Quebec family doctors will make more money — if they see more patients

The Quebec government is offering thousands of dollars in bonuses to encourage family doctors to take on more patients.

The initiative, a partnership with the provincial federation of family physicians, means doctors who see a total of 750 patients a year will get an extra $7,500 yearly, and those who see 1,000 patients will get $15,000.

They will be paid using $46 million set aside by the Couillard government.

Doctors who take on vulnerable patients, such as seniors, people with chronic illnesses and mental health patients, will see those bonuses doubled.

The goal, said Health Minister Danielle McCann, is for 175,000 more Quebecers to have a physician.

"I think there's a will with the family doctors to evolve in terms of the way they practise family medicine, in the sense that they will rely more on the multidisciplinary team," she told CBC Montreal's Daybreak.

The hope is that members of those teams, such as nurse practitioners, will be able to take on more tasks, freeing up the doctor to see more patients.

Right now, family doctors are expected to spend 40 per cent of their time treating patients in hospital, but McCann said the government is working with the specialists to see if they will step in to help free up family doctors.

They will also want family doctors to budget half of their work days toward seeing patients.

1,000 patients per year reasonable, says doctor

Dr. Paul Saba, a family doctor in Lachine, thinks that it's realistic for most of Quebec's family doctors to see at least 750 patients a year.

Saba already sees just over 1,000 patients a year, and hopes to take on an additional 100 patients each year going forward.

"I had patients who asked to be seen because they'd been on a waiting list at the CLSC, they couldn't be seen. I felt a commitment, I couldn't ignore the needs of the community," he said.

Saba thinks the government's plan will encourage other doctors to do the same. 

"I think we work better with incentives than disincentives," Saba said.

He's added two hours, on average, to his workday and has changed his schedule to allow for more time to see new patients.

He says that he hasn't had to shorten the time he spends with each patient, and is still able to follow up with each of them as needed.

"There's always a way of adjusting your schedule, and I still allow myself time for lunch, so it's not unreasonable," said Saba.

"I'm not saying that everybody can, but there will be enough physicians in the community who will see this as an incentive and will roll up their shirt sleeves and say, 'You know what? I can do it.'"

A new payment system

Premier François Legault, who has criticized bonuses for doctors in the past, said his issue was with the pay of specialists, who he said are "overpaid."

He said the government is moving toward a system called capitation, whereby family doctors are compensated based on how many patients they have and the number of services provided, instead of predominantly on the services provided.

Dr. Louis Godin, president of the federation of family physicians, said he believes the move will have a positive effect on doctors and their ability to take patients.

But while he believes the goal of getting 175,000 more people a family doctor is attainable, he wouldn't go so far as to guarantee it would happen.

"We will do our best to take the most patients [as possible]."

'Ridiculous,' former health minister says

Liberal MNA Gaétan Barrette said this plan rewards doctors for enrolling patients, but doesn't oblige them to actually see those patients.

"Basically, it is ridiculous. It's back to the future. It's exactly the same thing that was in place before that didn't work," he said.

In 2011, then-health minister Yves Bolduc, who is also a doctor, introduced a similar bonus system. He eventually found himself in hot water after benefiting from those premiums. 

Barrette changed the system when he became the health minister because he believed it to be ineffective.

In 2015, he introduced Bill 20, which would have implemented patient quotas for general practitioners. He eventually reneged on that plan, and gave the GPs until the end of 2017 to make sure 85 per cent of Quebecers had a family doctor or their salaries would be cut.

Barrette said his plan was based on doctors enrolling and seeing patients.

The doctors did not meet the 85 per cent target.

Parti Québécois interim leader Pascal Bérubé said instead of offering bonuses, the government should give more power to every health professional across Quebec, in order to spread out the responsibility.

"They're going to take the money, they're not stupid … but that's not the solution," he said.