Often cited as an example in the fight against medical deserts, Quebec also suffers from the phenomenon despite the regulation of the installation of doctors, put in place some twenty years ago.
Should young doctors be forced to settle in medical deserts? The question will be discussed again in France: the bill of the deputy Horizons of Seine-et-Marne, Frédéric Valletoux, on the subject is examined from Monday, June 12 in the National Assembly.
>> “That’s not what we’re asking”: GPs stand up against the bill to fight against medical deserts
In Quebec, regularly cited as an example in the fight against medical deserts, the regulation of the installation of doctors has existed for about twenty years. While the measure worked well at first, it did not last and many regions are once again facing a shortage of doctors, such as in Abitibi-Témiscamingue, more than seven hours by road north of major cities like Montreal. and Quebec.
“The imagination is very strong to say that it is a place where there are mosquitoes, forest and not much else”, launches Dr. Chantal Charbonneau, to describe this unknown and not very popular region. However, it is here that she landed as a young doctor after the government set up a system of quotas by region for new doctors in the 2000s. If the quota is exceeded, generally in Quebec and Montreal , and they still wish to practice there, they expose themselves to financial penalties, by being “paid at 70%”, says the doctor.
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“Happiness !”
To this must be added 15,000 dollars in installation bonuses and 10,000 dollars per year for young doctors who leave far from the big cities. A windfall that prompted Marylène Lessard to leave Quebec to become a doctor in Abitibi-Témiscamingue. “It’s not negligible! We’re leaving university, we’re a little in debt. I had to organize myself to pay for my accommodation and my studies, so I still had a certain amount of debt, she justifies. So it’s interesting to go to a remote area. That’s how we ended up in Abitibi-Témiscamingue even if it was really very far”, jokes the one who today does not regret her choice at all. “If I weren’t happy here, I would have gone back. Everything is next door, we have access to a large grocery store. There is no fishmonger’s with very fresh things, but if we want fish, we go go fishing. It’s not salmon, but trout. That’s what makes you happy!”
This is how, in the early 2000s, Quebec succeeded in distributing physicians throughout its territory. The number of GPs in medical deserts, for example, has doubled. This operation, prohibiting doctors from settling in areas where there are already enough practitioners, is precisely what 200 French deputies are demanding today.
A fleeting success
But the effect did not last and to realize it, it suffices to ask the inhabitants of Abitibi-Témiscamingue today what the situation is. “The lack of doctors is there. There are also people who lose their family doctors because the doctors who retire are not replaced”, says a young resident. “We have fewer doctors who want to come”, concedes a resident while another woman adds that her brother “has no doctor”.
He is not the only one: 10% of Quebecers do not have a doctor, as in France. This quota, penalty and financial incentive system no longer works. “Quotas are not filled, 1 is missing 500 family physicians”, says Dr. Jean-Yves Boutet, representing doctors in the Abitibi-Témiscamingue region, for whom the phenomenon also affects large cities.
“We are really experiencing the baby-boomer effect because at the time of retirement, we have a lot of orphan patients, without a doctor. We underestimated this effect and there, we find ourselves in a difficult situation.”
Dr. Jean-Yves Boutetat franceinfo
Seduction operations
As in France, Quebec has not trained enough doctors. Many regions are developing “La grande séduction” programs, in reference to this 2003 Quebec comedy, in which a village tried by all means to convince a doctor to stay. In Abitibi, today, the red carpet is being rolled out for future doctors like Isabelle Godbout, who is taking part in a one-month all-expenses-paid observation internship to discover the region’s hospitals. “The internship is to discover the region, to know what practice is in remote regions, but it is also to discover each specialty. I saw orthopedics, endocrinology, almost the set of specialties that are possible”, she details.
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This internship allows the discovery of the hospital but also of the region, says Dr Marie-Pier Nolet, who coordinates these internships. Kayaking, visits to gold mines and even a festival of Native American tribes are on the program, with “traditional songs and dances with costumes” or “food kiosks where you can eat beaver and wild meats”.
In summary, in Quebec, the quotas and financial penalties to dissuade young doctors from settling in the city, where there are already many of them, have worked. But this is no longer effective because, as in France, there are not enough trained doctors. Today, as in France, almost the whole territory has become a medical desert.