Quebec proposal to reserve family doctors for vulnerable patients is a symptom of healthcare collapse

_{Quebec Minister of Health, Christian Dubé / Jacques Boissinot / Canadian Press}

I imagine I wasn’t the only one who did a double take when I skimmed through the recent exploratory report on patient management from the Institut national d’excellence en santé et services sociauxOpens in a new window.

The report suggests that family medicine appointments could be redistributed according to patients’ health status, a first in Canada. In other words, healthy patients would no longer necessarily be registered with a family doctor; instead, priority would be given to those who are already vulnerable and do not currently have access to a doctor.

The mere fact that this kind of measure is being considered makes it clear how severe the current access to care crisis is. Fortunately, Minister Dubé set the record straight a few days ago, clarifying that patients who already have access to a family doctor would not lose that access. Nevertheless, the situation is dire.

A predictable crisis

Regardless of the party in power, the Quebec government has known for years that the population was aging and that this would inevitably put increased pressure on the health care system. The Institut national de la santé publique Opens in a new window reports that in 2011, around 1 in 6 residents were aged 65 and over, and that if the trend continues, that ratio will reach 1 in 4 by 2031. Yet instead of planning health care and resources accordingly, successive decision-makers have stubbornly held on to the formula of one family doctor per patient, to the detriment of more appropriate models. That formula has long since become unsustainable, and the future is starting to look bleak as a result.

But there is hope. More and more, we’re seeing the benefits of team-based care, where care is provided by interdisciplinary teams of medical professionals. This innovative model promotes timely access to appropriate professionals and, crucially, helps maintain consistent knowledge of the patient’s health and history over time. Because that’s the real added value of having assigned patients, whatever their state of health: a relationship of trust that lasts for years. It’s been proven that having a consistent care team has a positive impact on health, compared to à la carte care—which, while of course better than nothing, is far from ideal.

As a family physician who takes emergency and hospital calls and has over 1,000 patients through a family medicine group, having a functional care team with the appropriate resources would be an incredible way to improve access to care for my patients and be more available to my vulnerable patients. That interdisciplinarity must be implemented in collaboration with physicians, not used as an excuse to restrict our practices.

Moving past cynicism

We can have a health care system that is accessible to everyone, at all times. We just have to recognize that the current model can no longer hold and be brave enough to push forward with modern, long lasting solutions. These solutions should make family medicine more appealing, reduce physician burnout, and improve access to care for Quebecers. Let’s not forget that a strong front line is the cornerstone of a good health care system.

We need to act now—for the sake of public trust in one of the very foundations of our society.

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Dr. Jean-Joseph Condé is a CMA French spokesperson and board member for Quebec.

This commentary was originally published on the Canadian Medical Association website.