in our health system will have to be weighed with courage. The Ontario model of patient staffing, which pays the doctor based on his total patient care, deserves scrutiny.
The negotiation that is beginning must be done on the basis of as accurate a factual portrait as possible, reflecting not only the demographic reality of Quebec, but also the requirements of contemporary doctors, who do not all offer work availability. stretching over five days of the week. Let’s hope that patients will be big winners.