Quebec doctors say new bill will drive them away, threaten patient access
Province faces pushback for legislation aimed at getting physicians to see more patients
Doctors at a medical clinic in Kingsey Falls, a town in central Quebec, say they are contemplating closing their clinic and pivoting out of family practice — or Quebec altogether — if a bill allowing the province to regulate how physicians are paid is adopted as it is written.
Bill 106, tabled earlier this month, would link up to 25 per cent of physicians' pay to their performance in an effort to get them to take on more patients.
But in a statement posted to their social media, doctors at the Kingsey Falls medical clinic said the new rules would impose unattainable performance targets on them and reduce their ability to deliver quality care to patients.
"We can't take on more patients if we don't have more resources or a system that's more efficient and productive to be able to take good care of them," said Dr. Isabelle Lemieux, who works at the clinic.
As legislative hearings on the bill run their course, the clinic and others in the province are warning their patients that they risk losing their family doctor — despite Article 4 of the bill suggesting otherwise — and are asking them to write to their local MNA. The clinic has since deleted its statement and letter templates from its Facebook page.
Quebec's College of Physicians (CMQ) has condemned these types of communications after being confronted about them by Health Minister Christian Dubé during Tuesday's hearing.
"They transmit false information," wrote the college's president Mauril Gaudreault in a statement to Facebook.
In the halls of the National Assembly Thursday morning, Dubé said the college did the right thing by adding that "what is important are the interests of the patients."
But the debate rages on as doctors continue to voice their concerns, some echoed by the CMQ, about the bill's impact.
Gaudreault argues the bill and its title — An Act mainly to establish the collective responsibility and the accountability of physicians with respect to improvement of access to medical services — make explicit the government's attempt to place the burden of a well-functioning health-care system squarely on the shoulders of doctors.
What the bill changes — and what its blind spots may be
The bill proposes a mixed model of remuneration for family doctors: capitation payments (an annual flat rate per patient based on their level of vulnerability), an hourly rate for time spent with patients and a fee-for-service.
Part of their pay would also be tied to their collective performance based on targets set at the provincial and local levels.
Those targets aren't specified in the bill but could look like reducing waiting times and absenteeism rates as well as increasing quality of care, said Dubé at Tuesday's hearing, adding the targets would need to be discussed.
The president of the Fédération des médecins omnipraticiens du Québec (FMOQ), which represents family doctors, called the bill "catastrophic," warning that it will negatively affect accessibility to doctors.
"We need to stop evaluating the work of family doctors solely based on their clinical appointments because we're neglecting a whole lesser-known section of their work," said Dr. Marc-André Amyot.
He addressed the committee with a pair of family doctors who said the new rules would penalize the doctors whose colleagues chose to take on less work for mental health reasons or whose workload is underrepresented by Quebec's health insurance board's (RAMQ) compensation system.
"I work full-time all year, but the RAMQ thinks I work for barely four months," Dr. Benoît Heppell told the committee studying Bill 106, explaining that the hours spent training, doing administrative work or teaching aren't taken into account.
The province's four medical schools addressed the committee Wednesday raising a similar point. The bill, they say, does not recognize the time doctors spend with students during their training — 80 per cent of which is in clinics and hospitals.
They also want the government to pay physicians more for that training and put measures in place to prevent new doctors from leaving Quebec.
Heppell said the government's targets need to be tied to a promise of more resources.
Currently, there are 1.5 million Quebecers who don't have a family doctor, according to Dubé. "It's not about working harder, it's about working differently," he told the FMOQ.
For Roxane Borgès Da Silva, a professor at Université de Montréal's school of public health, the shift to capitation pay is good news. She says it encourages more collaboration and delegation between doctors and other health-care professionals and takes away the incentive for doctors to reach a high volume of appointments.
For example, under the proposed model, a physician wouldn't lose compensation for an appointment if a patient registered to them is treated by a nurse or physiotherapist instead.
Setting performance targets could help counter the shift away from productivity, said Da Silva, but they need to be the "right" ones and should be for all health-care personnel and not just doctors as the bill proposes.
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With files from Radio-Canada's Jean-François Dumas