Quebec is considering eliminating general practitioners for healthy patients

The Quebec government is considering the possibility of changing the way GPs are allocated based on the health of Quebecers, to ensure access to the most vulnerable.

Sources with knowledge of the discussions told Radio-Canada of a scenario that has been under investigation for several months.

Under this scenario, Quebec patients in good health or with minor health problems would be referred to an adapted hospital Guichet d’accès à la première line (GAP), the service currently intended to give Quebecers without a GP access to medical appointments.

This GAP would include all Quebec patients without major or moderate health problems, including those who currently have a primary care physician.

Only patients considered more vulnerable, such as those with complex or chronic conditions such as cancer, mental health problems, cardiovascular disease or diabetes, would be assigned a GP.

A report from the Institut national d’excellence en santé et en services sociaux (INESSS), commissioned by the government and made public on Wednesday morning, lays the foundation for such a model.

This INESSS report indicates that 500,000 sick Quebecers do not have a primary care doctor, and proposes transferring up to 1.5 million annual appointments from patients who have a doctor to those who do not.

Dr. Laura Sang, a Montreal-area family physician, says she worries about what this scenario could mean for both doctors and patients.

“Our goal is to provide primary care and follow people throughout their lives and see people of all ages,” she said. “From a patient perspective, even if you don’t go often, life happens and it doesn’t take much for someone to find themselves in a period of need.”

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Sang says that while she understands the goal is to increase access to care for those who are more vulnerable, she doesn’t think removing primary care physicians for others is the “ideal way” to go about it.

“Because we’ve already established that connection and know what that person’s baseline is, that background and their family situation, we can provide this level of care that is second to none,” she said.

She says there are already fewer places for her patients who don’t consult as often.

“I worry about the stress this will put on GPs, the risk of burnout, the risk of early retirement, the risk of moving to the private sector, and overall we will lose many more doctors than we have already lost.” she added.

Sang says removing administrative barriers that cost patient care time would be a “great” place to start.

Negotiations are ongoing with general practitioners

In an interview with Radio-Canada last week, Health Minister Christian Dubé emphasized the need to adapt to a patient’s specific circumstances.

“Right now we’re giving a lot of people a GP without taking note of their condition, and doctors are asking us to say, ‘If we want to take good care of people, can we be more aware of those who are, I wouldn’t say the most vulnerable, but those most likely to be sick?” he said.

Of the 2.1 million Quebecers not registered with a primary care physician in 2022-2023, INESSS estimates that nearly half a million have serious or moderate health conditions. These patients are classified by INESSS into the red and orange categories.

These categories include people with depressive disorders, anxiety disorders, cancer, dementia, eating disorders and acute palliative conditions.

Opposition denounces scenario

The Official Opposition’s health care critic, André Fortin, said he was shocked by the scenario being studied by the government Coalition Avenir Québec (CAQ) Government.

“We’ve gone from ‘one GP for everyone’ to ‘if you’re healthy, you don’t have one’. I think the CAQ government owes a serious statement to the people of Quebec,” Fortin told Radio-Canada, referring to an important election promise the party made in 2018.

He said he worries that taking primary care physicians away from people who are in good health will further overload emergency departments.

“It’s an extra step that goes against almost every basic principle in medicine – work on prevention, make sure people have easy access [to health care],” said Fortin.

The healthcare critic for the Parti Quebecois , For his part, Joël Arseneau said he found it “concerning” that the CAQ would study such a scenario without first engaging with voters. He noted that the allocation of primary care physicians would fall under Santé Québec, the new agency at the heart of Dubé’s health care system reforms.

He also questions the feasibility of the model, as it would force millions of Quebecers to turn to the GAP.

“There are numerous cases where people cannot even access the online platform or reach an operator on the phone,” Arseneau says.

‘Too early’ to continue, says Dubé

When asked to comment on the report on Wednesday, Dubé said it was a good summary of the situation.

On Thursday evening, the minister said in a statement on X that it was “too early” to determine what would happen with the scenario proposed by INESSS.

The scenario being evaluated by the government is part of the negotiations between Quebec and the Fédération des médecins omnipraticiens du Québec (FMOQ) which started in May.

Dubé’s office and the FMOQ declined Radio-Canada’s request for comment on the negotiations.

Based on reporting by Radio-Canada’s Alexane Drolet, written by Hénia Ould-Hammou and Cassandra Yanez-Leyton, with files from CBC’s Brittany Henriques