The Quebec government is considering the possibility of changing how family doctors are assigned based on Quebecers’ health to ensure that the most vulnerable have access.
Sources who are aware of the discussions told Radio-Canada about a scenario that has been studied for several months.
According to this scenario, Quebec patients in good health or with minor health problems would be referred to a modified Guichet d’accès à la première ligne (GAP), the service that is currently meant to give Quebecers without a family doctor access to medical appointments.
This GAP would include all Quebec patients with no major or moderate health issues, including those who currently have a family doctor.
Only patients deemed more vulnerable, such as those with complex or chronic conditions such as cancer, mental health issues, cardiovascular disease or diabetes, would be assigned a family doctor.
A report by the Institut national d’excellence en santé et en services sociaux (INESSS), commissioned by the government and made public on Wednesday morning, lays the foundations for such a model.
This INESSS report indicates that 500,000 sick Quebecers do not have a family doctor, and suggests transferring up to 1.5 million annual appointments from patients who have a doctor to those who do not.
Dr. Laura Sang, a Montreal-area family doctor, says she’s concerned about what this scenario could mean for both doctors and patients.
“Our goal is to provide primary care and follow people throughout their lifespan and see people from all ages,” she said. “From the patient perspective, even if you don’t go very often, life happens and it doesn’t take much for someone to fall into a period of distress.”
Family doctors in Quebec say they’re using a lot of time filling up insurance paperwork and that time could be served caring for patients.
Sang says while she understands that the goal is to increase access to care for those who are more vulnerable, she doesn’t think removing family doctors for others is the “ideal way” to go about it.
“Having that rapport already established and knowing that person’s baseline, that background, their family situation, allows us to provide this level of care that is unparalleled,” she said.
She says there are already fewer slots for her patients who don’t consult as often.
“I worry about the stress that it’ll put on family doctors, the risk of burnout, the risk of early retirement, the risk of moving to the private sector, overall, losing a lot more doctors than we’ve already lost,” she added.
Sang says removing administrative hurdles that take time away from patient care would be a “great” place to start.
Negotiations ongoing with family doctors
In an interview with Radio-Canada last week, Health Minister Christian Dubé highlighted the need to adapt to a patient’s specific conditions.
“At the moment, we’re giving many people a family doctor without taking note of their condition, and doctors are asking us to say: ‘Well, if we want to take care of people properly, could we be more aware of those who are, I wouldn’t say the most vulnerable, but those who are most likely to be sick?” he said.
Of the 2.1 million Quebecers who were not registered with a family doctor in 2022-23, INESSS estimates that nearly half a million have major or moderate health problems. These patients are classified in the red and orange categories by INESSS.
These categories include, among others, people with depressive disorders, anxiety disorders, cancer, dementia, eating disorders and acute palliative conditions.
Opposition slams scenario
The health care critic for the Official Opposition, André Fortin, said he was shocked by the scenario studied by the Coalition Avenir Québec (CAQ) government.
“We went from ‘a family doctor for everyone’ to ‘if you’re healthy you won’t have one.’ I think the CAQ government owes a serious explanation to Quebecers,” Fortin told Radio-Canada referring to a key election promise the party made in 2018.
He said he’s worried that taking family doctors away from people who are in good health will further congest emergency rooms.
“It’s an additional step that goes against nearly every basic principle in medicine — work on prevention, make sure that people have easy access [to health care],” said Fortin.
The health care critic for the Parti Québécois , Joël Arseneau, for his part, said he found it “worrisome” the CAQ would study such a scenario without engaging with voters first. He noted that the assigning of family doctors would fall under Santé Québec, the new agency at the heart of Dubé’s reforms to the health-care system.
He also doubts the feasibility of the model given that it would force millions more Quebecers to turn to the GAP.
“There are numerous cases where people can’t even access the online platform or reach an operator on the phone,” said Arseneau.
‘Too early’ to move forward, says Dubé
Asked to comment on the report on Wednesday, Dubé said it is a good summary of the situation.
On Thursday evening in a statement on X, the minister said it was “too early” to determine what would come of the scenario proposed by INESSS.
The scenario being evaluated by the government is part of negotiations between Quebec and the Fédération des médecins omnipraticiens du Québec (FMOQ) that began in May.
The office of Dubé and the FMOQ declined Radio-Canada’s request for comment on the negotiations.
Based on reporting by Radio-Canada’s Alexane Drolet, written by Hénia Ould-Hammou and Cassandra Yanez-Leyton, with files from CBC’s Brittany Henriques
