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Montreal Gazette
06-08-2025
- Health
- Montreal Gazette
Hanes: A bitter pill to swallow as Quebec's family doctor shortage deepens
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.
Montreal Gazette
16-07-2025
- Health
- Montreal Gazette
More than 900,000 Quebecers on wait lists for consultations with medical specialists
By Aaron Derfel Nearly two out of three Quebecers in need of a consultation with a medical specialist are waiting past medically acceptable delays — up from 41 per cent at the end of 2023, Health Ministry statistics reveal. In total, nearly 910,000 Quebecers were waiting for a consultation with a specialist as of May 31, the latest date for which such figures are available. That compares with almost 832,000 people who were waiting for a consultation on Dec. 31, 2023. The figures are the latest indication of persistent access problems in the health network more than half a year into the mandate of Santé Québec, the Crown corporation that was set up to run the public system more efficiently. 'It's going form bad to worse,' veteran patient-rights advocate Paul Brunet, executive director of the Conseil pour la protection des malades, told The Gazette. 'It means that some of these patients are likely to end up in the emergency room when their health situation become more aggravated. For some, that's the only way they will be operated on or taken care of by specialists. Meanwhile, the crisis in emergency rooms is still going on. 'The state of health care is degrading,' Brunet added. Health Minister Christian Dubé has focused much of his attention on improving access to family physicians. On that score, there has been some progress, although there are still almost 644,000 Quebecers waiting for a consultation in primary care using the online portal known as the Guichet d'accès à la première ligne (for those who don't have a family doctor) — up from more than 619,000 at the end of 2024. Yet the latest numbers suggest that access to medical specialists may pose an even worse problem. What's more, the Gazette reported last month that some heart patients who have been examined by a specialist are dying on wait lists as Santé Québec and the health ministry squabble over jurisdiction and resources. A record three dozen cardiac patients have died from sudden death while waiting for a life-saving operation since the start of the year. The lengthening of wait times to see a medical specialist is coinciding with an exodus of some specialists from the public system to the private-for-profit sector. For example, more than 108,000 Quebecers were waiting for a consultation with a dermatologist as of May 31. Meanwhile, since last July the number of dermatologists who have opted completely out of the public system has climbed to 49 from 41 . The private-sector dermatologists now represent about one quarter of such specialists practicing in the province. They are charging patients out of pocket an average of $250 per consultation. Another striking example concerns orthopedics, with nearly 60,000 Quebecers waiting (often in pain) for a consultation with a specialist. At present, there are 38 orthopedic surgeons who have opted out of medicare, with about 340 remaining in the public system. Quebec has since adopted legislation to prevent orthopedic surgeons from opting in and out of medicare regularly. But the new regulations are unlikely to have an impact on those who have quit the public system permanently. Audrey Noiseux, Dubé's press attaché, referred The Gazette's queries to Santé Québec. Marianne Paquette, a spokesperson for Santé Québec, said that improving access to specialists remains a priority for the Crown corporation that was established on Dec. 1 last year. 'Although the issues surrounding access to specialists are complex, concrete (solutions) are being actively implemented,' Paquette said in an email. 'These efforts are based on reinforced clinical coordination, process optimization and concerted mobilization of all network players. The common objective remains to improve access to specialized services, with a view to ensuring equity, efficiency and responsiveness to patients' needs, throughout Quebec.'
