Quebec doctor shortage still plaguing Montreal: ‘It absolutely makes no sense’

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In some parts of the city, the wait to be assigned a family doctor can be as long as four years. That's because doctors are only assigned permits to work in certain areas, leaving many communities underserved. As Global's Phil Carpenter explains, the government still doesn't plan to issue more permits for the coming year. – Oct 7, 2020

Montreal doctors say the Quebec government is still ignoring their concerns about the shortage of family physicians in the city.

The comment follows the health ministry’s revelation that it’ll issue 98 family doctor permits for 2021, about the same as this year.  Family physicians like Jhanzaib Sherwani believe it means certain populations will continue to be underserved.  He said he’s been trying to get a permit to practice as a family doctor in Parc-Extension for two years.

“Traditionally this has been an area which has lacked access to primary care,” he told Global News from a clinic he opened in the area.

Sherwani has a permit, known by the French acronym, PREM (plans régionaux d’effectifs médicaux) to practice in Ahuntsic-Montreal North jurisdiction.

PREMs are issued annually by region, meaning he cannot practice in Parc-Ex, which comes under the Côte-des-Neiges-Metro-Parc-Extension region.  Under the rules, he has to spend most of his time in the area which his permit covers — 55 per cent of his time, minimum.  It means his Parc-Ex clinic is open for just two days a week.

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Advocates say socio-cultural barriers in Quebec’s health-care system an example of systemic racism – Oct 8, 2020


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His wife Meera Kotecha, who recently completed her studies in medicine, also wants a permit to work in Parc-Ex, where the need is great.

“I have goals to work with marginalized populations and work with women, in particular, to advocate for them,” she explained.

According to Sherwani, one reason the Parc-Extension neighbourhood is underserved is that it falls in the same region as Côte-des-Neiges and a part of downtown Montreal where there are large hospitals and teaching institutions.

“Traditionally people who get the PREMs in this area tend to work at those institutions,” he pointed out.

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That leaves communities like Parc-Ex without enough family doctors, he argued, made worse because the area is densely populated, with many people considered lower-income.

“The number of PREMs that are allocated doesn’t represent the needs of the population of this area,” he noted.

Other general practitioners like Henry Coopersmith say they’ve been pressing the government to change the process of issuing of PREMs for years.

“Because it’s a management solution,” he insisted from his office in Westmount.  “It’s not just money.”

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Coopersmith says the current system leaves too many gaps, especially in Montreal because of its population, leaving people to have to wait years to get a family doctor.

“Which makes no sense,” he fumed.  “It absolutely makes no sense.”

He warns that the problem will likely get worse because a large number of doctors are about to retire, including himself, in a few years.

“I will have to be replaced by two and a half physicians, but the PREM will only give one physician place to take over my 3,800 patients,” he said, pointing out that most doctors take about 1,000 patients.

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“So I’m going to have 2,800 patients who are not going to have a physician,” he said.

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Quebec Health Minister Christian Dubé said Wednesday that his government is trying to find ways to make it easier for Quebecers to find a doctor.

“We’re working on the quantum, having more generalists,” he said. “But we’re also working on making sure that Quebecers can call a doctor and have an answer within 36 hours, even though they are not allocated to one.”

Sherwani said because Parc-Extension has to compete with big hospitals for physicians, he has been pushing to have the area become its own jurisdiction. For 2021, 10 permits have been allocated to the region, but three of the positions have already been reserved.  He and  Kotecha say they hope they each get one of the balance to be able to work in their Parc-Ex clinic.

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