No more family doctors for the well
Having failed to keep their early campaign promise to get everyone in Quebec a family doctor, the CAQ now shifts the goalposts, ordaining that healthy people simply don’t need a family doctor so we may lose access to them.
The CAQ is piling news story on news story lately, so that I had just read this piece about how Lionel Carmant is “confident” he has reversed the decline in mental health services when I spotted the family doctor story. I suppose healthy people who don’t need a doctor obviously won’t need mental health services either.
jeather 19:50 on 2024-10-10 Permalink
And if you have one, they’re just going to remove you from the list. Do they not understand that health is not a permanent state, and that catching things early helps?
Kevin 19:57 on 2024-10-10 Permalink
This is a bullshit idea from accountants who think a nurse practitioner who applies medicine via algorithm is all people need.
Penalize patients who cancel with less than 24 hrs notice, and stop prohibiting family medicine doctors from working a 5 day week with their own patients
yasymbologist 21:38 on 2024-10-10 Permalink
almost everyone is healthy, until they need to see a doctor. sounds like application of existentialism in domestic politics.
carswell 07:35 on 2024-10-11 Permalink
Dubé is shuffling the deck chairs. This is what happens when free-marketers run regulated markets. This is what happens when you put a business person in charge of health care (Dubé is an accountant and has worked for Price Waterhouse, Coopers & Lybrand, Domtar, National Bank Financial and the Caisse de dépôt. Common thread: zero experience in medicine).
It’s not just the crumbling medical system (about everybody I know, including physicians, is fed up with it). It’s acknowledging that the system is overly bureaucratic and then imposing yet another layer of bureaucracy. It’s making it up as they go along: for my prescription renewals last spring, I learned about and got an appointment through the GAP system. The physician I saw at the GAP clinic explained that that Friday was the last day of the program and the government was unable to tell them what was going to happen as of the next day. “We just built this clinic to handle the anticipated flow of patients. We may have to shut it down as of this evening. We just don’t know. How can this be?”
Suspicion: this is deliberate and part of an ongoing plan to involve the private sector and create a full-fledged two-level system: good for politicians and those who pay, not so good for everybody else. It’s why Geneviève Brion, ex-CEO of one of the largest Quebec private medical services providers, Biron Groupe Santé (her sister is now CEO; no potential conflict of interest there…), has been appointed head of that new layer of bureaucracy, Santé Québec.
GC 08:06 on 2024-10-11 Permalink
This is a terrible idea that ignores the value of prevention.
Kate 09:48 on 2024-10-11 Permalink
They’re even mentioning removing family doctors from “healthy” people, and making these patients have a relationship instead with a pool of clinic doctors, so that you may never interact with the same doctor twice.
They’re ignoring the value of continuity. Certainly, a doctor (or nurse practitioner, presumably, since it’s becoming usual to have an NP rather than an MD) keeps a record, so you ought to be able to at least have a health record at a clinic. But that isn’t the same as developing an ongoing relationship with a doctor who knows you and your history. You have to hope that Random Person MD has time to skim your file before s/he sees you.
Margaret 09:48 on 2024-10-11 Permalink
What our Accountant Health Minister fails to appreciate is that he has healthy citizens to wrench away from their GPs mostly because these citizens have had longstanding relationships with their doctors, which is a large part of the reason they are healthy. Yes, the vulnerable need to be a priority but that need not be done at the expense of those in productive long-term doctor-patient relationships. As with so many other policy decisions made by this government, a flawed but essentially working situation was examined, reassembled, and broken in their efforts to fulfill election promises. Instead of using our tax dollars to work towards a sustainable, creative solution to the healthcare problem, the burden is put on the shoulders of tax payers to wait or pay to go private, while the government spends our health $$$ on their failed reforms. What an incentive for our population to be healthy!
Joey 10:29 on 2024-10-11 Permalink
The government is working through some of the lowish hanging fruit – I think they moved this week on a number of items (expanded scope of practice for nurses and pharmacists, removal of a lot of BS admin by forbidding the requirement to produce a doctor’s note when an employee is sick, etc.) and seem to be legitimately attempting to allow doctors to spend more time on patient care and less time on paperwork.
In the context of a scarcity of first-point-of-access healthcare workers, this directive makes a certain kind of short-term sense: if the number of physician hours available for patient care greatly exceeds the demand among patients, it makes sense to prioritize sicker patients than, say, young health people. I think this has de facto been the case for a long time; I’ve been lucky to have the same family doctor for about 20 years, someone who is somewhat but not much older than I am. Annual checkups are basically done and were extremely rushed in recent years. Urgent consults are hit and miss; it’s usually easier to use telemedicine or find a different clinic with an opening. In other words, while this is a major policy change, I don’t know that it will be all that different once implemented.
We have three fundamental problems that none of these reforms are addressing, and whose resolution is essential to improving our health outcomes: we rely too much on family doctors to grant access to the rest of the healthcare system, we have too few family doctors (and the younger ones legitimately seek some semblance of work-life balance), and we lack a robust network of urgent care clinics to serve patients who are not in need of hospital ERs but can’t wait for their affiliated practice to see them. Until we chip away at these problems, we’ll never see progress. The degree to which doctors are abandoning the public system is really frightening (and lends credence to some of the comments above that this is an intended if unstated consequence) because it exacerbates the challenges we all are familiar with and it makes it increasingly difficult for the health minister to run the healthcare system.
Kate 11:24 on 2024-10-11 Permalink
Joey, I don’t have a beef with the first issue you mention. Access to specialists has to have some gatekeeping around it, because too many people consult Dr Google and jump to conclusions about their condition, and would be wasting specialists’ time with strange diagnoses.
As for your third point, for awhile I kept seeing news about new clinics being opened but very little followup in the media, and no clear sense whether they were helping reduce ER overcrowding, which was their main raison d’être.
Joey 12:54 on 2024-10-11 Permalink
@Kate it’s amazing how many well promoted ‘solutions’ to the crisis in Canadian healthcare, like Jane Philpott’s new book on establishing neighbourhood-based clinics, refuse to engage with the main issue: not enough physicians. Without solving that problem, we’re left with these kinds of solutions that, as we can see, do little more than remind citizens how bad things are.
jeather 12:59 on 2024-10-11 Permalink
Some gatekeeping, but not all: specialists have, for instance, a list of specialisms they can and cannot refer to — so my friend had an opthamologist who couldn’t refer to cardiology or whatever the actual two specialties were. And apparently every single test now gets lost in the vast new standardized testing bureaucracy — can’t be sick if you can’t get a test, and if you do get a test, you don’t get results.
But yes, the real issue: insufficient GPs in particular.
carswell 13:27 on 2024-10-11 Permalink
Re jeather’s point: last year, I tried to see the urologist who been following me for three or four years before the pandemic. When I called his office to make an appointment for a prostate exam, I was told it had been more than two years (two and a half to be accurate) so I needed a referral. The GP who finally issued one did so no questions asked because duh.
jeather 14:07 on 2024-10-11 Permalink
You also can’t get into the long Covid clinic at the Jewish unless you have a GP, the referral can only come from your GP and not a specialist.
MarcG 16:55 on 2024-10-11 Permalink
And of course GPs are known for staying abreast of the latest developments and will surely have heard of Long Covid, what defines it, that the Long Covid clinic exists, and will not just call you fat and prescribe anti-anxiety meds.
Kevin 00:10 on 2024-10-12 Permalink
Like every profession, there are good and bad doctors.
But we don’t need the USism of people seeking cardiologists directly because they have heartburn.
The biggest issue in healthcare is burnout because the govt treats it like a money-losing business instead of what it is: an essential *service *