Family doctors reject Quebec government’s latest offer

Family doctors have rejected the Quebec government‘s latest offer in the negotiations to renew the framework agreement.

The Fédération des médecins omnipraticiens du Québec (FMOQ) made the announcement Saturday. The 150 delegates of the FMOQ, which represents family doctors in the public health system, unanimously rejected the offer in a vote held over the weekend.

“There are elements to it that I believe are very agreeable to family doctors and there are others that I think require further discussion,” said Dr. Michael Kalin, Family Doctor & Sante Kildare Medical Director.

“I think that the proposal on the table does have some merits,” he added. “We just have to get it better.”

“We have to recognize that in its current form, it may actually inadvertently hurt patient care by decreasing access.”

The offer tabled by the government on March 19 would have changed the remuneration model for family doctors, particularly by introducing colour codes for each patient. The offer published on the Treasury Board’s website stated the government wanted to introduce “a performance-based principle, with relevant clinical performance indicators determined by the Ministry of Health.”

The government‘s proposal relied on colour codes established by the Institut national d’excellence en santé et services sociaux (INESSS) based on a patient‘s health condition to determine family doctor remuneration.

The colour codes were:

• $12 for a green patient (patients with episodic problems)
• $74 for a yellow patient (minor chronic health problems with no functional impact)
• $124 for an orange patient (moderate health problems requiring regular follow-up, such as cancer)
• $223 for a red patient (major health problems with complex conditions)

Dr. Kalin says the profession has run on a fee for service system for decades.

“The idea at its heart is you don’t want to pay a flat rate for everybody because not everybody is the same,” he said. “And we have to recognize that doctors who have more complex practices may need more time to see fewer patients.”

At the time, FMOQ President Dr. Marc-André Amyot said he was in favour of revising the remuneration method, but was quick to speak out against the government‘s colour codes.

In Saturday’s announcement, the FMOQ said it also rejected “the Quebec government‘s proposal to withdraw family doctors from patients who are registered individually in order to register them collectively.”

Treasury Board President Sonia LeBel’s office said it has taken note of the FMOQ’s rejection of the proposal.

“We will continue discussions with the FMOQ. No one will lose their family doctor. We are working to ensure that Quebecers have access to the right professionals and care when they need it,” it said in a written statement Sunday.

Though a lot of unknowns remain – among the many concerns Dr. Kalin noted – were on productivity and access for patients 

“There’s the economic aspect of it,” he explained. “There’s the goal to register more patients to the practices but there’s also the human aspect, which is, well, do I want to work harder to make an extra $15? And I don’t mean to belittle this because obviously some people make more than others but we don’t want a patient to be turned away because of the fee for service that rate.”

The FMOQ proposed resolutions to the province including new work tools and improving pay equity.

In a statement to CityNews, the Office of Quebec’s Treasury Board said:

“We acknowledge the FMOQ’s rejection of our proposal. We will continue discussions with them.”

They added that no one will lose their family doctor and that they are working to ensure that Quebecers have access to the right professionals and care when they need it.

“I think Montrealers and Quebecers in general need to be vocal with their MNAs to express their frustration,” said Dr. Kalin. “If you don’t have a family doctor, make sure people know.”

—With files from The Canadian Press, first published in French and translated by CityNews