Quebec minister says Montreal family doctors don't work enough, shifts new jobs to suburbs

Montreal -

Not only politicians but some Montreal doctors are angry after a sudden decision to move 30 doctor positions from the city to the nearby suburbs—which the health minister defended by saying Montreal doctors just aren’t working hard enough.

“My patients will say that the phones are always busy, it's hard to get through, because we have such a deluge, such a demand,” said Dr. Michael Kalin, a family doctor working in Cote-St-Luc.

“We're in the midst of a global pandemic, more than 18 months in—some of us have not had the time to grieve because we're trying to do our best to fill in the gaps,” he said.

“Your doctors would love to take on more patients, we get asked every day, but we want to do the best job that we can.”

The decision by Health Minister Christian Dubé, which ran contrary to the plans provided by the office that does these kinds of medical staffing calculations, has already sparked a legal challenge that could upend the province’s whole system for allocating doctors to the various regions.

And the Liberals accused him of playing politics with Quebecers’ health, doing a favour to Montérégie because its voters tend to support the ruling CAQ party.

In Montreal, “we only have 69 per cent that have that have a family doctor… versus 77 per cent of the people in Montérégie that have a family doctor,” Quebec Liberal leader Dominique Anglade told CTV on Friday, a day after the new plans were published.

“I think [the reallocation] is purely related to the fact that they're looking at their constituents,” said Anglade.

“That’s what it looks like, and if it's not based on that, then they have to tell us what is it based on, because there's no logic behind it.”

Dr. Mark Roper, a Montreal family doctor and the director of the primary care division at the McGill University Health Centre's department of family medicine, says nearly 650,000 people in the city don't have a family doctor, more than in any other region of the province.

DUBE: MONTREAL DOCTORS’ WORK ‘IS NOT ENOUGH’

The regional medical staffing plans, known as PREM, had provided for 102 new general practitioners in Montreal in 2022.

After Dubé’s involvement, this number was reduced to 72, while the number of family doctors promised to Montérégie, which includes the South Shore suburbs, rose from 67 to 90.

A few other regions also benefited in the late-day adjustment, but to a lesser extent. The Laurentians will now be up seven doctors from what was planned, Lanaudière will have an extra eight, and Laval will have nine.

The newspaper Le Devoir first revealed the change.

Dubé defended his decision in the National Assembly, implying that Montreal doctors aren’t working hard enough and should take on more patients.

“The support from the doctors of Montreal, it is not enough,” he said.

“It's not just a question of adding more doctors, it’s to respect the commitments that these doctors must make in relation to the clientele of the Island of Montreal.”

He also said that suburbanites are often forced to go to the city to get medical care and should have providers near their homes. A quarter of the residents of the 450 area code for the regions surrounding Montreal are in this situation, he said.

He said the accusations of political interference have things backwards, saying the decision was not a question of “partisanship” but of “common sense” and political “courage.”

“Me, with my team, we made a choice to send 30 more doctors to the 450, because it was the right thing to do,” he said.

Asked on Friday if his decision was political, Dubé told reporters, "I'll say one thing: if taking care of people in 450 is political, this is a political decision."

Dubé said doctors in Montreal need to take on more patients.

"I'll be very clear: we need to treat every Quebecer the same way, and when I have statistics that prove there are less doctors in those regions and they should be treated as fairly as any other citizen in Montreal or elsewhere, I'll make those decisions," he said.

In her interview Friday, Anglade challenged him to prove it, showing all the statistics.

“What is that based on, what is the logic behind it? We don't know. And that's the issue,” she said.

“The issue is that when making decisions without the basis of science or the expert committees, that they don't consider anything else but their own opinion.”

THERE ARE MORE DOCTORS, SO WHY THE WAIT LISTS?

Dubé is not wrong that younger doctors, trained more recently, have far fewer patients than their older counterparts, but that’s a well-established pattern happening across the country, not just in Montreal, for several reasons.

A major one, Kalin said, are that newer doctors tend to spend more time with patients.

Doctors are much more likely to be women now than in the past, and whichever gender they are, to have family duties that don’t allow consistent overtime.

“A generation ago, you had a doctor who was male, who worked 60 hours a week, and they had 4,000 patients,” he said.

“Nowadays you have a family doctor, which is much more representative between male and female, more responsibilities at home.”

Now, as well, “this has been combined with demands from the hospital, working in home care, seeing COVID patients,” he said.

“Also, today, patients are more educated, you know—we don't have that paternalistic approach anymore. You don't come to see me and I tell you what to do and it takes five minutes,” he said.

“We’re certainly not lazy.”

He also pushed back on Dubé’s suggestion that doctors simply add more patients, even if it means changing some of these methods.

“If we take on more and more patients, it means we're going to do bad medicine,” he said. “That doesn't mean that we’re going to provide better care to more people, it means we’re providing quick medicine, fast-food medicine, to the population.”

Anglade said she also worries that further increasing the wait list for a family doctor in Montreal will put put even more strain on hospitals.

“It's going to have an impact on our emergency rooms, because if you don't have family doctors, what you do is you go to the emergency [room] when you don't need to go to the emergency,” she said.

LEGAL CHALLENGE TO QUEBEC'S DOCTOR CALCULUS

After the news this week, Montreal-based civil rights lawyer Julius Grey said he will ask a judge to suspend Quebec's entire system for determining how many family doctors can practice in a specific region.

Grey told reporters Friday the system is unconstitutional and he plans to file a court challenge next week to have the placement system suspended. 

"I hope, certainly, that they will set aside these administrative changes and that they will declare the system … inoperative," he said. "I don't think you can give (the government) much time because it's so urgent."

Grey said the system Quebec uses to distribute doctors around the province is arbitrary and unjust and the lack of access to a family doctor in certain regions of the province violates the right to security of person. It also has a negative impact on mobility rights, he added.

-- With files from The Canadian Press