allison hanes: the prognosis for quebec's family doctor shortage is not good
the number of quebecers who have a family doctor has dropped again, but that's only one of many worrying indicators.
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it’s time for the quebec government to look in the mirror and ask some hard questions about why the family doctor shortage continues to worsen in the province and why fewer patients here have a general practitioner than anywhere else in canada.
the prognosis remains poor, despite stopgap measures to improve access to primary care and major reforms aimed at stabilizing the ailing health system.
one in four quebecers is in need of a family doctor, a proportion that has risen, according to the institut de la statistique du québec. the latest numbers show that only 73.3 per cent of the quebec population was assigned to a general practitioner in 2023, down from 76.6 per cent in 2022, 79.8 per cent in 2021, 81.4 per cent in 2020 and 82 per cent before the covid-19 pandemic.
“after several years of increasing, the quebec population eligible to be assigned to a family doctor has undergone several declines to reach 73.3 per cent in 2023,” a report published this month states. “this proportion nevertheless constitutes an increase of 7.2 percentage points from 2013, when 66.2 per cent of the eligible population was registered.”
but the rate is even lower in montreal, where just 64.3 per cent of residents had a family physician in 2023, down from 66.6 per cent in 2022 and 67.9 per cent in 2021. the proportion of montrealers with a general practitioner is the lowest in the province, aside from nunavik and james bay.
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and all signs suggest the situation in quebec is worse than anywhere else in the country. according to the canadian institute of health information, 88 per cent of the population outside quebec had a family doctor from 2019 to 2021, including 90 per cent in ontario and new brunswick. the analysis contained no information from quebec because the province did not participate in the most recent joint reporting exercise.
but the last batch of cihi comparables dating from 2019-20 demonstrated that 79.5 per cent of quebecers had access to a primary caregiver, below the canadian average at the time of 85.6 per cent. the situation was again worse in montreal, where just 69.8 per cent of the population had a family doctor.
so the new figures collected exclusively in quebec suggest the situation has deteriorated.
the isq pins the blame on more family doctors retiring in quebec than setting up shop, while new physicians are taking on fewer patients. additionally, the organization says that one of quebec’s solutions to the crisis has lowered the number of doctors taking on new patients. the guichet d’accès à la première ligne (gap) allows gps to take walk-in patients to deal with acute problems through a centralized booking system.
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“the agreement between the ministry of health and social services and the fédération de omnipraticiens du québec, which seeks to increase access to front-line and interdisciplinary services, introduced the notion of group registration,” the isq analysis said. “these group registrations contributed to a decrease in individual registrations among patients.”
but the number of patients waiting to find a primary care provider isn’t the only worrying indicator.
despite opening up more spaces to train family doctors in medical school, graduates are giving the specialty the cold shoulder. of the 75 family residency positions across canada that went unfilled after the annual matching process, 70 were in quebec in 2024.
also, some newly minted gps aren’t even bothering to apply for permits that dictate where in quebec they can practice. these plans régionaux d’effectifs médicaux (or prems), are supposed to ensure an equitable distribution of physicians across quebec, but instead create hurdles that deter many from choosing family medicine or prevent young gps from living and working where they want. as of july 31, 92 of the 479 prems for new billers were unfilled.
a record number of quebec doctors left the public system in the last year, a federal study on the state of the canadian health act revealed. the total number of “non-participating” general practitioners and specialists reached 780 in mid-july, an increase of 22 per cent from a year earlier, when there were 641 people practicing private medicine in quebec. for comparison, only 14 doctors in the rest of canada left the public system over the past year.
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not surprising then, quebecers are not only struggling to find a family physician, the wait time to see a specialist in quebec has doubled over the past five years, to 14 months in march 2024.
these are the statistics, but there are many intangibles contributing to this exodus.
many family doctors are demoralized, with more work being piled on their shoulders and increasing red tape tying them down. quebec gps are required to care for the elderly in nursing homes, provide medically assisted dying, deliver babies and do shifts in emergency rooms on top of seeing their roster of patients.
in the words of one front-line physician, the gap system has transformed family practice into “mcmedicine.” doctors may see a patient through the booking service only once. they may deal with one-off problems that take the pressure off ers, but they don’t do prevention, followup or build a rapport — the backbone of family medicine for both doctors and patients.
this undermines the very essence of what family practice is supposed to be and makes it less attractive to young medical students.
quebec has undertaken massive reforms that centralize control of the health system in a new agency, santé québec, that is the province’s sole employer in the public system.
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on top of that, a new language crackdown under bill 96 is casting a pall over health care and putting the imperative of protecting french above providing the best care. doctors could be prevented from communicating with their patients in “a language other than french” if they don’t meet narrow criteria and expose themselves to disciplinary sanctions if they address the wrong person in the wrong language.
it’s enough to give the most dedicated practitioners serious doubts.
but it ought to prompt some soul-searching in the ranks of elected government, the health ministry and santé québec about flawed policies that are driving away family doctors, to the detriment of patients.
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