I have 852 patients registered, and on my work schedule at the GMF clinic, I am not there full time. On paper, I’m one of those doctors who don’t do enough, and yet …
My week is divided into a 24-hour obstetrics call, a walk-in clinic, a social pediatrics center and pregnancy monitoring. All of these tasks lead me to see patients who are not listed in my name. In addition, clerical tasks have multiplied in recent years and are often done the day after a night on call, at noon or late in the evening. Being head of department, I have a wide range of administrative tasks to perform and I teach doctors in training.
After all these tasks, I have on average two half-days a week to see my 852 registered patients, many of whom have serious physical or mental health problems. I just can’t do it. I don’t even count the number of working hours per week anymore, but I know that the number of hours spent seeing patients registered in my name only counts for a tiny part of my job. And the reality is, like my colleagues, I’m not just a doctor.
The government’s comments
I also have a personal life, a husband who works full time and three young children, some of whom have special needs. And my story is no exception to those of my medical colleagues. Do all my colleagues work as hard? No. But those who actually work part-time are a minority. In all professions, there are people who, for personal or family reasons, cannot have a full-time job. It is a preferable solution to a work stoppage.
Do the government’s recent comments make us want to cry or even quit? Certainly ! Does that mean that we don’t care about the fate of the hundreds of thousands of Quebecers without family doctors, absolutely not!
Access to a family doctor is also one of the issues most discussed in our administrative meetings at all levels. Several local initiatives have been tried or are currently being considered to improve access. The observation is that it is simplistic to think that registering patients with a family doctor is the one and only solution. Enrollment without access to an overburdened physician does not result in acceptable care. The situation is much more complex than that and is based on system failures and not on the work of family physicians alone.
Quebec family physicians perform a large proportion of their tasks in hospitals or in the second line, which skews comparisons with other systems.
Fortunately, several laws in recent years have broadened the skills of certain professionals and the reform of the remuneration of family physicians based on capitation would certainly encourage multidisciplinarity.
On the other hand, the labor shortage situation, where we find it difficult to fill the positions of social workers, nurses and other professionals in the current network, is a brake on this multidisciplinary work.
Perhaps we should again question the central role of the Quebec family doctor, who is becoming the bottleneck for many services that are not health care.
For example, employers and insurers frequently request forms that are medically not required for short sick leave, certificates of fitness, eligibility for insurance or for reimbursement of expenses. Government forms for tax credits for the disabled, the Régie des rentes, Emploi Québec, parking stickers, CNESST and SAAQ are also a heavy administrative task and should often not require the expertise of a doctor. To see a medical specialist or other public professional, the patient must absolutely consult his family doctor, who must make the request.
Worse yet, to see this professional specialist again after a certain time, the patient must see their family doctor again to reapply.
The services of optometry, physiotherapy, speech therapy, podiatry, dentistry and others are unfortunately for the most part private, and patients often go to see the family doctor who is free for a problem that would be the responsibility of one of these professionals.
It is clear that there is a problem of accessibility to family doctors in Quebec, and the dissatisfaction of Quebecers with their health care is legitimate. On the other hand, reducing this problem to issues of remuneration or to a fixed number of registrations seems to us disconnected from the reality on the ground.
There are other possible solutions, such as simplifying the practice of family physicians so that they can focus on what they are trained to do and listen to local initiatives that best meet the needs of each region. .
This would not only increase access to care for Quebeckers, but would encourage physician buy-in and help curb their exodus to other specialties. Faced with the complexity of this issue, the different actors have much more to gain by adopting a position of listening and collaboration and, please, do not rely on simple statistics on paper.