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Commentary: The division of family doctors Montrealers

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The phenomenon of “traveling for health care” means that places reserved for local residents are taken up by patients from other regions.

Author of the article:

Mark Roper • Special to the Montreal Gazette

Published on April 16, 2024 • Last updated 5 minutes ago • 3 minutes of reading

With 26 family doctors estimated to be needed in the Faubourg-Plateau sub-region, more than half of registered patients come from other regions, thus removing places for local residents, writes Dr Mark Roper. Photo by Pierre Obendrauf /Montreal Gazette

Montreal's shortage of family doctors seems to be getting little attention in Quebec City's political corridors. Based on my experience in the medical and political arena over the last 20 years, the prevailing opinion is that Montreal is the “spoilt child” of Quebec's medical system. It has more health care resources per capita, including family doctors, than other regions. The need for a more equitable distribution of such resources has always been felt in the halls of power of the National Assembly. The government started with hospital beds in the 1990s and in 2004 succeeded in separating specialists and family doctors.

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Family doctors are specifically controlled by regional staffing plans (PREMs). Each season, the Committee on Human Resources (COGEM) issues a needs analysis and makes recommendations for the coming year. Based on the average family doctor to population ratio, the committee determined that Montreal is above average compared to other areas, so the Minister of Health transferred an additional 40 doctors from Montreal to 450 areas in 2021 and 2022. The 26 primary care family physicians in the Faubourg Plateau area south of Montreal are considered redundant. As a result, the area will have fewer family physicians than retirees.

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If so, why do so many Montrealers complain about poor access to a family doctor? In the COGEM document, we find data that contradicts the committee's findings that there are about 620,000 Montrealers without a family doctor, and that only 66 percent of the island-wide population is registered with one doctor, less than 10 percent. Quebec is average.

The Manpower Committee's figures are inaccurate because the 385,000 non-Montrealers registered with family doctors in Montreal are not included in their estimates. This health care-seeking population uses spaces reserved for local residents, thereby impairing their access. If spots for family doctors were restricted to local residents, the enrollment rate would increase to 88 percent, according to data from Montreal's DRMG Montreal.

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More than half of the patients registered in the Faubourg-Plateau sub-region – 68,000 – come from other regions, thereby removing places for local residents. As a result, only 57 percent are registered with a family doctor, leaving 57,000 local residents without a doctor, COGEM Montreal figures show.

According to documents from the Committee on Manpower, registration figures for Montreal and its central regions are getting worse every year.

Even more worryingly, the same principles apply to specialist care and hospital beds. Both are assigned to regions by population, without taking into account the many patients who come from outside their region. thereby reducing Montrealers' access to these other health services.

Unfortunately, despite being aware of this unfair situation, no provincial party seems willing to address the issue for fear of political fallout from mainland Quebec. A legal challenge to this situation – of which I was a part – failed in the provincial high and appellate courts. However, we believe that these decisions are wrong and an appeal to the Supreme Court is pending.

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Montreal Islanders make up about 25 percent of Quebec's population, pay a significant portion of its tax base, and have below-average access to health care. Some have to go to private clinics for first aid and surgery. Montrealers have the right to demand that this situation be rectified.

While Montrealers are waiting for a fair solution for their poor access, a government reimbursement for the use of private health services would be an interesting and immediate solution.

Another idea: former MNA Robert Liebman has repeatedly called for more autonomy for Montreal in our political system. Given the state of Montreal's medical system, this would be an interesting decision. Forget Sainte-Québec; What about Sante Montreal?

Dr Mark Roper is Director of QE Medical Group and Assistant Professor at McGill University.

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