As a family doctor, Hiromi Tissera prides herself on taking a compassionate approach to her patients.
She says that will be more difficult because of the targets outlined in the Quebec government’s new health reforms, known as Bill 2.
“We are going to be penalized for spending extra time with patients because we are going to have to meet certain targets, and I don’t think that’s how it should be done,” said Tissera, a family physician who works at District Medical, in Montreal’s Ahuntsic neighbourhood.
To provide the best care takes time, Tissera said. In her view, that means taking a moment to sit down with patients, make eye contact and ask, “What can I do for you?”
“They’re exposing their most vulnerable moments to us, and to make them feel comfortable is extremely important,” said Tissera.
Premier François Legault has said the changes, which include tying part of doctors’ pay to collective performance targets, will benefit the 1.5 million Quebecers who don’t have a family doctor.
But doctors have been in an uproar over the reforms — which were forced through the National Assembly last month, and many are threatening to leave the province.
District Medical, one of the city’s largest family medicine clinics, has lost nine of its 51 family physicians since the Coalition Avenir Québec government first tabled its health reform legislation last spring.
Some retired, others went back to school or transitioned to other positions and two moved elsewhere in Canada, according to its medical director, Dr. Georges Zaarour.
Tissera is also considering leaving for Ontario. She is among more than 260 doctors who recently applied to work in the neighbouring province.
One family medicine group in the city’s Ahuntsic neighbourhood says it’s lost nine physicians because of Bill 2, Quebec’s controversial law that ties a part of doctors’ pay to performance indicators. As remaining staff try to absorb the patients of those doctors, they say the new law will make care more difficult.
‘We feel very, very disrespected’
District Medical is what’s known as a GMF, the French acronym for family doctor group. GMFs are public-private partnerships, often owned by physicians.
They are financed through a combination of provincial funding and a portion of the revenues generated by the physicians who operate them.
Many of those physicians have voiced concerns about the reforms. Earlier this week, doctors at 18 GMFs in Montreal signed a letter denouncing Bill 2, first reported by the Montreal Gazette. The letter said the reforms would put their financial model in jeopardy.
While not all District Medical’s departures can be directly attributed to the government’s changes, Zaarour said apprehension about the changes hasn’t helped.
“The mood is very low. We’re insulted,” he said. “We feel very, very disrespected coming out of the pandemic where everybody rolled up their sleeves.”
Zaarour’s clinic has grown quickly since being founded in 2020 with six physicians and one secretary. The team now comprises 60 doctors and 60 support staff, and serves 55,000 patients. It offers a range of services including family medicine, pediatrics, physiotherapy and urgent care.
Stricter targets, at what cost?
Zaarour said part of the reason for its success is because the clinic has made it easier for doctors to focus on medical care — while support staff handle administrative tasks.
Now, the government is setting stricter targets for them.
“It’s going to be, ‘I used to see 20 patients, tomorrow, I have to see 40 patients in order to be able to hit those government targets,’” Zaarour said. That will put tremendous pressure on doctors, he said.
The law also assigns patients to doctors according to their level of vulnerability.
Family practitioners say this will make it difficult for healthy children to get access to care so doctors can spot a problem early on, before bigger problems develop.
Another doctor, Dr. Sabrine Manoli, said this is a fundamental part of her job.
“With kids, the truth is we spend so much time trying to prevent them developing pathologies,” she said.
“Kids are wonderful. If you help them early on, we might prevent all of this.”
Reforms meant to improve access, government says
In a statement responding to these concerns, Quebec’s Health Ministry said the changes aren’t meant to force doctors to see more patients, but instead to improve access by matching care to people’s clinical needs.
The new vulnerability classification will guide access and funding, but a ministry spokesperson said “it is wrong to assume that people not classified as vulnerable will have less access to care.”
“Access will always depend on clinical need, not on vulnerability status,” Marie-Christine Patry said.
Olivier Jacques, professor at the school of public health at Université de Montreal, said the law is designed to make doctors take on the most difficult cases and delegate the less difficult ones to other health professionals, such as nurses, pharmacists and physiotherapists.
In theory, he said, the change would make it possible for doctors at GMFs to be even better compensated. He said concerns about doing away with preventive medicine would make more sense if the current model was working.
“I’m not convinced the new system would really be much more of an issue for prevention,” he said. “We’re starting from so low.”
Cosette Wahba, who was at the clinic earlier this week with her three-year-old daughter, said she was saddened by the ongoing dispute.
“I just find it a bit sad that people don’t agree,” she said. “I feel like in any situation everyone needs to be involved in finding a solution.”
She said she’s grateful that she has access to care and is aware that many in Quebec don’t.
