Doctors slam Bill 20

By Joel Ceausu

Many of Quebec’s family doctors will soon forfeit salary and reduce working hours, with some considering early retirement, rather than abide by the Liberal government’s Bill 20, according to Dr. Michael Kalin.

Health Minister Gaétan Barrette’s reform bill, if adopted as is, will introduce financial penalties for doctors who don’t see a certain number of patients, rules that will punish any doctor that works less than full time; something the Côte St. Luc doctor says is counter-productive, coercive and will lead to ‘assembly line medicine’.

Apart from the bill’s new guidelines on in vitro fertilization guidelines that many critics describe as draconian, the biggest objection is to how it treats Quebec’s corps of General Practitioners.

“A family physician is not a radiologist,” the medical director of GMF Santé Kildare told The Suburban. “Barrette is taking a radiologist approach. A radiologist can look at films all day every day, but for a family physician to care for a patient takes time, conversations, getting to know them, whether it is taking care of kids, the vulnerable, or mental health patients takes time; it’s easy to say see more patients but do we want doctors working 15-hour days?”

The president of the 8,000-member Fédération des médecins omnipraticiens du Québec (FQOM) said Bill 20 “smacks of ignorance and disdain for the work of Quebec’s family doctors and absolutely dehumanizes the practice of family medicine by transforming it into assembly-line work.” Dr. Louis Godin maintains. “(Barrette) proposes penalizing family doctors who take on and follow sicker patients as well as doctors who take more time with their patients.”

Barrette has intimated that Quebec’s doctors don’t see as many patients as they should, but Quebec’s GPs counter that the province puts too heavy an obligation to work in a hospital setting in addition to seeing patients in clinical practice.

Deterring young and old

Godin says the bill will “impose unrealistic patient quotas on each family doctor and prolonging Quebec family doctors’ obligation to work in hospitals, which is a reality unique in Canada.”

The FQOM is warning the Bill could lead to shorter medical consultations to meet patient quotas, greater difficulty treating vulnerable patients; steering medical students away from family medicine; and premature retirement of family doctors approaching the end of their careers.

Kalin says the new regime will discourage young doctors from setting up practice in Quebec, and may even push older doctors into retirement.
“It will deter young and old: If you’re 67 years old and work four days a week; would you accept a 30-percent pay cut or just retire? If you are a young graduate and want to work less hours and will be paid less? Most doctors I know will fight tooth and nail but in the end would rather take a pay cut and work fewer hours. For senior doctors in their 60s and 70s, I would not be surprised if they just closed up shop.”

“The family doctor of today is not the doctor of 40 years ago,” he says. “Back then, doctors were predominantly male and worked much longer hours than the physician today, who is usually female, much more family-oriented and—while committed to her practice and patients—is unwilling to put in the same hourly commitment.”

“Many graduate in their late 20s and want to have families,” says Kalin, who counts 20 women among the 25 doctors in his two-year-old Groupe de médecine de famille (GMF), which provides comprehensive care for 18,000 registered patients. “They will have a hard time reconciling this with the practice of medicine,” he says, agreeing that young doctors are not the type of citizen you want looking for greener pastures.

Kalin says the answer is best found in his own GMF experience, based on the plan brought in under former health minister Philippe Couillard a decade ago. “We have greater resources and by working as a group we can cover for those doctors who take maternity leave or time off. It’s the right way to go, and we are starting to see the fruits of our labour now,” he says, noting that the group began with only two doctors in 2012.

“Yes there are doctors out there, and everybody knows one, who sees few patients, takes more vacations, or is just generally not as accessible as they should be. Believe me it makes me sick too, but this is no solution for that, which can be resolved without punishing the entire system.”

Kalin says the reform is based on “unrealistic and outdated models; it’s hard-handed, it’s counter-productive and ultimately, it really misses the mark.”

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