It is in this month of August 2022 that the million Quebecers still without a family doctor will see if there is finally a light flashing at the end of the tunnel. An agreement concluded last May between the Ministry of Health and general practitioners aims to ensure that by the end of March 2023, 500,000 citizens who have not drawn a lucky number on the doctor’s lottery can find out to whom to turn to in the event of a health problem.
But the waiting list does not give much sign of shedding, on the contrary. As of June 30, 2022, according to the most recent update of the dashboard on the performance of the health and social services network, 1,088,945 people had a request pending at the Guichet d’accès à un physician de famille (GAMF ), an increase of 2.24% compared to the previous month. Recent data may not have been added, in the middle of summer, but we still seem a long way from the goal. The magic hasn’t worked yet, but Quebec has promised spectacular results. As of July 31, 250,000 Quebecers languishing on the waiting list should have been registered at the new counter. The system obviously provides for the priority registration of the most vulnerable clienteles.
The proposed formula is simple in theory, as well as many previous programs whose clarity on paper has crumbled by hitting the chaos of the field. Rather than advocating the individual registration of a patient with a doctor, we imagined that a group of doctors would divide up the collective management of a group of patients. Upon registration of a group of orphan patients, a team of doctors — and not just one, always the same — agrees to see each patient at least once a year, if needed.
Everyone wants to believe it, including the Federation of General Practitioners of Quebec (FMOQ), which urges its members to understand that the reign of collective registration will miraculously solve a problem that many governments have tried to tackle. over the past decade. A pilot experiment carried out in Bas-Saint-Laurent showed that, out of a group of 100 patients registered “collectively”, and to whom each would have been promised the availability of at least one visit per year with a doctor, only 60 bothered to contact the medicine group for a service, and only 30 had the real need to see the doctor. It is by extrapolating this logic to the rest of Quebec that we think we can assign a doctor to the 400,000 vulnerable Quebecers who currently have no other recourse than the walk-in – if by miracle or luck they access it — or the urgency to find assistance for a health issue, however serious.
Citizens without a doctor who have had the urgent need to consult do not let themselves be confused by the government advertisements circulating these days and suggest that one can find a medical appointment as one calls the hairdresser for a haircut . ” Health problem ? we ask, then scrolling through a whole series of “options” (Info-Santé, “your” clinic, the walk-in clinic or the super clinic, the pharmacist), as if it were a panacea. Quebeckers lucky enough to have a family doctor of their own know that this coverage is no guarantee of quick access to said doctor, far from it: how many people languish in front of a busy line or come up against a appointment book full when, weary of the fight, they show up on the spot? No wonder countless non-emergency cases end up in the emergency room.
Even if we want to believe in this last formula, nothing indicates that it will be easy for groups of physicians to carry out the project successfully. The first line is fraying, although every effort is made to restore its luster. Fewer family physicians are enrolling in faculties of medicine, which does not bode well for countering the shortage that is already hitting hard, as 1,000 general practitioners are missing; the practice climate is so heavy and chaotic that in a recent survey conducted by the FMOQ, 47% of physicians surveyed (2,248 physicians responded, or 23% of members) said they were considering leaving the front line. More than 60% of them believe they would be ready to make the jump within five years. The situation is not rosy.
It is therefore not for nothing that Quebec and the doctors have decided to bet on group care, seeing that the doctor alone can no longer do it – if he leaves the ship, the others will be there to collect the patient. This system, if it works, completely discards the idea of individualized follow-up by the same doctor, which was nevertheless at the heart of the sacred principles of family medicine. But in a desperate situation, we fall back on the least bad in the hope of making a miracle bloom there.