The Legault government is due to table a bill on Thursday “aimed at increasing the supply of primary care services by general practitioners and improving the management of this supply”. The Federation of General Practitioners of Quebec (FMOQ) says it is “disappointed” and finds “incomprehensible” the approach adopted by Quebec.
Questioned on the subject of the bill in the corridors of parliament, the Minister of Health and Social Services, Christian Dubé, simply replied: “All I can say is that it will be a problem. hand extended to doctors. It is therefore impossible to know if a quota of 1000 patients will be imposed on each doctor or if coercive measures are planned.
The FMOQ claims to ignore everything about the content of this bill. She says she learned about it late Tuesday night. “If it is an outstretched hand, I unfortunately ask myself the question why already for three weeks, it is radio silence [de la part de Québec], says its president, the Dr Louis Godin. If we really wanted to reach out to each other so much, why didn’t we discuss [avec nous] for three weeks and that we have not started to work? According to the FMOQ, the “last formal meeting” with the government dates from October 20.
The Dr Louis Godin fears “that it is above all a bill of coercion, obligations or threats if we do not come to an agreement” with the government. “We have already expressed it, if it goes through coercion, it will have very negative effects on the ground,” he says. It will bring chaos, a demotivation. “Exhausted doctors have already announced their intention to reduce their care.
Impatience Explained
In Quebec, more than 800,000 people still do not have a family doctor. However, 15% of general practitioners in Quebec working full time in an office take care of less than 500 patients, according to data obtained by The duty.
For several months, Prime Minister François Legault has criticized family doctors for not doing enough in terms of patient care. In his inaugural parliamentary session address on October 19, he reiterated his impatience with them. “I have always thought that it was better to come to an understanding with the doctors, but, if necessary, we will not hesitate to impose a conclusion, because Quebecers expect to be taken care of then to to have front-line services within a reasonable time, ”he said at the time.
At a press briefing the next day, the Prime Minister clarified that this “conclusion” could take the form of a bill. He also reported that he had “figures from the RAMQ, doctor by doctor” indicating the number of patients registered for each. A list that François Legault wanted to send to the CIUSSS and CISSSS, if the law allowed it. The FMOQ denounced the maneuver.
The tone then lowered. Last week, the Minister of Health and Social Services, Christian Dubé, signaled that he would no longer comment on the family physicians’ file in the coming weeks, so that the parties have “a very positive and constructive discussion” . He specified that the list brandished by his government was “denominated”, that is to say that no name or practice number of general practitioner appears.
“I have the impression of hearing two speeches,” said the Dr Louis Godin. […] Us, it makes us think of what we lived with Gaétan Barrette and we see what it gave. It just gave way to family medicine. “
The arm wrestling method
According to François Béland, professor at the School of Public Health at the University of Montreal and expert in the management and evaluation of health policies, neither the population nor the government would emerge a winner from a standoff with general practitioners in the current context of a health system under pressure.
“Historically, when reforms or bills affecting doctors were made in the form of a coup, it hardly worked,” he explains. We don’t know what this new bill will do, but when we have to resort to sticks, usually there is a carrot that follows. “
In Quebec, apart from when the Quebec health insurance plan was created, to which general practitioners ended up joining after a long battle, most of the important and lasting changes were made following long negotiations, recalls François. Béland.
“What we can hope for from this bill is that the government will continue on this quiet path, since doctors and their unions are more and more open to other forms of care and types of payment, ”he thinks.
Even the liberal leader, Dominique Anglade, believes that the hard method once advocated by her party is no longer the right one. Prime Minister François Legault recently praised the merits of former health minister Gaétan Barrette’s Bill 20, which sought to impose financial penalties on doctors who did not meet the government’s productivity targets.
“These provisions [du projet de loi 20] were in a context where there was no pandemic at all, where there were no waiting lists that we know, it is a context that was very different. And that is why we will have to take a different approach to find a solution, ”Dominique Anglade said on Wednesday, specifying that it was now a position of the liberal caucus.
With Isabelle Paré and Marie-Michèle Sioui