Would you pay to see a doctor more quickly? Quebecers are, and critics are concerned

Audrey Leveillé's four-month-old son, William, had been ill for about a week and had intermittent fevers.

The mother of two was concerned and wanted to rule out an infection, but couldn't handle the prospect of waiting for hours in a hospital emergency department, she said. So Leveillé took her baby to Clinique Santé Plus, a private family practice in Vaudreuil, Que., about 45 kilometers outside Montreal.

“There is no infection today, which is great news. We need to continue to monitor his symptoms in the coming days,” she told Dr. Brian Goldman, CBC Radio's host. White jacket, black Art. no in an interview at the clinic last month.

Leveillé paid about $200 to $150 for the appointment, plus a one-time fee of $50 plus tax to create a new patient profile.

“I once waited twelve hours with my daughter at the Hopital Sainte-Justine,” she says in French. “So with a four-month-old, I prefer to pay to make sure everything is okay.”

That's a trade-off many Quebecers are making these days. More than Last year, 780 doctors left the public system therecompared to 14 in the rest of Canada combined. According to data from the Ministry of Health, the exodus of doctors to the private sector in Quebec has increased by 70 per cent in just four years.

Patients who spoke White jacket, black Art. no describe a situation where even those who do have a GP have to wait a month for an appointment, forcing them to make a choice between pulling out a credit card or waiting all day in the hospital for an acute problem such as pneumonia or a urinary tract infection.

Critics say the situation in Quebec should serve as a warning of what could happen elsewhere in Canada if incremental steps toward privatization could turn into giant leaps.

Earlier this month, Quebec Health Minister Christian Dubé announced that his government would introduce a bill that would forcing new general practitioners and medical specialists trained in the province to devote the first years of their careers to the public system.

Doctor who went private describes an overloaded system

Dr. Martin Potter, who founded Clinique Santé Plus in 2022, has taught and practiced in Quebec's public system for two decades. He said he encountered a number of systemic challenges during that time.

“If you're a primary care physician and you want new patients, it's not like a patient can just call and say, 'Can you see me?'” Potter said. 'You have to go through the government waiting list, as we call it the orpheline clientele.”

These lists have been found to be outdated, and some physicians report receiving lists of potential patients that include these lists those who have already been linked to a doctor, and even some who have passed away.

Additionally, Potter said, there is pressure to take on a large patient load, making it difficult for patients to see their primary care provider in a timely manner.

At his private clinic, Potter can see who needs his help, including those who have a GP who monitors them long-term and those who don't.

'A worrying trend'

Dr. Bernard Ho, vice-president of Canadian Doctors for Medicare, says the situation in Quebec is “a worrying trend that we are seeing not only in Quebec, but across the country and also in private family medicine.”

Quebec has the most primary care physicians who go private for a number of reasons, including rules that make it easier to go back and forth between public and private, said Ho, an emergency and family physician based in Toronto. “But I wouldn't say Quebec is an anomaly here.”

To varying degrees, “physicians in all provinces except Ontario have the right to opt out of their publicly funded insurance program,” he said.

Ho said he believes patient safety will be at risk if private sector medicine continues to rise in Quebec and elsewhere in the country. 'Studies have been done into the US, Great Britain and even in here Canada These show that when we outsource to the private sector, patient safety decreases and patient mortality increases,” he said.

In a comparison of for-profit and nonprofit U.S. hospitals published in the Canadian Medical Association JournalFor example, a notable difference related to patient mortality risk was that the pressure to make a profit often equated to employing fewer highly qualified staff per patient.

Dr. Isabelle Leblanc, President of Doctors from Québécois pour le régime public, a group of doctors advocating for a strong public system in Quebec is disputing the argument that private doctors are putting pressure on the public system.

“It doesn't help in any way … if the patients are seen at an outside clinic where they pay for it,” Leblanc said, noting that the private physicians are not new additions to the physician pool.

“If it's a pizza, you cut it in half, there's the same amount of pizza. But some of it is private. Some of it is public.”

She said research from other countries shows that overdiagnosis and overprescribing go hand in hand with private medicine.

For example, antibiotics do not work for colds or ear infections or sore throats, also caused by viruses. “But because the patient is paying $150 to see you, they expect a prescription. It's a lot harder to say no because otherwise you lose a customer,” Leblanc says.

Living on the waiting list

Like many of her friends, 62-year-old Marlene Harper has had the same doctor for 30 years, but that person has retired. That left both Harper and her husband, Keith Ball, who has diabetes, without a primary care physician.

Harper said she put herself on the province's waiting list two and a half years ago and never heard back.

“We have to have our blood checked and we have to have our annual check-up,” she said during a visit to Clinique Santé Plus in Vaudreuil. “So I went on the internet and I knew we had to pay, but I had no choice… If we want to stay healthy, we need checkups.”

Harper said her husband went to another private clinic near his work, where costs are higher. So far, he has spent $3,600 on private medical care related to his diabetes, she said.

In 2022, the province established a system known as GAP, which stands for Guichet d'accès à la première lineor an access point for primary care. If you need to see a doctor but don't have one, the province will arrange a one-time appointment for you, so that – at least in theory – you do not have to go to the emergency room.

But there are a few challenges with the system, Potter said. First, patients may bring up only one health problem per visit, which poses a risk of misdiagnosis, he said, since seemingly unrelated symptoms can be part of a bigger picture.

The second is that the GAP system uses the same group of GPs who work in the public system. “So now they have to take the time not to visit their own clientele, but to visit patients who don't have a primary care physician,” Potter said. “But the salary scheme is very advantageous for the doctors, so they really want to work at the GAP.”

In an email to CBC Radio, the Quebec Health Minister's office said in part: “the private sector – at no cost to patients – can complement the public sector. However, we need to better regulate private sector growth. sector and that is what we do.”

Starting December 1, a new Crown corporation called Santé Québec will take over the operation and management of Quebec's health care system. The company will release a strategic plan in March 2025.

Santé Québec spokesperson Jean-Nicolas Aubé told CBC Radio that his top priorities will be improving access to public health care, reducing the steps for patients to access care and addressing the root causes of problems instead of applying 'band-aid solutions'.

WATCH ⎸How Quebec's new crown corporation Santé Québec will work:

New Crown Corporation wants to improve Quebec's struggling health care system

But Leblanc said she worries that Santé Québec will only move the province further toward “health care commercialization,” especially considering that a private health manager was appointed CEO.

As for the mother of two, Leveillé says she has resigned herself to paying for some of her family's health care needs out of pocket.

“We can't do anything about it. When our children are sick, our first priority is to help them.”

Produced by Jennifer Warren. With a file from CBC Montreal.