Family physician retirements are accelerating in Quebec. Some 275 general practitioners caring for patients reported to the Régie de l’assurance maladie du Québec in 2021 that they were leaving the practice or would do so within two years. A number almost twice as high as in 2017, according to data obtained by The duty with the RAMQ.
“The phenomenon will worsen in the coming years, estimates the Dr Marc-André Amyot, president of the Federation of General Practitioners of Quebec (FMOQ). 25% of family physicians are over 60 years old. »
According to the RAMQ, the general practitioners of Montreal who announced in 2021 an immediate or imminent retirement are on average 68 years old. The average age is 65 in the Capitale-Nationale and in Montérégie. It is 62 years old in Estrie.
These upcoming departures are boosting the number of people registered with the counter for access to a family doctor (GAMF). Of the approximately 990,000 Quebecers who are listed, more than 136,000 are there because their general practitioner will be retiring in the next 24 months. Until then, they remain followed by their doctor.
Gaëlle Lebreton, she lost hers. She learned by chance that her family doctor was stepping down at the end of December. “My partner had a date with her and he heard the two secretaries talking about her retirement in a month,” she says.
The 41-year-old Montrealer, registered with the GAMF, recently had a taste of her new reality as an orphan patient. Getting a Pap test was “complicated”. “I had to find an appointment [médical] in a “walk-in” just to get the paper [la requête] to see a gynecologist, because the doctor didn’t do the Pap test,” she says.
Hélène Rochette fears that her 95-year-old mother – registered with the GAMF since September – will suffer the same fate. “She doesn’t move easily,” she says. Often, her family doctor would consult her over the phone to avoid having to go there. »
Hélène Rochette believes that the front-line access window (GAP), a measure intended for orphan patients at the heart of Minister Christian Dubé’s health reform, is not suitable for elderly people like her mother, who have files “thick” medical products. “They can’t be ‘barouetted’ from one professional to another,” thinks this Quebec citizen. They must, she believes, be taken care of by a doctor.
Lack of succession
Bridging retirements is far from simple. According to the FMOQ, there is already a shortage of 1,000 general practitioners in Quebec. A figure that the Ministry of Health and Social Services (MSSS) does not claim to be able to confirm.
“There are indeed several earlier retirements currently among doctors, writes the MSSS in an email. However, it is difficult to quantify the “missing number of doctors”, because a doctor does not necessarily work full time. Their level of activity varies throughout their career. »
The MSSS points out that medical admissions are on the rise (969 in 2022-2023, compared to 915 in 2021-2022). Minister Dubé’s reform also plans to promote family medicine to convince young people to adopt the profession.
Graduates in medicine shun family medicine. “Last year, 75 residency positions in family medicine were not filled,” recalls Dr.r Amyot. Since 2013, 400 positions have not been filled. »
To meet the needs of orphan patients, the Association of General Practitioners of Montreal (AMOM) believes that the number of positions for new doctors in the city must be increased. About one-third of Montreal family physicians are over 60 years old.
The vice-president of AMOM, the DD Odile Kowalski, denounces the “interference” of the Minister of Health, Christian Dubé, who intervened last summer to reduce the number of positions in Montreal – reducing them from 102 to 72 – in favor of 450.
His clinic suffered the consequences of these changes to the regional medical staffing plans (PREM). Two doctors from his GMF have retired and a third has moved to another region as a “pre-retirement”. “But I had no recruits, said the DD Kowalsky. There has been a reduction in positions in my RLS [réseau local de services]. Last year, there were nine PREMs, this year there were four. Candidates who wished to practice in his clinic did not obtain one of these places.
Nil Lefrançois, 75, left the practice of family medicine on January 2. He followed 3,000 patients at the Beauport Medical Center, a neighborhood clinic he founded in 1977. He was unable to transfer his clientele to a colleague, apart from “a few very heavy patients”.
His “small GMF” is struggling to recruit doctors. On-call shifts occur more often in a clinic with few general practitioners. He recalls that a FMG must respect the obligations imposed by the MSSS, such as “being open 68 or 72 hours a week, going without an appointment from 8 a.m. to 8 p.m. and working weekends”. “When there are 25 or 30 doctors, your turn comes much slower,” he says. According to him, superclinics appear more attractive than small medical centers for this reason.
Nil Lefrançois indicates that the PREMs have also thwarted the Beauport Medical Center’s hiring plans in the past. He pleaded his case with Quebec and obtained a waiver from the PREM in 2019, so that a doctor would join his team.