Quebec family doctors skeptical of health minister's plan to tackle ER overcrowding

The federation of general practitioners of Quebec is worried about an influx of new patients at family medicine clinics while losing access to nurses.

On Tuesday, Quebec Health Minister Christian Dubé announced measures aimed at lifting pressure on the province's emergency rooms — including setting up specialized nurse practitioner (SNP) clinics.

According to Dr. Élyse Berger-Pelletier, who is part of the province's crisis team formed to tackle overcrowding in ERs, the move will help urgent care teams by directing patients who do not have a family doctor to other services.

About half of the some 10,000 Quebecers who visit ERs daily could be going elsewhere, according to Dubé.

Dr. Marc-André Amyot, president of the federation of general practitioners of Quebec (FMOQ), welcomes the minister's intentions, but raised concerns that the province is setting up the new clinics while also redirecting thousands of patients from ERs to family medicine groups (GMFs) through its primary care portal.

"What we're asking of family doctors is over capacity," he said. "Family doctors are already working very hard to give time to patients who don't have doctors."

As the FMOQ notes, Quebec is short 1,000 family doctors, while about 2,500 emergency doctors are also currently working in family medicine.

Two new SNP clinics in Montreal, Dubé says, are set to open in a few weeks.

Amyot says he supports family doctors continuing to work with nurse practitioners, but argues deploying those nurses in clinics of their own could create more staffing issues.

"We shouldn't take nurses in GMFs to open SNP clinics because we'd be undressing GMFs to dress SNP clinics," Amyot said.

For Amyot, re-deploying nurses from the private sector to the public health-care network would be another solution to the shortage.

Taking charge

Specialized nurse practitioners can usually take charge of patients and refer to a doctor when an acute episode occurs, said Luc Mathieu, president of Quebec's professional order of nurses.

For follow-ups, adjusting medication and other chronic illnesses, he says SNPs can often take care of patients themselves unless the condition goes beyond their area of expertise.

That's when they can refer patients to a doctor, pharmacist, social worker or another health-care professional.

There are currently around 1,100 SNPs in Quebec. In 2017, Philippe Couillard's Liberal government launched a program to train 2,000 by 2025.