Access to doctors: skepticism about Quebec Health Minister Bélanger’s Bill 19

The Legault government has “thrown in the towel” on family doctors, and vulnerable patients are likely to pay the price, laments the Regroupement provincial des comités des usagers (RPCU).

The organization shared its concerns with Health Minister Sonia Bélanger on Wednesday during special consultations on Bill 19, which rewrites the controversial Bill 2.

That law provoked the ire of doctors last fall because it changed their method of remuneration, imposed performance targets on them, and threatened them with sanctions.

Bill 19 reflects the agreement that was subsequently reached with the Fédération des médecins omnipraticiens du Québec (FMOQ), with a 180-degree shift by the government.

It states that the government wants to “promote the achievement of a target increase in the total number of individual and group registrations to 500,000 by June 30, 2026, including 180,000 vulnerable patients.”

The voluntary enrollment of new patients would be accompanied by a $75 million incentive. The government is also increasing the remuneration envelope for family physicians by 14.5 per cent ($435 million).

Bill 19 also revives the concept of capitation payments for family doctors working on the front lines. However, many doctors may choose not to participate.

Last week, while Minister Bélanger spoke of “taking charge” of 500,000 patients, FMOQ President Dr. Marc-André Amyot spoke of 500,000 appointments that would be offered, the Liberal opposition pointed out.

“She should tell the truth!” said interim Liberal Party leader Marc Tanguay at a press conference on Wednesday. “Five hundred thousand appointments is not the same thing as 500,000 patients being taken care of.”

“Treatment is more than just a time slot,” RPCU executive director Sylvie Tremblay also pointed out in committee. “Doctors really need to be able to dedicate themselves to extremely vulnerable people.”

Québec solidaire MNA Guillaume Cliche-Rivard estimates that the 180,000 vulnerable patients referred to in the bill could need four appointments per year. “That’s 720,000 appointments,” he said.

To date, more than 78,000 Quebecers have received a letter telling them that they are now “being taken care of.” But they must continue to go through the GAP for orphan patients (by dialing 8-1-1) to try to get an appointment.

“There is a lot of frustration and loss of confidence,” added RPCU president Carole Tavernier. “We want to believe, we want to give it a chance, but we need to see results.

“When we receive the letter, then we are told that we will be taken care of in a GMF, and that we have to go back through the GAP and we have an appointment somewhere other than our GMF, we no longer understand anything as users,” she explained.

For its part, the Conseil pour la protection des malades (Council for the Protection of Patients) said that, upon reading Bill 19, it found that it “saves the day” and “saves the announced departure of hundreds of doctors.”

However, “we are obviously far from the 1.5 million orphaned patients and their automatic registration with a GMF or CLSC. We could have done better, no doubt, and we could have done worse,” said Council President Paul Brunet.

The special consultations on Bill 19 lasted barely two hours, in the absence of the FMOQ, lamented PQ MNA Joël Arseneau in a press scrum. “Today is not the time for doctors to shy away,” he fumed.

The Santé Québec agency also did not participate in the exercise. “We are already in contact with the various stakeholders for the planned implementation,” spokesperson Yann Langlais Plante told The Canadian Press.

“We are letting parliamentarians do their work and hear from groups that wish to contribute to legislative policy,” he added.

No equivalent increase for specialists, says Duranceau

Meanwhile, on Wednesday, the government responded to the Quebec Federation of Medical Specialists (FMSQ), which announced the day before that it wanted to take “action” to reach a “reasonable agreement.”

Specialists are demanding a 17 per cent increase in their remuneration envelope, but Treasury Board President France-Élaine Duranceau is advising them to temper their expectations.

“We have always said that we want to make family medicine more attractive. So, yes, there is a gap that must be maintained,” she said at a press conference. “The means of pressure are up to them,” she added.

The official opposition has called on doctors “to act in such a way that patient care and services are not reduced or affected.” “Clearly, we are relying on their professionalism,” said Tanguay.

–This report by La Presse Canadienne was translated by CityNews