An enticing promise, but with no guarantee of results
That’s the magic number everyone’s talking about: 500,000. It’s the number of patients without a primary care physician that family doctors have promised to take on by July 1. On paper, the commitment is impressive. But when you scratch beneath the surface of the agreement signed between Quebec and the Federation of General Practitioners (FMOQ), things get seriously complicated.
The problem? Nothing in the current text actually guarantees that these patients will be properly cared for. Committees will be created, to be sure, but specific performance metrics are conspicuously absent. Yet it is on this still-vague basis that the Legault government is drafting its bill, expected on February 28. This lack of clarity, incidentally, prompted former Health Minister Christian Dubé to resign on December 18. He criticized the agreement for maintaining the status quo on governance while granting doctors a 17% pay raise.
The major shift in compensation… with plenty of exit options
To adapt to an aging population, the payment method is changing. Is the fee-for-service model a thing of the past? Not quite. The idea is to introduce “capitation”: doctors will receive a fixed amount per patient, which will now account for 50% of their compensation. The remainder will be paid on a fee-for-service and hourly basis. François Legault is presenting this as a revolution that no other government had dared to undertake.
But watch out for the footnotes. According to our information, the list of doctors who can opt out of this new system is a mile long. Are you over 60? You’re out—to prevent early retirement. Do you teach? You’re out. Do you work in a walk-in clinic? You’re out, too. Even “young doctors” could say no, although no one yet knows how to define a “young doctor.”
Having a doctor “on paper” or having one in real life?
Let’s get back to our 500,000 patients. How are we going to make this happen? Quebec is putting an additional 137 million dollars on the table to keep the system running smoothly. A portion of that (49 million) is contingent on meeting the target. But don’t pop the champagne just yet. Of this half-million people, only the 180,000 most vulnerable patients (those with chronic illnesses or major health issues) will have a designated doctor in a Family Medicine Group (GMF), as Minister Sonia Bélanger assures us.
And the others? They’ll have a “group registration.” Basically, you’ll be affiliated with a service (the Primary Care Access Center), but not necessarily with a specific individual. Medical sources fear the worst: patient lists artificially inflated to qualify for bonuses, but patients who can never get an appointment. There are concerns about assembly-line consultations or “phantom access.”
The government has indeed provided for penalties (a 27-million deduction) if targets aren’t met, but again, the criteria for failure haven’t been defined. Damien Contandriopoulos, from the University of Victoria, points out that the technical challenge is immense for the RAMQ, whose IT systems are already struggling to keep up. Ultimately, the budget to pay our general practitioners will exceed 3.4 billion per year by 2028. It remains to be seen whether the service will live up to the cost.
500,000 patients treated: Why the devil is in the details
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