By Cynthia Lee
The faculties of medicine of Université Laval, Université de Montréal, McGill University and Université de Sherbrooke support the intent of the government to optimize resources in Quebec’s health care system to improve access to family physicians and specialists. However, yesterday the faculties voiced deep concerns to the Commission de la santé et des services sociaux about the expected negative impact on the training of future physicians and the number of family physicians in the province.
“As written, Bill 20 seriously compromises the activities that are at the heart of our mission,” said Dr. David Eidelman, president of the Conférence des doyens des facultés de médecine du Québec and dean of the Faculty of Medicine at McGill. “The Bill does not recognize the major role physicians play in training the next generation of family doctors, specialists, nurses and other professionals who provide health care to Quebecers. It also does not consider the clinical research conducted by many.”
Recognizing the role of the teaching physician
Under Bill 20, doctors would be subject to annual patient quotas that do not fully recognize the additional teaching and research responsibilities of professionals practicing in hospitals and other health care institutions with an educational mission, such as Family Medicine Units (FMUs). These physician teachers are responsible for receiving, supervising, training and evaluating the growing number of cohorts of students and residents in their institutions.
According to the faculties, the impact would be three-fold:
- Bill 20 would make it very difficult for physicians to fulfill their teaching responsibilities, which would undermine quality, make it difficult to train the number of family physicians envisioned by the Ministry and discourage those who wish to become physician teachers.
- Family medicine as a career choice would become increasingly less attractive; over time, this would reduce the number of family physicians in Quebec.
- Research activities would be similarly compromised.
“Bill 20 must contain specific terms so that physician teachers can perform both their teaching and their clinical tasks,” said Dr. Renald Bergeron, dean of the Faculty of Medicine at Université de Laval. “In its current form, Bill 20 would negatively impact the quality of care provided to patients, as well as the number and the quality of future family practitioners trained by Quebec’s medical faculties.”
Family medicine under threat
In the field of family medicine, given the shortage of family physicians, there has been a concerted multi-year effort by all stakeholders, including the Ministère de la Santé et des Services sociaux (MSSS), to promote and position this specialty to make it more attractive and to encourage generalism in medical training.
“At the heart of these initiatives, family physicians have worked rigorously in all areas of medical training. They have taken on this mission and done a brilliant job,” said Dr. Hélène Boisjoly, dean of the Faculty of Medicine at Université de Montréal. “Based on current projections, the annual number of family medicine residency positions, which has doubled over the last ten years, will continue to grow, peaking at 514 in 2017, but Bill 20, in its current form, would seriously compromise our ability to meet this target.”
Six principles that must be guaranteed
In its brief to the Commission de la santé et des services sociaux, the Conférence des doyens des facultés de médecine du Québec set out six principles that must be guaranteed for the faculties to consider supporting Bill 20:
- Principle 1 – Recognition of the crucial importance of formal, ongoing collaboration between the Ministère de la Santé et des Services sociaux, the Ministère de l’Enseignement supérieur, de la Recherche et de la Science and the faculties of medicine in the transformation of the network
- Principle 2 – Recognition of the status of the family physician teacher and the family physician researcher, and adaptation of clinical demands to academic requirements
- Principle 3 – Recognition of the status of the specialist physician teacher and specialist physician researcher, and adaptation of clinical demands to academic requirements
- Principle 4 – Recognition of a collective and interdisciplinary practice of family medicine in teaching environments
- Principle 5 – Recognition that clinical settings, and particularly FMUs, have variable configurations and require resources that are adapted to the populations they serve and teaching needs
- Principle 6 – Recognition that specific material conditions are essential to ensure accessibility and quality of teaching
“Everyone’s contribution is needed to achieve excellence in medical teaching and research,” said Dr. Pierre Cossette, dean of the Faculty of Medicine at Université de Sherbrooke. “We believe we all have a crucial role to play in ensuring high-quality health care is accessible to Quebecers, and teaching by our physicians is at the heart of the solution. We therefore invite the MSSS to an open, constructive dialogue, and ensure the government of our cooperation.”