Record number of Quebec doctors left public system in last year

More Quebec doctors are opting out of the public health-care sector than ever before, Radio-Canada has learned. 

A total of 780 general practitioners and specialists left the public system in the past year — an increase of 22 per cent compared to the year prior, according to data compiled by the Régie de l'assurance maladie du Québec (RAMQ).

"I think we're in serious trouble," Dr. Isabelle Leblanc, president of Médecins québécois pour le régime public (MQRP), said of the numbers, which were first reported in the Montreal Gazette. 

"On the one hand, the government is saying, 'Yes, there aren't enough doctors, we're going to train 600 more a year,' but at the same time, 780 of them are going to the private sector."

The Fédération des médecins omnipraticiens du Québec (FMOQ), which represents more than 10,000 family physicians, described the situation as "deplorable." 

"[The situation] is unfortunately attributable to the growing constraints imposed on family doctors in the public network," the federation said in a statement. 

"Doctors completing their studies would like to practise according to their field of interest in their region, according to the needs of the population. However, the system is increasingly directing their work and reducing the flexibility of their practice by virtue of constraints that date back more than 25 years."

Why are so many doctors leaving public system?

Leblanc says the exodus can be attributed in part to a campaign by private clinics to recruit doctors. 

"I teach residents who are specializing in family medicine, and from the very first day of their residency, private clinics are soliciting them to work with them afterwards," she said. 

Working conditions in the public system are also much more demanding than in the private network.

"It's a quality of life choice. There's no on-call duty. We don't work nights or weekends. The schedule is from 9 a.m. to 5 p.m. Patients are less sick because they work, are healthy and have the money to pay. It's a much lighter practice," said Élise Girouard-Chantal, a graduating family medicine resident and MQRP board member.

Another issue is the restrictions the Quebec government imposes on doctors, particularly in terms of restricting where they can practise, Girouard-Chantal says. 

"The restrictions are so intense that it's almost impossible to choose where you want to work and with which clientele," she said. 

Health Ministry warns against misinterpreting data

In a statement, Quebec's Health Ministry said not all physicians who left the public sector moved to the private sector.

It said this number also includes doctors who are on sabbatical, for instance.

"The percentage of non-participating physicians [in the public sector] increased, but only slightly, from 2.16 per cent in 2020 to 3.37 per cent [today]," the ministry said.

"This means that approximately 97 per cent of physicians in Quebec are participants. So, despite an upward trend in non-participating physicians, it remains a marginal practice."

What needs to be done to retain doctors?

Paying doctors more money wouldn't make any difference, according to Leblanc.

"Doctors are very well paid in the public system. It's really more a question of working conditions," she said. 

She says improving the working conditions of nurses, orderlies and other health-care workers is the way to start, because without retaining these essential personnel, doctors can't provide adequate care in an enjoyable working environment.

In short, she says, the more people the private sector attracts, the less efficient the public system becomes, and the less attractive it becomes to work there. 

Girouard-Chantal says successive government decisions have gradually opened the door to private health-care in Quebec.

For example, Quebec is the only province where new doctors, at the end of their studies, can choose between public or completely private practice. In the other provinces, laws prohibit exclusive private practice.

"We've organized the front line around family medicine groups that are private-public partnerships, we subcontract surgeries to the private sector, and we've de-insured certain services: psychotherapy, physiotherapy. This gives the private sector room to grow," Girouard-Chantal said.

According to a report by Radio-Canada in August 2023, in an attempt to reduce surgical waiting lists, a dozen Quebec health-care establishments issued calls for tenders to outsource more than 600,000 medical procedures to the private sector over the next five years, for a total of nearly $500 million.

But MQRP insists that a migration of the health-care system to the private sector is not a viable long-term solution.

"Private clinics are there to make money, not to provide care. They more or less take the patients who are richer and healthier," said Leblanc.