Quebec family doctors will have to take appointments, declare their hours under new system

The Quebec government has tabled a new bill that aims to improve front-line services by forcing general practitioners to declare their hours and to only take on new patients who have registered on the province's waiting list for doctors.

If Bill 11 becomes law, doctors will also have to put their working schedule in a new appointment booking system in order to make themselves available for patients. 

The goal is for those without a family doctor to eventually be able to get an appointment within 36 hours.

The first step, according to Health Minister Christian Dubé, is to gather more data about how appointment slots are being filled.

"If you want to manage something, you need the data, you need the information on what you're managing," he said during a news conference on Thursday.

"And unfortunately, on a local basis, I think the health system has been managed blindly for many years without the information that is necessary for good management." 

Dubé also said he was inspired after seeing how well Clic-Santé, the system used to book COVID-19 vaccinations across the province, worked for Quebecers.

Over 880,000 Quebecers are currently on the waiting list for a family doctor, but at a news conference Thursday, Dubé said he believed the true number to be almost double that, around 1.5 million.

"Because Quebecers are tired of signing up to a system that doesn't solve the problem," he said.

Dubé encouraged Quebecers without doctors to sign up, saying the new measures would apply only to those signed on to the Québec Family Doctor Finder (GAMF).

The government would also have the power to dictate what percentage of a doctor's hours must be before 8 a.m., after 7 p.m., or on the weekends, in an effort to take pressure off the province's emergency rooms. 

Dubé said family doctors will be forced to make some appointments available in the system, but how many will depend on the region and how much demand there is in the area.

The system would also allow the government to gather data on how many appointments doctors are actually taking.

"One side is saying we need more doctors, and the other side is saying [doctors] aren't working hard enough," he said. "I'm just saying: let's prove it, let's have the data."

The Health Ministry will also be allowed to use that information "for the exercise of the minister's functions," including sharing it with local public health agencies.

In late October, Premier François Legault said the government had drafted a list of names of family doctors across the province who "do not do a good job," but that it wasn't legally clear if he was allowed to share that information.

Dubé said that those who use the platform will not be taken off the waiting list until they have been permanently assigned a family doctor. 

Workload already heavy, doctors say

Dr. Michael Kanevsky, who works in Montreal, says he welcomes the province's attempt to track hours in order to see if he could take on more patients, but he adds that the time he spends working in an intensive-care unit must also be taken into account.

During the pandemic, he says he spent two weeks per month being on call 24 hours per day at the ICU. 

"The weeks that I'm not doing that, technically I am recovering, trying to be a decent dad to my twin nine-year-olds that I have to do some homework with, be a present dad, and also rest and recuperate. But it's during those weeks that I'm at the clinic as a [family] doctor," he said.

"For me to increase [the number of patients I see], I would have to take one week of ICU [work] away."

He says he loves his job, but acknowledges that the lack of rest can also affect his physical and mental health.

They're not just sitting at home with their legs up on the couch doing nothing," he said to describe the workload of family doctors who also work in hospitals. "They have other responsibilities."

Dr. Louise Caron, a family doctor in Quebec City, says she knows several doctors who already have as many as 2,000 patients.

As far as she's concerned, having more family doctors in the public system is the only way to increase access for Quebecers.

"We need more arms," she said. "I can't see how we're going to be able to give an appointment to every Quebecer inside of 36 hours."

In 2018, Legault's CAQ government promised that every Quebecer would have a family doctor by the end of the government's first mandate in 2022.