After more than four and a half decades practicing family medicine in Quebec, Dr. Brian Gore states he has never encountered provincial legislation with consequences as profound as Bill 2. The proposed law is facing intense criticism from medical professionals who believe it will fundamentally damage patient care.
The Core Problem: Volumetric Medicine
Dr. Gore contends that the legislation effectively transforms primary care into a system of volumetric medicine. In this model, the central focus shifts from the quality of care to the sheer number of patients seen. Medical professionals would be financially rewarded for higher patient throughput, while providing thorough, time-intensive care could become a financial liability.
The bill mandates that Family Medicine Groups (GMFs) and their doctors add a staggering 1.5 million more Quebecers to their patient rosters. This immense responsibility comes without a promise of additional resources or support, stretching an already strained system even thinner.
Increased Oversight and Patient Triage
Beyond the volume pressures, the law introduces a new layer of government control that Dr. Gore describes as draconian. A key feature involves Santé Québec being tasked with policing the medical profession to ensure adherence to new performance indicators.
Furthermore, a patient colour-coding system would be implemented by Health Ministry agencies. A patient's medical status, as determined by this government system, would then dictate their level of access to healthcare services, raising concerns about equitable treatment.
The law also stipulates that GMFs must accept all additional non-assigned patients (known as GAP patients) who will be directed to a local clinic for care by various health providers. This adds another unpredictable variable to a physician's already demanding workload.
Impact on Specialists and Medical Training
The financial implications for family physicians with specialized practices are severe. Doctors focusing on areas like mental health, pediatrics, and geriatrics could see their income drop by as much as 50 percent under the new framework.
Dr. Gore, who has been involved in teaching, also highlights the devastating impact on medical education. He questions the ethics of training new generations of family doctors to practice under a government-imposed, stopwatch approach that rushes patient visits to meet quotas. He believes this will decimate the appeal of family medicine as a career in Quebec, exacerbating the existing physician shortage, particularly for an aging population with complex care needs.
A Call for Negotiation, Not Legislation
Dr. Gore and his colleagues are resoundingly unified in their opposition. He asserts that Bill 2 must be suspended immediately to allow for a resumption of collaborative and non-menacing negotiations between medical federations and the government.
He concludes that barrelling ahead with this legislation, even with piecemeal concessions, is doomed to fail. It will transform healthcare into a model that physicians deplore and, most importantly, will not improve access to quality care for Quebec citizens. The singular objective, he argues, must be to reach an agreement that establishes a healthcare delivery model which truly works for everyone.
