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Quebec to limit family doctors next year


Aaron Derfel

Gazette health reporter



Friday, November 28, 2008



Despite a shortage of doctors across the province, the Quebec government is planning to issue fewer permits than the actual number of graduates in family medicine next year, The Gazette has learned.


A total of 238 doctors are expected to complete their residencies in family medicine and pass their board exams in 2009. However, the government is counting on issuing 220 permits, according to the Quebec Federation of General Practitioners.


The gap stems from a five-year-old permits policy aimed at making sure that young doctors start their careers in short-staffed regions across the province. In the past, the government had issued more permits than the graduating class, and some regions had a harder recruiting new doctors.

This year, however, the government has decided to keep a tight lid on permits to make sure that all regions are able to hire new doctors. But the policy - known as Plans régionaux d'effectifs médicaux or PREMs - has actually backfired and led to an exodus of mostly anglophone, Quebec-trained doctors quitting the province for Ontario and elsewhere, say critics.

"It's absurd," said Mark Roper, a Westmount family physician, who is also chairman of the medical manpower committee of the Regional Department of General Medicine of Montreal.


"It's almost like they're pushing young doctors out of the province."


Most new doctors prefer to practise in Montreal rather than in small rural communities. Quebec has offered doctors financial carrots to work in the Far North, but it has used the stick to get them to practise in La Mauricie, the Outaouais and other regions.


Before the PREMs, new doctors who decided to stay in Montreal were docked 30 per cent of their billings for the first three years of their careers. Most doctors toughed it out, so the government switched to the more restrictive PREM system.


Each year, the Health Department - in co-operation with the federation of GPs - decides on a certain number of positiongs for the 15 regions of Quebec.


Newly-graduated doctors must then apply for positions in a number of regions. Most apply to work in Montreal as their first choice, and if they don't get accepted, they are more likely to get hired by another region.


For Montreal, the government has decided to issue only 54 permits even though the city has a shortage of about 300 family doctors. If new doctors decide to stay in Montreal, their billings will be docked by 25 per cent, not for the first three years but their entire careers.


Figures obtained by The Gazette show that recruitment was actually higher before the PREMs system went into effect in every region except La Mauricie. So where have all those young doctors gone?


Coincidentally, Quebec has been a net exporter of doctors to other provinces in the past five years, according to the Canadian Institute for Health Information.


Serge Dulude, director of planning at the federation of GPs, confirmed the gap between the number of permits to be issued and the graduating class.


But he said that these are projections and adjustments can be made. Some doctors might decide to pursue another medical specialization apart from family medicine. Others might fail their board exams. There are also young doctors who go on sick or maternity leaves, and so won't be applying for a PREM.


"Besides that, some decide to take a break and to travel for a year, some decide not to go into medicine (after all), and some decide to leave Quebec."


Health Minister Yves Bolduc has defended the PREMs policy as necessary, saying that without it some regions would have even bigger shortages of doctors.


Marie-Éve Bédard, Bolduc's press attaché, provided The Gazette with different figures, but they still show a gap. She said that the government is projecting next year 217 new doctors, or new billers as it prefers to call them.


At the same time, the governmet expects to issue 211 PREMs. However, she said that some regions still have PREMs that have gone unfilled from previous years, and when those are included, the true total is 235.


Still, the federation of GPs is projecting a graduating class of 238.


"It's totally false to suggest that this incites new doctors to practise elsewhere," Bédard said of the PREMs policy. "We're aware that there is a shortage and we have designed a plan to make sure that there is a fair distribution of doctors in all regions."


Even so, the Quebec College of Physicians has criticized the PREMs policy as restrictive, and most doctors bitterly complain about it.


Doris Streg, a Montreal GP who graduated in 1978, described the PREMs system as "magical thinking."


The government is "not discussing the real bottleneck, which is the PREMs," Streg said in an email.


"No matter how many new doctors are graduated, there will be no increase in availability of GPs to Montrealers unless this policy is removed."






© Montreal Gazette 2008

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Euh quel commentaire ignorant et méprisant.


Parceque (en partie) des anglophones quittent c'est pas un problème??!?!


Si tu faisais allusion aux étudiants de mcgill, sache qu'il y a une bonne proportion qui sont des immigrants francophones et des québecois de souche. (j'en connais un personnellement).


Y a pleins de francophones qui quittent aussi pour ailleurs parcequ'ils ne veulent pas travailler a gaspé ou la charlevoix...


on est pas à l'ère soviétique pour forcer les gens à travailler là ou ils ne veulent pas.


Le programme gouvernementale devrait bonifier ceux qui partent en région, et non pénaliser ceux qui ne veulent pas y aller.

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Ce n'est pas un commentaire ni ignorant ni méprisant, c'était une question. On fait référence dans cet article au étudiants anglophones qui quittent. Ceux-ci sont une minorité des étudiants en médecine. Ça donne quelle proportion de ceux qui finissent leur cours? Est-ce que c'est une majeure proportion? Beaucoup de finissant dans d'autre matières partent, est-ce qu'on en fait une aussi grosse affaire, est-ce pire?


Pour ce qui est de bonifier le travail en région, on l'a essayé, ça a pas marché. Autre question: le nombre de médecins qui partent à la fin de leur études est-il une conséquence qu'on peut accepter si on réussit à fournir des régions?


Ce n'est pas une affaire d'ère soviétique. C'est une histoire de besoins et de moyens. Quand tu t'en va en médecine, tu accepte comme en éducation de pas nécessairement choisir où tu travailles. Tu vas où y'a un besoin. Et le besoin, il est pas en ville, y'a pire ailleurs.

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