MONTREAL – At first glance, Bill 20 seems like a great plan — “a family doctor for every Québécois,” promises Health Minister Gaétan Barrette. Once we get into the logistics of it, however, we can see that Bill 20 will create a system that will dramatically change patient care for the worse.
As a result of comments by Barrette, family doctors have been portrayed in the media as “paresseux,” or lazy. As well, many misleading statistics have circulated.
Barrette claims that more than half of family doctors work fewer than 175 days a year.
He has arrived at this absurd number by neglecting to factor in the time that family doctors spend teaching students in school and residents in the hospitals, time spent working in hospital administration, doing research, attending conferences, being on call, or providing services to refugees or out-of-province students.
His numbers do not factor in all the time that doctors spend with their patients to explain an illness, to check labs, to call specialists and to facilitate access to tests and to care.
Essentially, these numbers don’t account for the time that good doctors spend doing the things that make them good doctors.
The government has indicated that all GPs will be required to take on a minimum of 1,000-1,500 patients, depending on their years in practice.
In addition, they will be required to do a minimum of 12 hours per week of hospital-based work.
As well, GPs in Quebec would be forced to ensure a minimum “adherence rate” of 80 per cent — this means that at least 80 per cent of a patient’s visits must be to their own family physician, as opposed to a walk-in clinic or a hospital.
Failure to meet these targets would result in their pay per patient being cut by up to 30 per cent.
Your patient sees you twice a year, but breaks a leg and ends up in the emergency room anyway? Tough.
There is no system in place to see whether those ER visits are justified are not, and creating one would not only be a wholly subjective exercise, but expensive as well.
Upon closer inspection, we see a proposed law that will turn every patient in Quebec into a number instead of a person.
For a GP to commit to 12 hours of hospital work a week and handle a load of 1,000-1,500 patients, appointment times will have to be drastically cut.
My patients are booked every 20-30 minutes, depending on their age and on their health issues, and, as my patients know, I sometimes need more than even this with them.
An elderly patient who has been having chest pain for week, has a lump in her breast, has dangerously uncontrolled blood pressure and has depressive symptoms from being recently widowed would only have five to 10 minutes with me, according to Barrette’s new plan.
This is conveyor-belt “medicine” that rewards quantity over quality.
Our population is aging. Medicine, and the tests and treatments available have become more complex, as well.
Medical appointments therefore take more time than they used to. Saying that doctors are working less because they see fewer patients in a day is a misleading oversimplification of the challenges faced by our health-care system.
These older, more complex patients are likely to be hurt the most by the new proposed law.
It puts the onus on numbers: Barrette’s plan will have the effect of encouraging doctors to preferentially take on young, healthy patients they can see quickly.
As for the family practitioners who instead keep their more complex patients and take the time needed to keep them healthier longer — are those really the ones our health minister wants to penalize with a 30-per-cent pay cut?
Despite this disgusting tactic that targets the most vulnerable of patients, family doctors across Quebec have vowed that we will never sacrifice our professionalism and practise just to meet Barrette’s targets.
In addition to this, time spent in clinic directly translates into less time in hospitals. Our regional hospitals in Quebec are almost entirely run by family physicians.
They run the paediatrics wards, the internal medicine floors, they deliver babies in obstetrics and work all hours in the emergency.
If they are forced to cut their hospital practices to only 12 hours a week because they have to take on patients and follow them, the hospitals will not be able to stay open.
These doctors are the pillars holding up the hospitals in the regions, and this new law devalues their essential, important and specialized work.
This law is an attack on family practitioners. A large proportion of GPs today are women with young families. I am one of them. These young female physicians, same as women in other professions, are often not working the incredibly long hours of their male counterparts.
Despite this, it is illegal to discriminate against women in the workforce for having children and families, and it is illegal to pay them less per hour worked than their male colleagues. Barrette’s Bill 20 directly attacks female doctors.
He must realize that women with young families will be unable to meet his quotas, and therefore will be deemed “non-adherent” and thus will be penalized by a 30-per-cent reduction in pay for each patient they see, as compared to their colleagues seeing over a thousand patients.
And, in doing so, he will have effectively managed to pay female doctors 30 per cent less than their male colleagues for the same work. This is not only patently misogynistic, but also illegal and unconstitutional.
The principles of family medicine are based on those of whole-person care. As a student and resident, I was taught to see a person in light not only of their medical needs from birth to death, but also of their social, cultural and even financial realities.
The hours of excellent teaching that I had were not included in Barrette’s “175 days a year” of work.
They have not been deemed important or even counted at all, in Bill 20. Who will be educating our future doctors if today’s teachers are being told to take on more patients at any cost? It is a sobering thought.
As family physicians, we agree, fervently, that there is a huge problem with access to health care here in Quebec, and we want to help to solve it.
We want to be part of a dialogue for change, and not the subject of attacks on our work ethic. Bill 20 is not the way to improve the health of our population, nor does it provide better access to doctors for those patients who need it the most.
Quebecers deserve so much better than a scheme designed to erode the quality of the care they receive, in the name of greater accessibility.
Please know that the family doctors in this province have vowed to protect our patients and never let this law pass.
We treat people, not numbers.
Tara McCarty, BSc, MD CM, CCFP