Dr. Perle Feldman has been a general practitioner in Montreal’s Parc-Extension neighborhood for 40 years but faced with the government’s latest plans to get physicians to take on more patients, she is ready to withdraw from her practice and focus instead on training medical students.
“The plans of the government to micromanage us even more than they are already micromanaging have taken a lot out of all of us,” said Feldman, now 68. “We’ve been working like dogs throughout most of the pandemic.”
Many others are feeling the same.
Last year, 275 doctors either retired or notified the province’s health board, the Régie de l’assurance maladie du Québec (RAMQ), of their intention to retire within the next two years.
That number is up sharply from 2017, when 145 announced their intention to leave.
At least 1,000 family doctors are urgently needed in the province, said Dr. Marc-André Amyot, the president of the general practitioners’ association, the Quebec Federation of Omnipractical Physicians (FMOQ).
“In the next five to 10 years we will have a significant wave of retirements,” he said.
Age is part of it. Amyot points out that roughly 25 per cent of family doctors in Quebec are over 60.
The region facing the highest number of potential retirements is Montreal, where 44 doctors announced they planned to leave. Over 30 family doctors have retired or will soon in both Quebec City and the Montérégie region as well.
The average age of retirement was 68 in Montreal, and 65 in Quebec City and the Montérégie region.
It’s a blow to the 945,000 Quebecers who are still on the waiting list for a family doctor, according to official estimates. The actual number may be closer to 1.5 million.
Last year the Legault government proposed setting a quota of 1,000 patients for each family physician with penalties suggested for those unable to meet demands, something they have since backtracked on.
At the peak of her career, Feldman says she had roughly 1,500 patients, whom she cared for from “womb to tomb.”
‘Doing everything and being expected to do more’
Dr. Michel Minh Tri Tran says young doctors are already dealing with a heavy workload.
Trin, who works in Ahuntsic, already serves roughly 1,000 patients as a family doctor. He points out doctors are required to work additional hours in hospital ERs or CLSC clinics.
“We’re just doing everything and being expected to do more,” said Minh Tri Tran.
“If we try to rush it all it starts to feel like we are being pressured to deliver fast-food medicine.”
Minh Tri Tran says he wants to see the province do more to get foreign doctors trained and accredited to respond to the shortages.
The province has announced its intention to step up alternatives for careby giving nurse practitioners, paramedics and pharmacists more power to treat patients instead.
The province has also promised to provide a phone service where a nurse can direct patients without a doctor to the medical services they need.
Health Minister Christian Dubé has said he hopes most without a family doctor will be able to access the service by the end of the summer. It was initially supposed to be in place across the province by March 31.
The phone line has already been made available in the Lower Saint-Lawrence region through a pilot program.
The phone service is a move in the right direction to reduce doctors’ workload, but more needs to be done to attract medical graduates into family medicine, Amyot said.
Last year, 75 residency positions in family medicine were left vacant in Quebec because fewer graduates are choosing family practice. Over the years that has amounted to 400 fewer family practitioners in the province, he said.
“Imagine what we could do if we had 400 more family doctors in 2022?” Amyot said.
Quebec’s Health Ministry said it is difficult to put an exact number on how many family doctors are “missing” in Quebec, considering not all work full time throughout their career.
“Admissions to medical schools are on the rise and actions have also been underway to better promote family medicine,” a spokesperson for the ministry said.