Incoming doctors can’t cover existing needs

With doctors always in short supply, a system is in place to ensure equitable distribution of family physicians in Quebec.

Who knew the aging population in Quebec included so many doctors? A retirement boom is compounding the already significant labour shortage in the healthcare system, leaving more and more Quebecers without a family doctor by the day.

Even with 442 new doctor permits opening up for the coming year in Quebec, 25 of which will be allotted to the Estrie, the province is far from catching up to the doctor shortage.

According to information provided by the Ministry of Health and Social Services, as of July 31, 2021, there were 830,686 Quebecers on the waiting list for a family doctor, doubling in the last four years. However, the percentage of the population signed up with a family physician has actually increased from 79.6 in 2018 to 81.2 per cent in 2020.

The jump in numbers coincides with the Coalition Avenir Québec’s (CAQ) commitment in 2018 to provide all Quebecers with a family doctor, essentially opening the flood gates on a new online registration system.

The CAQ has since tempered that promise to now try and reach 83 per cent family doctor coverage for the population.

In July, 2021 an average of 80.2 per cent of Quebecers were signed up with a family doctor. That ranges from rates in the 90s in areas like the Gaspé (91.86) or Saguenay-lac-saint-jean (92.2) down to rates in the 60s in urban centres (64.2 per cent in Montreal West).

The time on the waiting list can fluctuate depending on a person’s condition.

For people who have an urgent or pressing need, or whose condition is judged a priority, the average wait time to be assigned a family doctor is 451 days. For those who consider themselves in generally poor health, or who simply want a doctor for regular follow ups, the average wait time across the province is 602 days.

In Estrie, 83.11 per cent of the population has a family doctor and 69,419 people are on the waiting list. For priority cases, the average wait is 550 days, and for general population the wait is around 656 days.

With doctors always in short supply, a system is in place to ensure equitable distribution of family physicians in Quebec. Doctors don’t just graduate from medical school, decide where they want to live and open up a practice. The number of slots available for doctors in Quebec to practice is controlled through the Plans régionaux d’effectifs médicaux (PREM).

Each year, a certain number of PREMS, basically permits, are made available in certain regions to respond to varying needs, and doctors are required to bill a certain percentage of their workload in the territory where they hold their permit.

According to Dr. Raymonde Vaillancourt, head of the regional department of general medicine at CIUSSS de l’estrie-chus, Quebec is missing 1,000 doctors.

The 25 coming to the Estrie region will far from fill local needs, she added.

To get caught up, Vaillancourt said the region would need 46 full-time doctors. Eleven retired last year, she pointed out, and 33 are expected to retire in the coming year.

So where will the new PREMS go? Unfortunately, it’s not as easy as replacing a retiring doctor with a new one. A complex formula is used, factoring in the number of patients in need in a given sector, as well as the needs of local hospitals, emergency rooms and other health centres. There’s also the matter of free will. Doctor candidates have the right to choose where they would like to go. A

PREM can only require them to spend a certain amount of time in the territory where the permit is given.

At least one new doctor will be allotted to each of the nine regional sectors covered by the CIUSSS de l’estrie-chus, Vaillancourt said, and seven will be placed in Sherbrooke. But whether or not they will work full time remains to be seen. The new doctors will also be spending about a third of their working time in hospitals, she added.

It’s not like the health network is being extra selective, or doctors are graduating and then hightailing it out of the province, Vaillancourt explained. The health network has been managing a shortage for a decade. The problem is systemic, she explained. They need more teachers to train more students, and so on.

In the meantime, Vaillancourt said at the administrative level, the network is trying to improve the current model and make services more accessible to users waiting for a family doctor.

Since doctors like to work together in groups, sharing nurses and pharmacists to form healthcare teams, Vaillancourt said efforts are being made to associate people on the waiting list to a groupe médecine familiale (GMF), so that even though they don’t have an assigned physician, they can be prioritized at a GMF rather than resort to an emergency room for care that isn’t urgent.