Bill 20 in Quebec

An Open Letter from Catherine Johnson

I am concerned that Bill 20 sends the following misleading messages to the general public.

a. Bill 20 implies that Family MD's are lazy
This has not been my experience in 20 years working as a family physician. My colleagues work hard and are dedicated to excellent patient care. Do we really want to send the population of Quebec the message that their family MDs aren't working hard enough? Blaming family physicians for the problem of access perhaps isn't the message that was intended, but it is the message many hear.

b. Bill 20 implies that there is an easy solution to the problem of access.
The solution being proposed is to "force" family MDs to work more hours, and see more patients, or be penalized.

I want to emphasize that the problem of access is complicated. This government does the general public a disservice by suggesting to them that Bill 20 will fix this complicated problem. Access to medical care is not simply a problem of access to family MDs. Access also involves access to lab test, radiology, consultations, etc. Asking family MDs to see more patients, will not fix these problems. In fact, the problems of lack of access to testing and consultation are what make it more difficult for family physicians to see more patients.

For example, I often see patients in follow-up 2-3 times before they are able to access radiologic tests or consultations (medical and Para-medical). I am left providing follow-up to ensure the patients are not deteriorating while awaiting tests/consultations. If tests and consultations were more accessible, I would have more spots to see other patients.

c. Bill 20 implies that doctors who work part time and not contributing, as they should to society.
It sends the message that if MDs choose to work part time, (regardless of their reasons) they should be penalized. Most MDs working part time are women. This issue has been well documented. Usually these women have young children, or other complicated life circumstances. (They may be taking care of aging parents or family members, or be involved in other community activities.) Bill 20 sends the message that their contribution to society, if it isn't full time in health care, is somehow less valuable. It sends the message to both women and the larger society that women's contributions are worth less.

This is not a message that I think benefits our society, especially young women who are contemplating a career in medicine. Women who stop and raise families make other interesting and valuable contributions to our society. Wouldn't that be a better message to send to women of Quebec? Your contribution, whatever it is, matters!

d. Bill 20 implies that good patient care is about volume. This bill implies that seeing more patients = better care.

I beg to differ. Good patient care takes time. It takes listening. When patients are listened to, and their concerns are addressed, they are less likely to return for unnecessary care, or to seek another opinion with a second physician, or to go to the emergency room.
I am a family medicine teacher and am concerned about the message Bill 20 sends to students and residents. We are trying to teach them about whole-person and patients centred care, but Bill 20 sends a very different message to them. It tells them that volume is more important than patient care.

Here are some suggestions/solutions and some messages that I think we need to hear from this government:

1. We can work together to solve the problem of access.

The government may find it useful to talk to more family MDs about access and to seek the opinions of a wider variety of physicians including those working both full and part-time. Including family MDs, and their association in seeking solutions, will benefit all. Family MDs are not the enemy. Why not first try working together with us before imposing a solution? I think society needs to hear loud and clear from this government that they want to work together with members of the community to solve problems.

2. We want all Family physicians in Quebec to participate fully within the Quebec Medicare system.

I know many great Family MDs who are working off Medicare because they couldn't get a PREM. What a waste! I trained several of these physicians during their residency. Why not let them re-enter the work force in a meaningful way by abolishing the system of PREMs. This would be a quick and easy way to recruit more physicians.

3. We need to support and assist clinics that are trying to provide same day access.

Give them support staff resources to make this happen. This has great potential to improve access and decrease ER visits.

4. We want to make it easier for Family MDs to do their jobs and to see patients, not harder.

First let's improve access to radiologic tests and consultations. Let's get rid of year long waiting lists for ultrasounds.

Secondly, let's simplify the system. Don't make it more complicated. The current system for family MDs including PREMS, PEMs and AMPS will be further complicated by Bill 20. I have read the rules being proposed. As it stands now, I can see that I will be wasting a significant amount of time trying to figure out how much "patients are worth" to fill my quota. For example, I see a healthy patient, so they are only worth 0.8 of a patient, while another patient is terminally ill so they are worth 20 patients. Time calculating what patient's are worth towards my quota is time that will be taken away from patient care. Additionally, patient's health will change with time, so does that mean I have to continually re-calculate what my "patients are worth" in the system? I can think of better ways to spend my time, like seeing patients

Thank you again for your listening ear. I hope the government will take the time to work with family MDs and hear from the front lines our ideas for change.

I hope the government will carefully consider the intended and unintended messages that they are sending to the public with Bill 20. 

Finally I hope they might consider the value of working toether. Working together is far more likely to lead to creative and useful solutions, instill mutual respect, and ultimately to solve the problem of access.

Respectfully,

Dr Catherine Jarvis
CCFP
CLSC Cote des Neiges