Quebec family doctors say political discourse must first change to value family medicine

Quebec family doctors are calling on a change in the political discourse to attract more students to the profession. (Nathan Denette, The Canadian Press)

Many Quebecers still don't have access to a family doctor, and the solutions are not simple.

The Canadian Press spoke to a number of family medicine students and seasoned doctors about the value of their profession. They are all convinced that the political discourse must first change.

The results of the second round of residency matching showed an increase in the number of students choosing family medicine. Despite the increase, the majority of vacancies are in family medicine in Quebec (70 positions).

The Legault government says that it is making "considerable efforts" to increase the training capacity of medical faculties.

Health Minister Christian Dubé announced this week that the doctoral policy will authorize 1,165 new MD registrations for 2024-2025, 335 more than in 2018. The government hopes to train 660 new doctors over four years.

"It's true that there's a recruitment problem in family medicine. Every year, we don't fill all the positions for a bunch of reasons," said Sarah Guertin, from the Université de Sherbrooke, who will be doing her residency next year at GMF-U Jacques-Cartier.

"Every year, there are vacancies, there's a huge shortage of family doctors and we're not doing anything to improve the situation, because the doctors who are retiring are often doctors who have a lot of patients in their care," said Laura Mandjelikian, a family doctor in the Montreal region.

In Quebec, 25 per cent of family doctors are over 60 years of age, which points to a number of retirements over the next few years.

"To replace a retiring doctor, we often need two or three new graduates to take over, because of the specific medical activities involved," said Mandjelikian. "From what I can see, we're heading for more and more patients without a family doctor."

Guertin acknowledges that retirements are a challenge, but for the time being, in the context of her young career, she's not too worried about it.

"I think we're working on this aspect precisely to enhance the value of the profession," she said. "We're trying to reduce the paperwork that family doctors have to do on a daily basis. It's the little things that will reduce irritants over time, but you can't wave a magic wand and change that overnight."

Pamela Hafazalla is a family doctor in the Laval and Laurentians region, who subspecializes in pediatrics and is experiencing the effects of retirement.

"We are more and more saturated, which means that these patients have gone back on the list of the guichet d'accès à un médecin de famille," she said. "They find themselves without a family doctor until there is new availability."

Stop blaming doctors

Mandjelikian believes that recruitment into family medicine is difficult, particularly as externs see the challenges associated with the profession: "They see it when the students do their internship with us in family medicine that our practice is becoming more and more cumbersome. We lack resources, we lack support," she said, adding that this is probably driving some to choose another speciality.

"It's complex, but there's a big reorganization of practice that's needed to make it more interesting for family doctors, so that we're less exhausted and put to good use," said Mandjelikian.

Université Laval's Gabrielle Guillemet, who will be starting a family medicine residency in July, agrees.

"What makes me panic a little is seeing how many people still don't have a family doctor," she said. "And even though we're going to have more (patients) in our care, necessarily, we can't take on hundreds more."

She criticized the limit on the number of patients per family doctor that Dubé wants to increase: "If we put too many, well, the doctors will go crazy and we'll end up with even fewer family doctors for all the patients," she said.

She recognizes that this is a difficult issue to manage, but hopes to see the government's rhetoric change.

Camille Boileau, from the Université de Sherbrooke, who completed her first year of residency at GMF-U Charles-Lemoyne, would also like to see a more positive discourse from our politicians.

"We hear political rhetoric that too often blames family doctors for failing to reduce waiting lists," she said. "The emphasis is never on those doctors who go out and treat so many patients every day."

Boileau also points out that, in Quebec, we often talk in terms of statistics: "In political discourse, there's a lot of emphasis on workflow in a practice, rather than humanity," she said "Yet the reason why most of us chose family medicine is for the human contact with the patient.

"This duality can sometimes be hard to bear," she continued. "Organizational constraints at the moment mean that we are constantly struggling to offer the best possible service to patients in what is, after all, a limited amount of time. By attracting a lot of negativity to the front line, we discourage people from getting involved."

Hafazalla made the same point.

She said that the focus is often on access to doctors and that the finger is pointed at the fact that they don't take on enough patients.

"The government's discourse suggests that, as family doctors, we're not doing our part enough, whereas as we saw during COVID, we were mobilized to change our front-line activities to support the system," she said.

The public and universities

Public recognition also plays a role in attracting people to the profession. Guillemet recounted how, during her academic career, she was often asked whether she wanted to specialize or "just be a family doctor."

"My specialty is family medicine, and I'm proud of it. It's a specialty like any other," she said in defence.

In her opinion, the public needs to be made aware of the fact that family medicine is a speciality: "When you go to medical school, you don't automatically become a family doctor. So a surgeon doesn't have the skills that a family doctor has, and a family doctor doesn't have the skills that a surgeon has. It's vice-versa."

Boileau also pointed out that universities are making significant efforts to promote family medicine.

"That would be a good step forward, in my opinion," she said.

Guillemet agrees.

"There are a few family doctors who come to see us, but there are mostly other specialists," she said. "Giving us courses more focused on family medicine could be interesting, but I also understand that we already have busy schedules."

The students and doctors surveyed by The Canadian Press also shared their passion for their profession.

Family doctors accompany people throughout their lives, developing a relationship of trust with them. They are able to see the patient as a whole, and each day is highly diversified, ranging from cardiology, to sexual health, to musculoskeletal in a matter of hours.

They also emphasized that family medicine is a team effort and that many other professionals can help relieve congestion on the front line.

This report by The Canadian Press was first published in French on May 12, 2024.

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