While the spotlight shines on Top Guns at Santé Québec, 70 family doctors are missing in action on the front lines.
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There was a lot of hoopla over the unveiling Monday of the “Top Guns” now in charge of fixing Quebec’s broken health system.
Health Minister Christian Dubé named Geneviève Biron, who previously managed an eponymous private health group, as CEO of Santé Québec, while Frédéric Abergel, the current head of the Centre hospitalier de l’Université de Montréal, was appointed vice-president. This duo will oversee the brand new agency that will centralize management of health care in Quebec and act as the network’s sole employer.
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But while the spotlight focuses on these two, 70 people are missing in action on the front lines.
The Canadian Resident Matching Service, or CaRMS as it is known, announced the results last week of its annual recruitment process for placing newly graduated medical students in residency training programs, be it specialties like cardiology, or family medicine. In 2024, 97.7 per cent of 3,705 positions were filled — “the highest ever number,” CaRMS noted. Of the 87 posts that remain vacant, 75 are in family medicine.
But here’s the kicker: 70 of the 75 empty family medicine residencies in Canada are in Quebec this year. So that’s 70 fewer new physicians taking on the roughly one million Quebecers who don’t have a family doctor. That’s 70 fewer pairs of hands working up to 12 hours a week in overburdened emergency rooms, which are forced to pick up the slack, or understaffed long-term care homes, additional duties required of general practitioners on top of their regular patient loads. That’s 70 fewer new doctors setting up shop in underserved communities, including eight in Gatineau, six in Trois-Pistoles and five in Les Etchemins, according to a list of the vacancies supplied by CaRMS.
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It’s a continuation of a trend of young med school graduates giving family practice the cold shoulder at the time they are most needed to fill the shoes of older physicians who are retiring. The lack of relief has been compounded over the years, exacerbating the family doctor shortage in Quebec.
“The numbers speak for themselves,” said Dr. Marc-André Amyot, the president of the Fédération des médecins omnipraticiens du Québec. “We have 70 unfilled residencies. This happens year after year. And it adds up to around 650 positions over the past 12 years that were not filled. Imagine what we could do with 650 more family doctors in Quebec?”
Things only seem to be getting worse, he added. In 2022, Quebec saw a net loss of family doctors, the FMOQ calculated, because 49 more retired, quit medicine, went private or left the province than entered service.
“Every year, there’s a certain number of students, who, rather than choose family medicine, prefer to do a sabbatical year and do more research, to increase their chances of being admitted to another specialty next year,” Amyot said. “And we see an increase in that number compared with past years, when there were 40, 45. Last year, close to 60 took a sabbatical year and we’re worried again this year about seeing that number rise.”
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Between the upheaval in the province’s health care network and the political context where language and identity tensions have been stoked, the vacancies in Quebec are no surprise to Dr. Michael Kalin, a family doctor in Côte-St-Luc and a member of the Départment régional de médecine générale (DRMG) for Cavendish, a body that is in charge of determining staffing needs in the district.
“We should consider it fortunate that it was only 70 unfilled spots because when we look at what has happened in our landscape over the last few years — and I mean Bills 11, 15, 21, 96 — it’s actually remarkable that it’s only 70,” he said, citing government reforms that created Santé Québec and proposes to take away doctors’ autonomy in choosing their patients, as well as the secularism and language laws.
And since Premier François Legault abandoned his promise of a doctor for every Quebecer, pledging “one-stop shopping” for access to care instead, Kalin said the practice of family medicine has changed dramatically.
“The heart and soul of family medicine is that you want to build a doctor-patient relationship. You can’t do that any more because you’re being sent patients from 811 (health phone line) with complex, difficult issues that you need to resolve and then you may never see the patient again,” Kalin said. “So family medicine as we teach it, as I wanted to practise it, no longer exists in Quebec. And we need to recognize that. That’s why they don’t choose family medicine any more, because family medicine doesn’t exist like it does elsewhere in Canada.”
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Still, some are trying to look on the bright side.
Dr. Cédric Lacombe, president of the Fédération des médecins résidents du Québec, said 458 family medicine positions were filled this year, out of the 894 residencies of all types in the province. That’s 17 more than last year, when 441 family residents were recruited.
“It’s 51 per cent of the matches this year for the CaRMS process. So 51 per cent of the future residents are in family medicine and there are more than 60 specialities. It’s huge,” said Lacombe. “In the last 15 years, it’s an increase of about 36 per cent of the number of residencies in family medicine. … We don’t see those numbers in any other specialty. It’s the biggest specialty in Quebec.”
Quebec offers the most family medicine residencies in the country. Starting in 2022, it also boosted enrolment in its medical schools, so the results won’t be evident for a few more years.
“The number of residents in family medicine could very well increase in the future,” Lacombe said.
That’s the goal, but is it wishful thinking?
While there are doctor shortages across the country, family medicine has unfortunately gotten a bad wrap, particularly in Quebec.
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It’s a job that comes with long hours, lots of pressure, not enough support and too much paperwork, said Dr. Jean-Joseph Condé, a family doctor at a Groupe de médecine de famille in Val-d’Or who is the Quebec representative on the board of the Canadian Medical Association.
“In my (clinic), we’re missing nurses, psychologists, social workers, pharmacists, so of course it makes the work of the physician that much more,” he said. “Every day I finish seeing patients at 5 p.m. but I am in the office doing paperwork until 8 p.m. That’s 10 to 12 hours a week of paperwork.
“When you have medical students working with family doctors and they see them working long hours and spending hours on paperwork … and when they look at us and our quality of life and have to make their own decisions, it makes it unattractive.”
In Quebec, there are extra hurdles for practising, Condé said. Obviously fluency in French is a prerequisite. Then there are Activités médicales particulières (AMPs), which require general practitioners to fulfil extra duties like delivering babies or administering medically assisted death.
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Family doctors also have to contend with Plans régionaux d’effectifs médicaux (PREMs), permits handed out by the government that dictate where they can work, including what region or district. The licences are intended to ensure an equitable distribution of physicians across Quebec. But the red tape surrounding the process to obtain one and the restrictions it places on practices have become another major turnoff for med students considering family medicine.
No other province has AMPs or PREMs. No other province came up as short in recruiting family doctors through CaRMs this year.
“The reality is that in other provinces that don’t have these constraints, young doctors seem more attracted to family medicine,” Condé noted.
On top of that, there’s a pay disparity between general practitioners and specialists.
“It’s a bit taboo to talk about it, but nevertheless, when students make a choice, it has implications,” said Amyot at the FMOQ.
But there are many intangibles, as well, like the political discourse that insinuates family doctors aren’t working hard enough while increasing the demands on them to make up for problems elsewhere in the health system.
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“Putting so many responsibilities on the shoulders of family doctors is very discouraging, generally speaking. We don’t see the light at the end of the tunnel where we can offer the service that meets the public’s expectations. Family doctors work hard and giving people the impression they don’t work hard, it profoundly hurts them. That’s one of the key reasons students don’t choose family medicine,” said Amyot.
“All the context brings us to the devalorization of family medicine. The difficulties, the paperwork, the constraints, cause a quadruple exodus of family doctors: an exodus to the private sector; an exodus to other provinces; an exodus to other specialities; and an exodus toward a premature retirement. It’s extremely worrying.”
So forget the “Top Guns” managing health care from the top down. Without more family doctors — and better working conditions to attract and retain them — Quebec’s ailing system will not be healed.
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