Quebec has too many doctors not accepting enough patients.
That’s the assessment of Quebec Health Minister Gaetan Barrette, who said he may pressure medical schools to slightly reduce admissions in the next few years.
He's thinking having the schools accept 30 to 50 fewer students each year.
With 20,000 practicing physicians, Barrette said there are about 10 per cent more doctors than necessary.
“It’s been known for years that on a per capita basis, we have more doctors than anywhere else in Canada,” he said.
"With the numbers we have, we have enough doctors to provide services, that's for sure."
Barrette said part of the issue is that not every doctor works full-time, or accepts as many patients as possible. The Health Minister said that should change because of new legislation and agreements.
"Bill 20 has been tabled and adopted because of that. So the burden is definitely on their shoulders, and that's their engagement. they engaged themselves to solve this problem by December 31st, 2017," said Barrette.
Here’s how the math works out:
Quebec’s four medical schools admit more than 900 students a year, releasing some 850 graduates, the largest cohort in the history of the province. The same pace will continue for several years.
About 500 physicians retire every year, the province estimates, generating a net 350 doctors per year added into the health network.
Because of the overflow, Barrette said he would like to gradually reduce admissions to medical school in 2018 or 2019, because the province’s health ministry can’t sustain 30,000 doctors.
“Were not talking about many doctors, but we need to address that, because there are implications 10, 15 years down the road,” he said.
At the current rate, more than 1,000 new doctors could end up on the labour market before Quebec's changing population reduces the number of medical patients, and the surplus could reach as high as 3,000.
Dr. Mark Roper said managed Quebec's medical manpower is complicated.
"We have an aging population that requires more and more doctors every year, our population is increasing every year, the new generation of doctors with feminization work slightly less than the outgoing generation so all these things have to be adapted to," said Dr. Roper.
He believes that because of part-time doctors, Quebec should actually increase the number of general practitioners.
"If we did move all those doctors out of emergencies, out of long-term care institutions, out of wards in the hospital, we probably would have enough family doctors in the province," said Dr. Roper.
"Because we're used to this structure what do you replace them with? And that is the problem."
Patients’ rights advocate Paul Brunet said he agreed with Barrette’s assessment that there are too many doctors, adding that there’s another problem keeping people from get access to doctors.
“We agree with him, that we have as many doctors as we need in the population as there are in other provinces. Our problem is that still even though we’re raising the salary of our doctors, we don’t get more efficiency. We still have a problem with accessibility. I’m not saying the doctors are fully responsible for the problem, but they are part of the problem,” he said.
Adopted last year, Bill 20 had initially aimed to force penalties on family doctors if they didn't meet a patient quota, but Barrette backtracked on that proposal after a backlash from the Quebec Federation of General Practitioners.
The compromise was that quotas would be taken off the table for two years – if GPs made sure 85 per cent of Quebecers got a family doctor by the end of 2017.
The onus is now on the doctors to adjust and for those doctors who are not already, to take on more patients, said Barrette.
“When I tabled it and adopted (Bill 20), we had enough doctors at that time that were not providing the correct amount of care… to the public. Access was not there,” he said “The burden is definitely on their shoulders.”
He said doctors who do not meet their quotas will be penalized.
