Don't have a family doctor? It could be because you live in Montreal

Human rights lawyer Julius Grey is continuing his battle against Quebec's family physician allocation system.

He is expected to be heard by the Court of Appeal on Thursday morning in Montreal in the hope of having the measure declared unreasonable.

All general practitioners (GPs) in Quebec's public system must uphold a notice of compliance allowing them to practice in a region determined by the Ministry of Health and Social Services (MSSS).

This authorization comes with the obligation to carry out "at least 55 per cent of their billing days" within this zone, as specified on the government portal.

These are known as "plans régionaux d’effectifs médicaux" (PREM).

The government says the goal is to balance the presence of GPs across all regions to achieve an 85 per cent take-up rate.

However, according to Dr. Mark Roper, represented by Grey, the calculations used by Quebec are simplistic, unrepresentative and based on erroneous data.

As a result, he says the Island of Montreal is at a significant disadvantage.

According to information presented by Roper at a conference this week, Montreal is the region with the lowest registration rate with a family doctor in Quebec as of Dec. 31, 2021.

It stands at 68 per cent compared with 75 per cent in Montérégie, which had the second-lowest rate.

The best-served regions are Saguenay-Lac-Saint-Jean at 91 per cent and Gaspésie-Îles-de-la-Madeleine at 89 per cent.

Even at the sub-regional level, the five worst enrolment rates are on the Island of Montreal -- eight of the last 10 places among the 129 Quebec sub-regions.

However, doctors argue the MSSS is not considering these figures when determining how it distributes its medical staffing.

Rather, the government weighs the population living in a region and the number of doctors practicing there.

In Grey's opinion, this is downright "absurd."

He criticizes Quebec for ignoring patients' right to mobility -- that is, patients being allowed to consult a doctor in the region of their choice, regardless of where they live.

As a result, the metropolis, which attracts thousands of workers from the northern and southern regions, is seeing its patient pool swell.

The lawyer also points out that the presence of tourists, diplomats and refugees, who sometimes need care, must be considered.

According to Grey's arguments, general practitioners in Montreal are also busy with responsibilities aside from office-based family medicine, such as being employed by specialized institutes or research centres.

Contrarily, Quebec City includes this in its calculation.

In an interview with The Canadian Press, Grey explains that he wants to attack the PREM system on two fronts.

Firstly, he wants to demonstrate that this criterion is an "unreasonable" administrative decision based on a ruling by the Supreme Court in the Vavilov decision.

The directive determines that an administrative decision must be understandable, reasonable and made in accordance with the rules of natural justice.

Grey is also alleging that the current version of the PREM contravenes section 7 of the Canadian Charter of Rights and Freedoms, which protects the "right to life, liberty and security of the person."

He says he intends to demonstrate that the risk of mortality increases significantly among people who do not have access to a family doctor. Therefore, limiting the number of permits granted on the Island of Montreal would harm its population.

Moreover, he states the Health Ministry exercises a discretionary right to modify the number of places granted to a region without justification.

According to data compiled by Roper, Health Minister Christian Dubé cut 30 general practitioner positions in Montreal in 2021 and a further 15 in 2022.

In her first-instance judgment, dated Sept. 8, 2022, Superior Court Judge Dominique Poulin concluded that the "allocation exercise" fell "within the scope of the expertise, knowledge and information available" to the ministry and the minister.

She stated she did not have the data to question their decision or qualify it as unreasonable.

This time, Grey hopes to convince a three-judge panel.

If he is successful, the Court of Appeal could force the government to review its allocation system.

This report by The Canadian Press was first published in French on Oct. 25, 2023.

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