It’s time to reinvest in family physician practices

Everyone agrees on the importance of a strong medical front line. However, the current financing of the offices and the medical part of the CLSCs represents only 3% of the health budget. Investments in second and third line medical services will remain ineffective until the first line, the base of the pyramid, is solidified.

Francois-Pierre Gladu
Doctor

However, budgetary choices do not explain everything. We cannot understand the difficulty of accessing the services of a family doctor in Quebec without reviewing all the management errors made by governments, all parties combined, over the past 30 years:

• decrease in the number of physicians in private practice and obligation to work in a hospital for the first 10 years of practice or specific medical activities (Liberal Party of Quebec, 1992);
• chronic overcrowding of emergency rooms following the excessive reduction in hospital capacity (Rochon reform, Parti Québécois, 1995);
• retirement of thousands of nurses and doctors (Parti Québécois 1996-2000);
• decrease in the number of physicians in practices and specific medical activities extended to the first 20 years of practice (Parti québécois, François Legault, 2002);
• exodus of young family physicians from outside Quebec and into the private sector (regional medical staffing plans, Liberal Party of Quebec, 2003);
• quasi-nationalization of medical practices with nurses on loan from hospitals (family medicine groups, Quebec Liberal Party, 2005);
• excessive centralization of network management and departure of hospital nurses to private agencies or to retirement (Bill 10, Liberal Party of Quebec, 2015);
• political harassment and devaluation of family physicians that caused hundreds of premature retirements (Bill 20, Liberal Party of Quebec, 2015);
• repatriation of nurses from FMGs to compensate for staff management problems in hospitals (Coalition avenir Québec, 2020-2022);
• maintenance and amplification of all these management errors (Bill 11, Coalition avenir Québec, 2021-2022).

As a result, Quebec has seen 467 post-doctoral positions in family medicine unfilled since 2013, to which we must add 400 family doctors who have left for the private sector, and the growing number of doctors who have fled the practice for the hospital, occupational medicine or a medical consultant position (federal, Hydro-Québec, etc.).

Without forgetting all those who left outside Quebec because, not surprisingly except perhaps for the senior officials of the Ministry of Health, no other province has followed Quebec in these bureaucratic excesses.

That’s why there are now one million people looking for a family doctor, despite the record number of registered citizens per family doctor.

The lifting of all the bureaucratic constraints that stifle family medicine is urgent, but more will have to be done to make it once again a prized career for the next generation.

The management of a patient involves a longitudinal follow-up by his doctor. This is the essence of the well-studied added value of family medicine, but also the source of the heaviness of the work for a doctor who is not adequately surrounded.

As the population ages, the era of the family doctor who takes care of everything is over. Other workers are better placed to complete administrative forms, integrate the investigations prescribed by other specialists into the file, keep the file summary up to date, take vital signs and body measurements, manage prevention and screening examinations, and treating several minor ailments (URTI, nail fungus, constipation and other functional conditions, insomnia, labor disputes, etc.) within the team serving the patient in the medical office.

To permanently reverse the disaffection of office practice, we must refocus the action of the family physician on the diagnosis and treatment of illnesses. This can only be achieved by encouraging the creation of stable teams of professionals employed by family medicine practices, like radiology practices and pharmacies. The GMF model has clearly demonstrated its limitations.

Will politicians support the necessary reinvestment in family doctor’s offices or will they lock themselves into a logic of sterile confrontation that serves the public network?