A famous campaign slogan attributed to US President Herbert Hoover in 1928 promised “A chicken in every pot, a car in every garage.” It was a promise that no government could keep.
Recently, the Premier of Quebec, François Legault, and his Minister of Health, Christian Dubé, turned away from another unrealizable promise: a family doctor for every citizen. Today we learn that the Province of Ontario is also moving towards a more realistic goal of providing family medicine care by funding more neighborhood clinics like ours.
As negotiations continue between the federal and provincial governments, it is clear that the challenge facing patients, politicians and healthcare providers is immense and complex.
According to an article published last year in the Canadian Medical Association Journal, “primary care in Canada is going through a crisis; 4.6 million people were not registered with a family doctor or frontline clinician before the COVID-19 pandemic and the situation is getting worse.”
Just talk to your family members, colleagues, friends and neighbors, many of whom don’t have a family doctor and can’t access care outside of walk-in clinics and hospital emergency services.
strength in numbers
As a family physician with 35 years of experience, I saw how desperate things had become and wanted to try something new. Our first family medicine clinic opened in downtown Montreal nearly 15 years ago, serving residents of the Notre-Dame-de-Grâce neighborhood. Since then, it has grown and, in 2015, we became a funded GMF clinic (for Family Medicine Group).
Last year, after negotiations with the Government of Quebec and the Federation of General Practitioners of Quebec, my colleagues at the MDCM-GMF clinic presented our own family physicians with the province’s new proposal for access to care.
More than half of our family physicians have agreed to take on the additional responsibility of providing frontline care to an additional 5,500 patients on the Quebec government’s family physician waiting list for the surrounding neighborhood.
The proposal was made possible by an unprecedented policy change: in the past, Quebec only allowed individual patients to be registered with individual family physicians. The new program allows groups of patients to be registered with a group of family physicians willing to offer reserved care appointments.
So far, this group registration approach is working: to date, more than 500,000 Quebecers have been able to register for clinics like ours.
How does it work? The government identifies people with the most urgent health needs and sends them a letter indicating the name and location of a neighborhood clinic, informing them that they are registered there for care.
The person then calls a central telephone number, is screened and then directed to one of the approximately 100 reserved places available each week in our clinic. Her health information is entered into an electronic records system, which ensures security, confidentiality and continuity of care.
Clinic patients also have access to on-site medical specialists as well as nurse practitioners, clinical nurses, social workers, pharmacists, and more. Services offered may include preventive health care, diagnosis and treatment of mental health issues, urgent health care, and chronic disease management.
Today, more than 30 family physicians care for more than 35,000 patients registered with our clinic. The age of our patients ranges from newborns to centenarians. The MDCM-GMF clinic is open seven days a week, 52 weeks a year, 12 hours a day on weekdays and 4 hours a day on weekends and holidays.
After months and years of using walk-in clinics or hospital emergency departments, our new patients are thrilled with the care we provide. They say, “Now that I’m registered with your clinic [GMF], I ask everyone: “Who needs a family doctor? It’s better in many ways.” »
Patients have also noticed that a visit to our clinic is different from a visit to a walk-in clinic, where appointments are shorter and usually focus on urgent care issues, with little attention. focus on preventive care, mental health or chronic disease management.
When one of our doctors retires, dies or leaves the system, a registered patient can continue to receive care at Clinique MDCM-GMF.
Physicians mobilized
So much for the patient side of this potential solution. But what about family doctors? Why are they massively leaving their practice or simply not opening a traditional family medicine practice? In Quebec alone, there are currently close to one million people waiting to be matched with a family doctor.
Why this shortage? First, fewer medical school graduates choose family medicine as their specialty. They have witnessed the growing expectations placed on poorly resourced family practices and the resulting physician burnout, and do not want to pursue this type of career.
Finally, some physicians are choosing to retire from practicing family medicine sooner than expected, in part due to burnout from the COVID-19 pandemic. In less than a year, the signs are encouraging. Many of the licensed family physicians we have approached to join our clinic have been enthusiastic about joining us.
We have also recruited some family doctors who are currently working in hospitals, emergency rooms, long-term care centers or rehabilitation institutes to earn a living. They are attracted to this new FMG model because they have the option of not having to register the patients they see for the long term.
The young doctors who have joined us can consult with each other and they can easily talk to more experienced consultants and colleagues. This is usually not the case in a walk-in clinic.
We are convinced that the FMG model (with grouped patient registration), which works so well after a relatively short period, could continue to be applied effectively and conclusively throughout Quebec and in other provinces.
I want to emphasize that this model works within the framework of Canada’s single health insurance system. The care provided in our clinic does not entail any additional costs for the patients.
We are determined to push for continued funding from the provincial and federal governments, so that we can continue to welcome new family physicians and more patients to our neighborhood FMGs.
We were told that in 2024-2025, the Quebec government could introduce other changes affecting the FMG model. We hope that elected officials have noticed our progress and that they will move closer to this neighborhood clinic model rather than extending funding to walk-in consultations.
Patients, families, doctors and others in the health care system have called for change, vigor and innovation to solve the enormous problems we face. That’s what we do, and it works. I have to hope that our partners in government will continue to prioritize what works and limit what doesn’t.