The Minister of Health, Christian Dubé, and general practitioners are dancing a last-chance tango to save the GAP (First Line Access Counter), one of the health system’s greatest recent successes, from disaster. If the medical appointments made possible by this collective care were reduced drastically, as we now foresee with dismay, it would be a return to square one for thousands of orphaned patients again.
Mr. Dubé seems to be a fan of reasoned negotiation. He does not have the vociferous profile of some of his predecessors, who played threats with groups of doctors to try to achieve their ends — without much success. The Minister of Health would like to save the GAP from disaster, but to do this, he must come to an agreement with family doctors. The disagreement concerns, among other things, the end, on May 31, of the agreement on accessibility, which since 2022 has allowed the registration of some 940,000 patients in a collective care system. Rather than associating a doctor with a patient, we associate a patient with a group of doctors. On paper, this system is fabulous ingenuity.
In fact, it works thanks to a premium of $120 per patient, negotiated at the time of signing the agreement. This was to stop being paid on May 31, 2024. The two parties are currently discussing a way to extend the agreement, but already, clinics have announced that they will stop collective care, which has reduced the available appointment slots between now and June 15. This is a real aberration, which once again contributes to vulnerable patients being trapped between the interests of doctors and the wishes of the government.
The exasperation is not only due to the fact that this announced slip-up could not be avoided, especially when we know that it concerns the vital issue of access to family doctors for the population. Many health ministers before Christian Dubé have committed to resolving it. The advent of GAP, a system to be perfected, finally made it possible to believe in it. To ax it in the name of the legendary inabilities of doctors and the government to get along is purely insane.
In the contemporary history of Quebec, standoffs between doctors’ federations and the government in place are legion. Former Minister of Health and Social Services François Legault found himself imposing a special law in 2002 to force the work of doctors in crisis emergencies. Having reached the end of his negotiating efforts to stem a serious problem in hospital emergency rooms, he had to resort to threats and force. In the negotiations that followed between general practitioners and the Quebec government, several of the same elements often found themselves weighing in the balance: salary catch-up compared to other provinces, the number of hours worked by doctors and their accessibility for orphan patients. Almost always, the negotiations ended in increases – often excessive – attached with bonuses and special agreements. Among the population, impatient to see these salary increases improve their lot, we have often felt irritation with these king doctors.
Fortunately, unconditional increases are no longer popular. In exchange for the extension of the agreement on accessibility, Minister Dubé must receive a firm commitment that the high-priced appointments will indeed serve their original purpose. Family doctors argue that this is the case, but they are ready to improve functioning where there are flaws.
This does not bode well for the “real” negotiations which are beginning between the Federation of General Practitioners of Quebec and Quebec, on the conditions of remuneration. Doctors’ past earnings at the table helped to build an image of them as financially demanding clients, to the point where sometimes it bordered on indecency. On the ground, more and more frequent echoes come from doctors disillusioned and sickened by the crisis shaking the health network, who say they are working tirelessly for a system that is biting its tail. These grievances should not leave anyone indifferent. Not only is family medicine less and less popular in medical schools, but more and more young doctors are leaving or thinking about doing so. We do not need an exodus to worsen an already glaring shortage.
The challenges for the Minister of Health are therefore immense. After putting his fist on the table at the general council of the Coalition Avenir Québec, he now commits to “not being intransigent” with doctors. Although it makes perfect sense that he wants to ensure that family doctors fulfill their commitments, he must also take into account a population of doctors who, clearly, no longer have the heart for reforms and major changes. . On this thin wire, the balancing minister must move forward while ensuring that the population gains.