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What's gone wrong: More than 800,000 Quebecers wait for family doctor

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Four years ago, the CAQ promised a family doctor for every Quebecer, but in the last election campaign, it had to admit that wouldn't be possible, which has left many people feeling lost in the system.

Gevevieve Charrette has been on the waiting list for a family doctor for over a year, ever since she learned her doctor was switching to a specialty and giving up her family practice.

"Especially at this time, of the age I am at right now, I'm probably in perimenopause, and I think it's the time I would need the follow-up of a family doctor and go through that process in the upcoming years, but I'm left alone," she said.

According to the health ministry, Charrette is one of 864,062 Quebecers on the waiting list for a family doctor, a list that has more than doubled since 2018.

The head of the Primary Care Division at the MUHC, Dr. Mark Roper, says a full-time family doctor will make more than 2,000 diagnoses per year, everything from high cholesterol, to hypertension, to diabetes. By catching conditions and illnesses early, family doctors can prevent life-threatening complications such as stroke and heart attack, he said.

"For every 100,000 people who do not have a family doctor, we observe an increased mortality of 60 per year," he said, adding that would mean 360 Montrealers die each year because of lack of access to a family physician.

MAJOR HURDLES TO OVERCOME

Roper says one of the larger issues is an unequal distribution of family doctors across Quebec. The province dictates where doctors can work, based on need, through a permit system known as PREM.

In recent years, the CAQ has reduced the number of doctors who can work in Montreal, though Roper said there aren't enough family physicians in some parts of the city.

"We're at about 68 per cent [of people with a family doctor] on average across the island," he said, adding some neighbourhoods in central and downtown Montreal, only hit 58 to 60 per cent.

The province isn't accounting for what's known as 'portability of patients' when it looks at its data, he explained, so it only counts the population of people living in a given neighbourhood.

"What's happening is a lot of people work or study in Montreal, but they live in the 450 area, the suburbs -- but they still have a doctor in Montreal," he said.

By his estimate, around 388,000 non-Montrealers are registered with Montreal family doctors.

Quebec's family doctors are also retiring at a much faster rate than they're being replaced, said Dr. Alain Papineau, the president of the Quebec College of Family Physicians.

"We're barely replacing the ones that are leaving," he said, adding 24 per cent of doctors are over 60 years old, and medical students aren't necessarily choosing to specialize in family medicine.

"If you want to go to Montreal and there's no [positions] in Montreal you'll be offered a position in the regions somewhere, not necessarily what you want to do and not where you want to go," he said.

He also believes some students are turned off by that lack of flexibility in the system, and seeing doctors struggle to achieve work-life balance. The relationship between physicians and provincial governments over the years has often been tense, with doctors pressured to take on more patients and with some politicians suggesting they don't work hard enough.

"Physicians are tired. They've given their maximum for COVID, and they're just overwhelmed with their practices right now," said Papineau.

ACCESSING HEALTHCARE FOR CHILDREN

Many parents in Quebec are also struggling to access care for their children, especially in situations that may not require a trip to the emergency department.

Across the province, 427,763 children are without a family doctor.

Philippa Bell's children, ages 5 and 9, fall into another category entirely: those who have a doctor, but who are under-served.

She says their pediatrician is excellent; however, they're almost always booked solid when they try to make an appointment. When their children are sick, Bell and her partner spend a lot of time on the phone and online, trying to get an appointment at another clinic.

"It's stressful because when it's so difficult to have access to care, you don't want to take your child if you don't need to take your child. However, as a non-doctor, how are we supposed to know what is really urgent and what's not?" she said.

Papineau said all children don't need to be followed by one family doctor or pediatrician, though he understands that would be reassuring for parents.

"[Children with] chronic illnesses, asthma, for example, I think those children should have follow-up by a physician or family physician in a team," he said.

Dr. Laurie Plotnick, who heads the emergency department and the Montreal Children's Hospital agreed, adding someone should be following children, but that could be a team of doctors within a family medicine group or nurse practitioners.

"A health-care practitioner who can assess them, follow them, treat them," she said, and added expanding those types of clinics in the Montreal area is difficult because there isn't enough staff. Primary care practitioners already see a huge volume of patients, and there's a shortage of nurses and other health-care workers provincewide.

The province set a goal in the spring to register 375 000 people in Group Family Medicine clinics by De. 31. Today it says it has surpassed that goal, registering 388,284 people. It’s aiming to get the number to 500,000 by March 31, 2023. 

With many respiratory viruses circulating and hospital emergency rooms overwhelmed, Plotnick recommends checking the Montreal Children's Hospital website for tips on determining if your child needs to go to the ER.

"Certainly a child who's having trouble breathing, not just a stuffy nose, but they really look like they're using all their muscles to breathe," she said. "They're very sleepy when they shouldn't be. Kids are quieter with a fever, but I'm talking about kids who are difficult to wake up when they should wake up. [Children] who are dehydrated, very dry mouth, not urinating, children with head injuries, sleepy, very, very bad headache -- those are kids we need to see."

Plotnick also recommended parents return to preventative measures with their children, such as frequent hand-washing, getting the flu vaccine, keeping children home from school when they're sick, and wearing masks.

MITIGATION MEASURES

For Roper, introducing family medicine groups and super clinics into the health-care network has been a positive change in improving access to care. Not everyone needs to be seen by a doctor, or the same doctor, at every visit, he added. The clinics combine doctors, nurses and other health-care professionals.

The province has also expanded the 811 Info-Sante phone line to include a primary care access point, known as the GAP, to help direct people to the appropriate health service, to ease pressure on emergency rooms.

For children, 811 also includes a feature based on the 'One Call, One Appointment' hotline set up for parents during the Omicron wave. If it's determined a child needs a consultation, someone will help parents book an appointment with the appropriate resource, be it a doctor, nurse or pharmacist.

Last week, Quebec’s health minister said 811 was "working well" but there weren't enough people staffing the phone lines. Christian Dube called for retired and private agency nurses to sign up at the province's Je Contribue site to help with the busy phone line, noting they could use around 5,000 nurses. 

The province is also opening two specialized clinics in Montreal where people can see nurse practitioners.

Ultimately, it will take a full review of the health-care system, to really improve access to care, Papineau said.

Until that happens, Charrette is still holding onto hope she'll be paired up with a new family doctor.

"Just someone who will have my background history, someone who's able to do all the needed follow-ups, someone who will know what happened in the previous months and years," she said. 

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