The Minister of Health, Christian Dubé, opened the door on Wednesday to a reform of the system which distributes the positions of doctor between the different regions of Quebec. By revising the model of regional medical staffing plans (PREM), he hopes to convince the next generation to turn more to family medicine.
This is at least the message he wanted to convey to a group of students during a webinar organized on Wednesday by his ministry. “We have already listened to you to implement various changes, and we will also listen to you on the PREMs,” he said.
Shortly before, Christian Dubé had asked them if the PREMs were part of “the obstacles to accessing the practice of family medicine” and “how the PREMs could be reviewed”. The minister also wanted to know if it would be “sufficient” to “soften” them.
No less than 412 new PREMs were granted in family medicine across Quebec in 2023, including a determined number for each region: 85 for Montreal, 21 in Laval, etc. However, more and more students are shunning these positions — and family medicine in general. In the past two years, 140 of these positions have not been filled in Quebec. During this time, the number of patients waiting for a family doctor exceeded 800,000 people, or 11% of the Quebec population.
At the Federation of Resident Physicians of Quebec (FMRQ), it is confirmed that the subject of PREMs “is of great interest” to the next generation. “We think it’s part of the solution,” says its president, Jessica Ruel-Laliberté.
The FMRQ does not want the PREMs to be abolished, she says, but rather made more flexible. For example, when a new family doctor inherits a position, the state requires that he devote a few hours a week to a “special medical activity” (PMA) in a place imposed on him (at emergency, obstetrics, CHSLD, etc.).
“It can be restrictive for a person who has not planned to do follow-ups in a CHSLD in a context of practice, notes Mme Ruel-Laliberte. But at the same time, if AMPs don’t exist, how do we ensure that there are enough doctors in CHSLDs? Perhaps, she says, we could “enhance MPAs” without them being compulsory.
An irritant among others
A concern shared by the Quebec Student Medical Federation (FMEQ). The many “restrictions” affecting the practice of family medicine are largely in the disinterest of students, reports the delegate for political affairs of the association, Vanessa Bisson-Gervais. “Some of the students have the perception that they will not be able to begin their practice in Montreal and that they will have to move to the regions,” she mentions.
However, PREMs are “an irritant among others,” said the FMEQ spokesperson. Students are also “afraid of the office” and the administrative burden that comes with the job. The many articles in the media about “overworked” family physicians also contribute to demotivation, she says. About ten days ago, the daily Montreal Gazette also revealed that 47% of family medicine graduates from McGill University did not plan to practice in the Quebec public network in 2023.
The minister’s exit on PREMs comes as he prepares to table a bill on the efficiency of the health system and on the creation of a new agency outside the ministry.
In his message to students on Wednesday, Mr. Dubé said he wanted to “debureaucratize” their practice.
The Minister of Health is also not the biggest supporter of PREMs, whose terms he has not hesitated to revise in the past. The duty had revealed in October 2021 that a third of the family doctor positions granted in Montreal for the year 2022 had been transferred to the 450 regions. The Minister repeated the exercise on a smaller scale for the year 2023: the metropolis has then lost 4 of the 89 positions that were intended for him.
The PREM system was established in the early 2000s to counter the shortage of physicians in the regions. The distribution of positions is determined by a committee made up of representatives of the Ministry of Health and medical federations, which is based on various calculations to decide.