The model of family medicine groups (GMF), created 20 years ago to improve the first line and relieve emergency room congestion, not only failed to solve these problems, but it encouraged the emergence of private companies holding ” private super-FMGs”, 25% of which have no doctor on their board of directors.
At least that is what a study conducted by the Institute for Socio-economic Research and Information (IRIS) concludes, which associates the path traveled since the creation of FMGs in 2002 with an economic and medical failure, given the objectives departure.
According to researcher and author Anne Plourde, “the FMGs have been unable to ensure better access to the first line and they have not succeeded in relieving emergency room congestion either.”
According to information obtained by IRIS through the Access to Information Act in February 2022, when FMGs had to unclog emergency rooms — by opening a minimum of 68 hours a week — it appears that a GMF sur six has entered into an agreement with an emergency service in its region so that it covers part of its opening hours. Especially during evenings and weekends.
Nearly half of the super-GMF-Rs (GMFs with a network designation), provided with additional funding from the Ministry of Health, transfer part of their opening hours to emergencies as part of agreements signed with them, argues the researcher.
In addition, the real increase in the number of patients treated by FMGs since 2014-2015 would have been only 2%, according to RAMQ data obtained by the researcher.
“Since 2017, half of the super-GMF-Rs have not met the criterion of the number of unregistered patients to be treated, therefore do not meet the criteria required to obtain their funding”, underlines the researcher, recalling that the Auditor General of Quebec had already pointed out these failings.
The ratio of patients taken care of would have increased from 827 to 848 patients per doctor in five years, below the target of 1,000 patients set by the Ministry of Health. And this, despite the 340 million invested in public financial and professional resources in FMGs by the MSSS, in 2020-2021, so that they can accomplish their mission.
“The increase in the number of patients followed in FMGs is essentially due to the fact that more and more physicians have joined FMGs over the years and that their clientele has followed. This 2% does not constitute a big real improvement in the number of patients treated, ”says Ms.me Plunder.
The number of physicians practicing in FMGs has increased from 4,316 in 2014-2015 to 6,364 in 2020-2021, activities for which they receive a 35% bonus remuneration from the RAMQ to cover office costs. In fees alone, the bill associated with FMGs paid by the RAMQ now reaches $600 million, according to IRIS.
A logic of profit
Moreover, the IRIS study affirms that the emergence of private GMFs and super-clinics (GMF-R) has fostered the growth of a new business model, with several of these GMFs now being owned by holding companies or even shell companies, which allows optimization of their taxation and the payment of lower taxes on some of their dividends.
“This favors the development of a “medicine inc.” where FMGs are increasingly taking the form of profit-oriented businesses. There are even companies like Telus among the owners of some super-GMF-Rs. A quarter no longer even have doctors who sit on their board of directors, ”notes Anne Plourde. And this, despite the existence of a regulation that imposes the presence of doctors among the managers of medical practices incorporated, she says, which the new models of ownership of several FMGs seem to escape.
This situation contributes to the opacity surrounding the use of public funds by these companies, whose financial statements do not have to be made public, deplores the IRIS research. “That’s a problem,” she adds. There is clearly a problem of transparency on the part of these companies, especially since this model is far from proven. The latter considers that the management of FMGs should instead be entrusted to non-profit organizations.