Baranyai: Quebec proposal takes health care rationing to new level

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Last weekend, Canadians gathered to binge-eat tryptophans and reflect on gratitude.

In recent years, we’ve learned to appreciate comforts long taken for granted, which can be ripped away with little warning: things like well-stocked grocery shelves, and hosting dinner parties indoors. To this list of precarious blessings, we might add seeing a family doctor.

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A radical proposal in Quebec, made public last week, gives consideration to taking family doctors away from healthy patients and reassigning their appointments to people who are medically vulnerable or ill.

The proposal is contained in a study on primary care published by the Institut national d’excellence en sante et en services sociaux (INESSS), which reports to Quebec’s minister of health and social services. It outlines a scenario in which family doctors could be reassigned to patients with complex or chronic conditions, such as cancer, mental health issues, diabetes or cardiovascular disease. Derostered patients would be referred to a service that helps them secure medical appointments when needed.

There are 2.1 million Quebecers without a family physician; half a million of them are medically vulnerable or sick. Though they may have access to a specialist, they are left cobbling together regular care from emergency room visits, at three times the cost of a trip to a doctor’s office.

The Coalition Avenir Quebec (CAQ) swept to power in 2018 promising a family doctor for everyone. The government has since recognized it simply cannot deliver.

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The shortage of family physicians is a concern across Canada. A national survey pegs the number of adults without a family doctor or nurse practitioner at one in five. Health care burnout has accelerated since the pandemic. The situation will only worsen with another 18,000 family physicians set to retire by 2031.

Some municipalities have turned to physician recruiters to design enticing welcome packages and retention strategies. If luring doctors to practise in your community carries a whiff of desperation, the scenario under discussion in Quebec has the stench of battlefield medicine.

Health care rationing isn’t new. Occasional prescription shortages are an ongoing challenge. Early in the pandemic, Canadian hospitals faced a dearth of personal protective equipment, along with fraught inventory counts of available ventilators. Reassigning doctors, however, would take health rationing to a new level.

It violates our sense of fairness to penalize people for being healthy. These folks already aren’t using up much of their doctors’ time. If an ounce of prevention is worth a pound of cure, the occasional check-in to keep things on track seems like a solid investment. On the other hand, it’s hardly fair to leave those less fortunate struggling to sort it out on their own.

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The obvious solution – increasing the number of family doctors – has been hampered by onerous certification requirements for internationally trained physicians. Foreign-born doctors must complete a residency at a Canadian university regardless of how long they have practiced medicine. Practice-ready assessment programs in nine provinces now give internationally trained doctors the option to complete a clinical, 12-week workplace evaluation in lieu of residency, but they have not yet succeeded in filling the gap.

This month, three senators tabled a report with solutions to “quickly and cost-effectively” help more internationally trained physicians become doctors in Canada. Their proposal would add 500 federally funded spots a year to practice-ready assessment programs, and directly fund another 750 residency spots for international medical graduates.

The report by senators Ratna Omidvar, Stan Kutcher and Mohamed-Iqbal Ravalia suggests this plan could add 6,000 new, practice-ready family physicians within a decade, serving some nine million patients. It’s not the whole solution, but it’s a pretty good start.

write.robin@baranyai.ca

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