Inequalities in access to a family doctor

Inégalités dans l'accès à un médecin de famille

Photo: Jacques Nadeau Le Devoir
More than 107 000 Montrealers are still waiting at the counter of access (GAMF) will be assigned a family doctor.

Nearly half of local networks of service (RLS) in Quebec, 43 93, reach the purpose of giving a family physician in 85 % of their citizens. They were only 9 in 2014.

The promise of a flagship of the liberal government in the beginning of the mandate meeting of some of the pitfalls in several of the RLS where the enrolment rate could decline or improve timidly, as shown by a mapping of the evolution of the situation since the past four years, carried out by The Duty.

Between march 2014 and may 2018, the enrolment rate national family doctor improved by fourteen percentage points, from 65.2% to 79.9 %, according to data provided by the ministry of Health and social Services (MSSS) and the Régie de l’assurance maladie du Québec (RAMQ).

-9% in four years

The national data hides a reality that is just another in the RLS of the Granite in the eastern Townships. Approximately 6800 patients have lost their doctor for three years in the corner of Lac-Mégantic, and 2600 are still waiting in the atm access (GAMF). Result : 78.8 % last may, this is the only RLS where the enrolment rate has declined since 2014, with a decline of nine percentage points.

The exasperation is so intense that the secretaries of the clinique santé Le Frontenac complained of verbal abuse and intimidation.

The doctors have to promise to “banish” any patient who will use intimidation to the staff, that is to say, never give him a family doctor, reports the newspaper The Echo of Frontenac.

The doctor in charge of this group of family physician (GMF), Dr. Patrice Laframboise, tells that patients were at the clinic by refusing to leave ” as long as they do not have a doctor “. It would be five general practitioners in the region.

“The catastrophe that awaits the rest of Quebec, we saw her before all the world,” he warns.

The region lost three doctors who followed more than 2000 patients each. Most young people are much less patient, trying somehow to reconcile their shifts at the emergency department, the births to achieve day and night, the office and family life.

Recruit a nurse practitioner and a respiratory therapist, delegate a part of the follow-ups of pregnancy, to nursing, to integrate social workers in the GMF, encourage colleagues to take new patients : Dr. Laframboise has been working on several solutions. “But it does not offset the retirement “, he says, lucid.

The second area where improvement is most tenuous in four years, if we exclude the RLS that reach the target, is that of the RLS of the Suroît region, which includes the cities of Salaberry-de-Valleyfield and Beauharnois, in Montérégie. The enrolment rate has improved by only four percentage points. Retirements have also leaded the effort, acknowledges the CISSS de la Montérégie-Ouest. In addition, the atm access is still relatively unknown to a part of the population, ” said the communications officer, Dominique Fontaine.

It is in the Montérégie region, where population growth is strong, that we also find the RLS where the atm access is the most stocked, with 24 310 people waiting in Pierre-Boucher.

The North Shore out of breath

More than 700 miles separate them, but the realities of Lac-Mégantic and the North Shore meet. The RLS where the enrolment rate is the lowest, 59.4 %, (with the exception of RLS nordic, where the front-line care to take another form).

It is necessary to interpret this data with caution, warns Dr. Pierre Gosselin, Port-Cartier. Of the citizens of this territory obtain care from doctors who come from the south two weeks at a time and can not register. Other villages rely on a dispensary nurse.

But the region remains on the tightrope, finds the one who is the head of the regional department of general medicine (DRMG). To avoid any stripping at the hospital, he is working on the schedule… next January ! For the past two years, the Baie-Comeau region has been able to fill less than half of the new positions available. Doctors have even postponed their holidays this summer in order to ensure permanence.

“Everyone has the language to the ground… It’s going to take that you could see the light at the end of the tunnel,” sighed he. It is the support from the bureau that cash when the doctors are less numerous to ensure the functioning of the hospital, ” he recalls. Then, when an employee calls to ask her why the rate of attendance decline, he is impatient a little. “We’re in misery, don’t they see in Quebec city ? “

“We don’t ask big,” he said, a smile in the voice. A single doctor more, it would change everything ! “

107 000 Montrealers waiting

More than 107 000 Montrealers are still waiting on the GAMF they’re assigned a family doctor. The lowest enrolment rate in Quebec may be observed in many RLS montreal, such as Parc-Extension–Metro Côte-des-Neiges and Saint-Michel–Saint-Léonard. The RLS doing better, Dorval–Lachine–Lasalle, to nearly 73 %, is still far from the target.

The head of the DRMG of the metropolis, Dr. François Loubert, admits : there is still ” medical deserts “, such as Hochelaga-Maisonneuve and Montréal-Nord. He believes that it will force young doctors to settle there. “It is also necessary to stimulate the emergence of “clinical,” he adds.

The president of the Association des médecins omnipraticiens de Montréal, Dr. Michel Vachon, opposes the idea of forcing young doctors to locate in a sub-territory specific. “This is precisely the coercion which has harmed the attractiveness of family medicine in recent years,” according to him. Evidenced by the 65 positions of family medicine residents remained vacant this year.

“Many hospitals and NURSING homes consume the time of the doctors,” explains Dr Loubert. In addition, patients registered with a doctor montrealers live in the suburbs. The Fédération des médecins omnipraticiens du Québec (FMOQ) has even calculated that, if we take into account all their enrolled patients, doctors montreal almost reach the target of 85 %. But their patients are too many in the Laurentians or Brossard.

The invisibility of refugees and asylum-seekers at night as in the statistics. They are not counted as enrolled patients. Even a visit to a “super clinic” is not compiled. “It would be important that this is recognised, believes Dr. Loubert, otherwise, it marginalizes these people and it discourages doctors to see them while they are vulnerable. “

Of course, a real improvement has taken place for the past four years in several RLS. The Duty you will present examples of these successes Monday, in the continuation of this story.