Quebec tables bill that would force family doctors to take appointments from patients on waiting list

Quebec City -

The Legault government is giving up, at least for now, on provoking a confrontation with family doctors.

With the next election campaign approaching, it has chosen to put on ice, at least for a few months, its threat to force general practitioners to take more patients under their wing, preferring to adopt a new approach focused on management rather than punishment.

Contrary to the government's rhetoric in recent months, there will be no obligation of results, nor any specific target for the minimum number of patients per physician in Bill 11, tabled Thursday by Health Minister Christian Dubé.

Quebec is also postponing a major irritant for physicians, namely the prospect of having to suffer possible financial penalties or sanctions related to the objectives pursued by Bill 11. The government prefers to give itself time to see how general practitioners will respond to the proposed new directions.

Bill 11 is quite technical and essentially aims to do two things: first, to provide detailed data on medical practice on a local and regional basis, and second, to require physicians to make a certain number of time slots available, which may vary from one region to another and from one physician to another, allowing them to see patients who do not have a family physician thanks to a modified appointment scheduling system.

Quebec would like a patient to be able to see a physician within 36 hours of making an appointment.

"If the expected collaboration of doctors does not manifest itself in the next few months, Minister Dubé reserves the right to move on to another step," he said at a press conference, without specifying what he was referring to. A parliamentary committee is scheduled to study the bill in January.

1.5 MILLION QUEBECERS WITHOUT A FAMILY DOCTOR: DUBÉ

When the government took office in 2018, there were 400,000 patients without a family doctor in Quebec. According to the most recent data, it was believed there were now more than double that number, between 800,000 and 850,000, forming an ever-growing waiting list. But Dubé said Thursday that the most accurate figure would probably be around 1.5 million patients on the waiting list. 

In 2018, during the election campaign, Premier François Legault pledged to guarantee a family doctor to all Quebecers before the end of the mandate. On Thursday, despite the obvious, Minister Dubé would not say that this commitment would be on the list of broken promises by his government, now in its fourth year in office.

Still with the goal of facilitating access, Legault had also committed to changing the way doctors are paid, by favouring a mixed mode based in part on fee-for-service payment, as is currently the case, and on the number of patients seen. The change has still not been made and also appears to have been put on hold, Dubé said on Thursday.

Contrary to what he had claimed recently, the Legault government has agreed to continue to negotiate with the Fédération des omnipraticiens (FMOQ) in order to obtain the support of the medical profession for the new approach advocated by Bill 11.

For years, the issue of access to family physicians has been one of contention between the government and the FMOQ. 

Quebec believes that too many family physicians are neglecting to treat large numbers of patients in their offices. The FMOQ counters that the average family doctor already works 45 hours a week, forced by the government to diversify their practice away from the office and into hospitals and long-term care facilities. Some have teaching duties. It is also worth noting that one in four physicians is over 60 years of age, an age when one might consider reducing their hours of work, not increasing them.

In recent months, the premier has threatened legislation to force doctors to take on at least 1,000 patients on several occasions. He had set the tone by stating that he had the names of physicians who did not meet this minimum standard, based on a list obtained from the Régie de l'assurance maladie du Québec (RAMQ), which was criticized by the FMOQ. 

The access issue is not new. In 2015, former Liberal minister Gaétan Barrette had passed Bill 20, which provided for financial penalties of up to 30 per cent of remuneration, if physicians defied the government by not meeting the targets set by Quebec.

In the end, the Couillard government backed down and the penalties were not applied.

This report by The Canadian Press was first published in French on Nov. 11, 2021.