Family doctors fear new Quebec regulation will make it harder to see patients in need

Family doctors in the province are urging the Quebec government to reverse course on proposed regulations which they say would further limit access to health care in the province.

General practitioners fear that the regulation will prevent them from providing care to unregistered patients who come to their office using the walk-in service, even those coming from Guichet d'accès à la première ligne (GAP), a service Quebec Health Minister Christian Dubé promotes for people who don't have a family doctor.

According to the new regulations, patients registered with the Guichet d'accès à un médecin de famille (GAMF) will receive priority, so if a family doctor wants to take on other patients, they will have to justify their choice.

"If I see a patient who doesn't have a family doctor at a walk-in, I can currently choose to take care of them if I judge that they have significant health needs. I do this by only signing a form, sent to the Régie de l'assurance santé du Québec," said Chantal Guimond, a family doctor and the president of Réseau MAclinique.

Now, she says, she and her fellow physicians will have to justify their decision to provide care to patients who come from the family doctor access desk.

"I listened to them, I partially took charge of the problem, I want to see them again to continue providing care, but this puts the brakes on that," said Guimond.

Dr. Anne-Marie Beaulieu says she fears having more paperwork because of the new rules. If for example, a family of two parents with two children ask her to register and take care of their new, third child, she will have to fill out even more forms than she currently has to do.

She says she already spends an average of 10 hours per week on "administrative paperwork."

However, while the regulations do provide for certain exceptions such as the care of members of the same family, meaning a new baby could therefore be followed by the same doctor, the answer wasn't clear to Beaulieu.

Dr. Marc-André Amyot, the president of the Fédération des médecins omnipraticiens du Québec (FMOQ), the federation representing general practitioners, says the rule change "risks freeing up less time for doctors who want to provide clinical services to patients."

Several weeks ago, the FMOQ sent a letter to Quebec Health Minister Dubé — who wants doctors to take care of 13,000 vulnerable patients still waiting at the GAMF — asking Dubé not to implement the new regulations.

"I am not suggesting there aren't any access issues. On the contrary, we know that it is difficult," said Amyot.

Last Friday, the FMOQ said the regulations would negatively impact the professional autonomy of family physicians working in th province.

A family doctor looking to accept a patient who isn't registered with the GAMF must get prior authorization from a medical coordinator, a process they family doctors say "largely eliminates the clinical judgment that a physician must exercise regarding whether a patient would benefit from registration."

The consultation period for the regulation has just come to an end, meaning the Legault government could make changes to it.

But the health minister's office continues to say that the regulation prioritizes patient care for those who need it most..

"It is our responsibility to ensure that vulnerable patients are treated as a priority in the health system," said Dubé.

"We are talking here about Quebecers living with HIV or having suicidal thoughts, in particular. Caring for a new patient should not be to the detriment of a person who is vulnerable. It is therefore entirely logical that these people should be given priority care."