The Quebec government says it has found a way to improve access to family doctors: a “first-line access window” (GAP), which has proven itself in Bas-Saint-Laurent. However, this solution, which will be presented as part of the study of Bill 11, could be implemented regardless of what parliamentarians decide.
“There are people in the Rimouski and Rivière-du-Loup region who have found solutions to triage,” said Health Minister Christian Dubé enthusiastically when he arrived at the parliamentary committee. on Bill 11 on Tuesday morning.
Inside the room, the general practitioners were waiting for him with a brick and a lantern because of the bill which aims in particular to give the State better access to their data.
But the Minister and general practitioners agree on one thing: the benefits of the pilot project developed in Bas-Saint-Laurent, the GAP.
Launched in November 2020, this counter consists of a telephone appointment line dedicated to so-called “orphan” patients. The formula is simple: on the telephone, a nurse sorts the calls and refers to the family doctors only the people who really need it. The others are referred to other professionals (nurses, psychologists, pharmacists, phytotherapists or social workers). Over the past year, only 43% of the 10,000 calls received were routed to physicians.
In the Bas-Saint-Laurent, where 15,000 people do not have a family doctor, the idea of this line germinated in the minds of doctors in the region. Excited, Minister Dubé wants to reproduce the recipe everywhere.
The project will also be the subject of a presentation on Thursday with the passage of the CISSS du Bas-Saint-Laurent to the parliamentary committee on Bill 11.
Possible without bill
However, the expansion of the GAP to all of Quebec can be done now without Bill 11. The minister himself recognized this during the discussions. “What was done in Rimouski, we don’t need a bill to do that. We just have to set it up elsewhere, ”said Christian Dubé on Tuesday.
At the Federation of General Practitioners of Quebec (FMOQ), we say we are completely in favor of this plan. “It’s an important piece of the puzzle in the context of the shortage. […] We can no longer assume all the needs of the first line, ”argues its president, Marc-André Amyot. “Only for family doctors is what requires the expertise of the family doctor: that’s our solution. »
Nearly one million Quebecers are currently waiting for a family doctor at the access counter, according to the Ministry of Health and Social Services. However, the FMOQ pleads that its some 10,000 members are not able to take care of more patients, because the network is short of 1,000 physicians.
Tuesday, the group insisted on the fact that the challenge had never been so great while the network is struggling to attract the next generation. In 2021, 76 family doctor positions were not filled in Quebec, compared to 38 in 2020 and 24 in 2019.
The minister said he was willing to increase the number of doctors, but argued that he needed data on them to justify this investment to taxpayers.
The data node
Which brings us back to the heart of the bill and the main reason for the confrontation between the government and the medical associations: access to data on doctors. The bill remains relatively vague on the nature of the data from the Régie de l’assurance maladie du Québec (RAMQ) that the Minister wishes to dispose of. The wording speaks of “information necessary for the exercise of these functions” to plan, in particular, the medical workforce, ie the number of positions for family physicians created each year by region.
In a parliamentary committee on Tuesday, medical residents argued that access to data risked, on the contrary, putting off the next generation. Resident doctors fear that they will be “imposed on practices”, even that they are moved from one region to another, explained Jessica Ruel-Laliberté, president of the Federation of Resident Physicians of Quebec (FMRQ).
Remember that the Minister of Health already has access to data on family doctors from the RAMQ. But with Bill 11, he wants to ensure that this information is also communicated to the bosses of those who manage the services locally, in the regional departments of general medicine (DRMG).
In addition, the government also wishes to have access to this data with a view to negotiations with family physicians on their remuneration. “To be able to negotiate well, you need the data, and unfortunately, with the [omnipraticiens], we do not have regional data. »
On Tuesday, the invited groups all expressed concerns about the nature and use that could be made of this information. The College of Physicians, for example, fears that physicians who have fewer registered patients will be identified and punished, without taking into account the work they can do elsewhere (at the hospital, for example). Christian Dubé said he was open to “improvements” to the section of the bill that deals with data. “We will refine as needed. »