Tue. Feb 27th, 2024

The threat of adopting a new law or regulation has an air of déjà vu.

Analysis | More ping-pong between Quebec and doctors

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The Quebec Minister of Health, Christian Dubé, wants to force family doctors to take care of the 13,000 patients who still do not have access to such a doctor. (Archive photo)

  • Hugo Lavallée (View profile)Hugo Lavallée

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The Minister of Health showed signs of impatience after leaving the Council of Ministers on Wednesday. “The line is drawn, there are very clear regulations; now, give me your timeline,” said Christian Dubé, aimed at family doctors. Within two weeks, he said, a new regulation will be published to force them to take care of the approximately 13,000 very vulnerable patients who still do not have a family doctor.

The response did not take long. On social networks, the Federation of General Practitioners of Quebec (FMOQ) firmly responded: If 13,000 of these patients still remain too long at the GAMF [Guichet d'access to a family doctor], the responsibility lies with the government alone. In short, we're passing the buck once again. Nothing very surprising for those who have followed, in recent years, the evolution of relations between medical federations and the government.

As early as November 2014, the Minister of Health, Gaétan Barrette, tabled Bill 20, the first words of the title of which were An Act to Promote Access to Family Medicine Services. The minister wanted, among other things, to force general practitioners to take care of a larger number of patients, under penalty of financial penalties. Physician representatives protested, denouncing a mathematical approach of quotas, number of patients, and equivalence which is squarely against what family medicine is.

The law was eventually adopted, but many of its articles were never implemented. The government wanted to avoid an open confrontation and instead focused on negotiating new arrangements with doctors.

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Gaétan Barrette was a minister of Health and Social Services from 2014 to 2018. (Archive photo)

Similar scenario in 2021, when Prime Minister Legault attacked family doctors in the middle of his inaugural speech: Unfortunately this desire for change is not always there, particularly among certain family doctors. […] I must say that I am starting to get impatient, and so are the Quebecers. I have always thought that it was better to come to an agreement with the doctors, but, if necessary, we will not hesitate to impose a conclusion, because Quebecers expect to be taken care of and then to have front-line services within a reasonable time frame.

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Minister Dubé tabled, in the following weeks, a new bill aimed at increasing the provision of front-line services by general practitioners and to improve the management of this offer. There is talk of forcing doctors to offer appointments during certain time slots and to take care of certain types of patients.

Once again, the law is adopted but is not fully applied, the government negotiating in parallel with family doctors the terms of a new agreement. The same game has also been played out several times with the Federation of Specialist Physicians in recent years.

The scenario seems destined to repeat itself this year. The logic seems the same each time: the government tires of negotiating with doctors and adopts a law or regulation allowing it to exercise greater control over the way they practice their profession. The medical profession is turning away, talking about a breach in professional autonomy and even, sometimes, threatening to sue the government. The government does not dare to carry out its threat. The new law or regulation is not put into effect, but rather is used as leverage to negotiate. The doctors are letting go. A new agreement is reached.

Each time, the government and doctors maintain that the new agreement will allow them to achieve their common objectives, without coercion . After some time, however, pressed by public opinion, the government ended up judging the progress as insufficient and the scenario repeated itself.

Not surprising, in the context, to see former minister Gaétan Barrette congratulate his successor for following in his footsteps. Go! Go! Go! Christian Dubé, wrote the former MP on social media, in reaction to the announcement of his successor. Gaétan Barrette has never hidden the fact that he would have liked to tighten the screws even more on the medical profession, but that the government to which he belonged had prevented him from doing so.

This time, it is mainly the data that the government wants to have access to. For three years, the appointment systems of family medicine groups have all been networked, which gives the government the opportunity to have a better idea of ​​the actual availability offered to patients.

< p class="StyledBodyHtmlParagraph-sc-48221190-4 hnvfyV">An inveterate fan of statistics and dashboards, Minister Dubé wants to have access to this information to better understand where the bottlenecks are. Obtaining the data, he said, would also allow him to ensure that family medicine groups are indeed following the schedule they have committed to respecting in the agreements concluded with the ministry.

< p class="StyledBodyHtmlParagraph-sc-48221190-4 hnvfyV">The government also wants to tighten the rules for assigning patients. Currently, around half of those who are under the care of a family doctor are not referred by the access counter, but rather are selected directly by the professionals themselves. It therefore sometimes happens that healthy patients pass in front of patients with more pressing needs. Without preventing family doctors from taking care of the people of their choice, the minister would like the sickest to come first.

The FMOQ, for its part, speaks of systemic failures, points the finger at the administrative machine and asks the government to give its members the tools to do [their] work well rather than always blaming those on the front lines.

If everyone says they want to care for the most vulnerable, the government and family doctors clearly do not agree on how to achieve this objective. Listening to the various interviews he gave last week, however, we already feel that Christian Dubé is ready to make compromises, if he is able to come to an agreement with the FMOQ. In fact, the new regulations will not be published for another two weeks and their publication will be followed by a 45-day consultation period. Only then will it actually come into force – unless the government softens its position by then.

I will not negotiate in public, Christian Dubé repeated last week, while suggesting that time was running out. Once again, things risk being settled behind closed doors.

In short, we risk once again witnessing a repeat of the scenario described previously: a new regulation will be adopted, but its usefulness will not lie so much in its application as in the balance of power that it will offer to the government to enable it to extract new concessions from doctors. We will see if Quebecers come out winners from the exercise this time.

  • Hugo Lavallée (View profile)Hugo LavalléeFollow

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