Opinion: Fast-food approach to health care doomed to fail
With over 45 years of practising family medicine in Quebec, I cannot recall any provincial legislation that will have such far reaching effects as Bill 2.
Not only does it render GMFs (family medicine groups) and their family physicians responsible for adding an additional 1.5 million Quebecers to their rosters without additional resources, it adds an element of government oversight that is nothing short of draconian. Patients are to be colour coded by Health Ministry agencies according to their medical status; this designation will then determine their access level to care.
Santé Québec is being tasked with policing the profession to ensure GMFs and physicians adhere to new performance indicators. Make no mistake — performance is merely camouflage for seeing more patients, including all additional non-assigned patients (GAP) who now will be sent to a local GMF for care by any one of a number of different health providers.
The law transforms primary care into volumetric medicine, where seeing more patients is rewarded and quality of care becomes a liability. Family physicians with specialized practices in mental health, pediatrics and geriatrics, among other areas, could see their income fall up to 50 per cent.
Throughout my career, I — like my teaching colleagues — have always emphasized the importance for family medicine residents to be attentive, thorough, understanding and respectful during interactions with patients. Efficiency is certainly an element of working with patients in a GMF or office setting; however, it would be illusionary to believe that rushing a patient through their visit using a stopwatch approach to meet “quotas” will improve care.
Complex medical problems require time. Mental health management is not a dépanneur or fast food stopover. Being held to a government-imposed substandard of volumetric care will, in my view, potentially destroy the practice of competent primary care in Quebec and decimate the attractiveness of family medicine in this province. I do not know any colleagues who would be tempted to stay in a teaching role that trains our future physicians to this manner of practice.
Quebec already has a shortage of family physicians to meet the needs of its aging population. Care is more complex. Expectations are higher. Bill 2 will fail to improve access to quality care, contrary to what our politicians are trying to sell to the public.
Bill 2 must be suspended to allow a resumption of collaborative and non-menacing negotiations between the medical federations and the government. Barrelling ahead with this legislation with piecemeal government concessions is doomed to transform care in a manner that all physicians resoundingly deplore.
We must do better to resolve this impasse with the singular objective to reach an agreement that will establish a heath care delivery model that works for everyone.
Brian Gore is a Montreal family physician and former director of professional services at Donald Berman Maimonides Geriatric Centre in Côte St-Luc.
