The four directors of Quebec universities’ family medicine departments expect Bill 20 will negatively impact patients by reducing the number of new doctors trained and, consequently, the capacity and quality of care.
The directors presented their position on March 19, to the Commission de la santé et des services sociaux during hearings held on the proposed Bill. They affirm that the lack of accessibility to family doctors and primary care is a major issue, and they support the government’s goal to remedy it. The directors say, however, that the approach put forward by the Minister to address the problem is not viable, and they are proposing alternate solutions to meet both the current and future needs of Quebecers.
The Bill, the directors explained, will make it impossible for family physicians who teach to reconcile their educational mandate with their clinical practice. The minimum caseloads they will be required to support will jeopardize the faculties’ graduation targets, which are set by the government. In addition to training the next generation of family medicine practitioners, family doctors who teach are also responsible for 20 per cent to 60 per cent of the training of first-, second- and third-year medical students, regardless of their future specialty, in each of the faculties.
The directors affirm that the equivalency system the Minister is considering for the regulations cannot take into account the full complexity of teaching. “The system will be heavy, hard to manage and incapable of encompassing the range of scenarios we deal with in the field, including the unique needs of our patients and the teaching we provide,” said Dr. Jean Pelletier of Université de Montréal.
“Our faculties are currently training highly skilled and motivated new physicians to serve the public. This system will greatly compromise everything we have introduced in recent years to make family medicine more attractive to our students,” added Dr. Guy Béland of Université Laval.
To improve access to quality care in Quebec, the signatories of the brief proposed five solutions. Among these is a system referred to as “timely access to care,” which aims to increase the number of patients seen in Family Medicine Units (FMUs). “This approach to scheduling makes it possible to see patients who need care at the moment when they need it, and it has already proven successful in certain locations in Quebec and in other Canadian provinces,” said Dr. Marie Giroux of Université de Sherbrooke.
They also recommend training all graduates of family medicine programs in “timely access to care,” so that new doctors can quickly and effectively take on a larger number of patients. In the next three years, 1,000 additional graduates will be trained to practice based on this system. These physicians, in turn, will sensitize their colleagues to this more efficient scheduling approach and will use it to train future students.
“We recognize how serious the problem of access is in Quebec. The notions of social responsibility and comprehensive patient care are core values of our profession,” said Dr. Howard Bergman of McGill. “Physician teachers play a crucial and decisive role in the accessibility of medical care for Quebecers. The main responsibility of our departments is to train a new generation of family physicians and emergency room doctors, in sufficient numbers, to meet the needs of the population.”
Currently, 3,300 family physicians contribute to medical training in Quebec; 800 of these work in one of the province’s 48 FMUs. Over the past 10 years, the number of students entering residency in family medicine has doubled. Bill 20 puts these excellent results, which are in large part the outcome of the faculties’ efforts, at risk.