Hanes: A bitter pill to swallow as Quebec's family doctor shortage deepens

Montreal Gazette

06-08-2025

The lack of access to a family doctor is one of the Quebec health system's chronic problems.
And despite all the government's attempts to cure the ailment, the prognosis only seems to get worse.
The latest checkup by the Institut de la statistique du Québec revealed how much the situation has been deteriorating. It shows the proportion of Quebecers assigned to a family physician dropped to 72 per cent last year from 82 per cent in 2019. And that was actually a high for the decade. It had climbed steadily from 66 per cent in 2013, but then drooped again over the past five years.
Like most chronic conditions, the causes are no mystery.
According to the ISQ, the main reason is that there are still more physicians retiring or leaving the public health system than are being recruited into family medicine.
But that doesn't tell the whole story.
First off, newly minted doctors have other responsibilities the health system depends on, like working in long-term care, birthing centres or emergency rooms. So the new recruits being counted on to provide relief have less time to see patients in their offices.
But beyond time constraints, young doctors have been giving family medicine the cold shoulder in recent years, despite the government opening up more residencies in the field.
This year, 69 residencies in family medicine went unfilled in Quebec, out of 94 in Canada, after the annual matching process. Last year, 70 of 75 empty family medicine spots in Canada were in Quebec. Over time, those absences have added up to around 700 new recruits missing in action, by some estimates, out of a shortage of nearly 2,000 physicians across Quebec.
While all provinces face challenges finding enough family doctors, there are other complications in Quebec.
These include physicians having to perform those extra duties, known as Activités médicales particulières, as well as having to obtain a special permit (PREM) dictating where in the province new physicians can hang out their shingle. These extra hoops, which limit mobility and exist nowhere else in Canada, have become major deterrents for medical students choosing family medicine. So many fresh graduates end up leaving Quebec to practise, or go to work in private health care, in order to avoid the hassle.
Many of the remedies the government put in place to improve access to a physician have actually compounded the scarcity.
As the ISQ noted, the assignment of orphan patients to family medicine groups through the Guichet d'accès à un médecin de famille, or GAMF, has also contributed to the declining ratios. Those patients do have some access to appointments, but they don't figure into the tallies of Quebecers followed by a family doctor.
On top of that, the Guichet d'accès à la première ligne (GAP), which allows orphan patients to find urgent appointments with a general practitioner rather than having to clog up the ER, is also sucking up physicians' time, depending on how many appointments they open up for walk-ins compared to their own patients.
The GAP may give patients access to a doctor for their urgent health needs, but it has undermined the whole premise of family practice — not to mention preventive health care. This fast-food ethos has made family medicine even less attractive.
But as efforts to resolve the chronic physician shortage falter or fail, the government of Premier François Legault has doubled down.
These include legislation to force young doctors who train in Quebec to remain in the province to practise — or face hefty financial penalties. Along with the PREMs, some have likened the new constraints on doctors' autonomy and freedom of movement to a prison.
Instead of slowing the flow, a Gazette investigation found that the new restrictions have only accelerated the departures, since the law didn't slam the door on the parallel private system. There are now just over 560 doctors who have opted out of public health care in Quebec, including 5.4 per cent of all family physicians, compared to 12 doctors in the rest of Canada. Yes, 12. If ever there was a clue Quebec is on the wrong track, that is pretty compelling evidence.
The Legault government also presented legislation to impose a new remuneration mode on family doctors that will include a performance-based component. The move rankled young and practising physicians alike.
Legault's strong-arm approach to dealing with doctors dates back to when he was health minister in a Parti Québécois government two decades ago. Legault was the one who introduced PREMs, after all, to ensure an even distribution of doctors across the province.
But as the coercive measures have multiplied since his Coalition Avenir Québec came to power, morale among doctors has plummeted while anger and mistrust have risen. All of this has fuelled a quadruple exodus — avoidance of family medicine, hastened retirements, leaving the province and moving to the private system — the results of which the latest status report from the ISQ laid bare.
The Hippocratic oath obligates doctors to do no harm. If only the Legault government would apply the same principle to its management of the health system.
This story was originally published August 5, 2025 at 5:00 AM.