In Quebec, we pay very dearly for a universal health system. But access to care is so bad that it sometimes seems like a denial of service.
Waiting for years for a family doctor, patients find themselves in a critical situation.
Is it normal for a 61-year-old woman to wonder if the advanced ovarian cancer she was diagnosed with after an emergency room visit could have been treated sooner if she had had a family doctor?
Is it normal for a young student struggling with serious mental health issues to be referred by her CLSC to a private psychiatrist who charges more than $1,000 just for the first consultation?
No ! These very real cases are blatant proof that our health system does not fulfill its promises.
Last Tuesday, Liberal MP André Fortin demonstrated, in full parliamentary committee, the impossibility for a simple citizen to obtain an appointment using the mechanisms developed by the Coalition Avenir Québec (CAQ).
By appointment Santé Québec? He couldn’t find any available places. With the First Line Access Counter (GAP)? Nothing neither. And on Clic Santé? Patients are often referred to the private sector.
Christian Dubé was forced to admit that “it happens regularly1 “.
But in wanting to defeat the Minister of Health, the Liberal MP found himself making a pass at the palette of Christian Dubé who is leading heated negotiations with the Federation of General Practitioners of Quebec (FMOQ) about the failures of the GAP.
Established two years ago, the GAP allowed more than 900,000 Quebecers to have access to a group of family doctors (GMF).
With this great innovation, the CAQ scrapped its unrealistic promise to offer a family doctor to all Quebecers, by instead offering them care from a multidisciplinary group. Perfect ! Many health issues can be resolved by another professional to allow doctors to concentrate on value-added tasks.
As part of the agreement with the FMOQ, Quebec agreed to pay the GMF $120 per year per registered patient, in addition to the usual remuneration of doctors. This agreement was to be the first step towards a broader reform of physician remuneration.
Instead of fee-for-service payment which is horribly complex, it would be simpler to rely on “capitation” as in Ontario, that is to say remuneration based on the number of patients treated.2.
But the government still needs to be able to ensure that doctors actually provide services, without cutting corners. And this is where it sticks.
In the government, it is estimated that half of the patients registered in GMFs thanks to the GAP have not seen a doctor for two years. The number of consultations remained stable in Quebec, at around 1.5 million per month.
The question arises: are we getting what we pay for? We’re talking about 100 million per year.
Outraged, the general practitioners’ union replied that the agreement was respected. That patients were seen by nurses and other experts hired by the GMF. And that they will be forced to lay them off if the minister stops the funding on May 31, as he announced.
“If the minister turns off the switch, it could be dark,” says the president of the FMOQ, Dr Marc-André Amyot.
The fact remains that the government is right to demand results. The Auditor General has shown on several occasions in the past that the government had offered bonuses to doctors to encourage them to follow more patients, without obtaining the expected results.
To avoid repeating this bad film, Minister Christian Dubé passed, to the great dismay of the FMOQ, Bill 11 which will soon give it the data to measure the results.
Until then, the standoff continues.
But beyond this war on remuneration, the minister is fighting against an implacable enemy: demography.
The actions it puts in place, however useful they may be, will perhaps not lead to a significant improvement because the aging of the population increases the task of doctors who are, moreover, more and more numerous to take their retirement… and to go to the private sector.
Moreover, last year, the number of family doctors in the public network decreased, for the first time in more than 20 years, despite the increase in registrations in medical schools.
It is therefore urgent to find solutions to enable family doctors to face the gray tsunami. Here are three:
- Reduce the paperwork that eats up a quarter of their schedule.
- Use telemedicine more: so many minor issues can be resolved over the phone and by email, which would be more productive for everyone.
- Leverage other professionals, such as specialized nurse practitioners (IPS) who will be able to take care of front-line patients… which makes the FMOQ cringe, because doctors will lose their supervision bonus.
If we want to move forward, we must leave corporatism in the locker room.
1. Read “The PLQ embarrasses Christian Dubé”
2. Read “Let’s pay doctors differently”