“Dear Patient, has After much thought about the future of my practice in family medicine, I have decided that I will no longer practice medicine in a general setting (RAMQ). As a result, I can no longer follow you as a family physician in the general setting…”
As the exodus of doctors from the public network accelerates, more and more Quebecers are receiving this type of letter calling for the private sector to follow their family doctor.
But what a price!
“It was pretty steep” when Kayden Faubert learned he would have to subscribe to an annual package of $4,300 for 10 visits to stay with the family doctor he’s been following for about fifteen years.
It is prohibited for an 82-year-old who visits the doctor only once a year. Otherwise, the hospital offers to pay $1,345 for an annual test, including a battery of tests and follow-up for results.
The bill is staggering when we know that a family doctor typically earns between $50 and $130 depending on the complexity of the case if he visits a doctor’s office in a public network.
But patients are stuck: 650,000 Quebecers are on a waiting list for a family doctor. That’s not counting the 833,000 people waiting to see a specialist, more than half of whom ran out of time.
This lack of access pushes patients into the private sector, where doctors can build a profitable practice free of government restrictions. By migrating to the private sector, these doctors bleed the public network even more, fueling a vicious circle.
As there are more doctors in the private sector, the waiting list in the public sector is longer. We see this clearly in dermatology, a specialty with the most private doctors…but with the longest (97,000 people) public waiting list.
Overall, 774 doctors now work in the private sector, according to statistics provided by the Régie de l’assurance santé du Québec (RAMQ). This is almost three times more than ten years ago.
This phenomenon was particularly noticeable among general practitioners, 514 of whom were not RAMQ participants. This is 5% of all family doctors. This is no longer a fringe story that we can turn a blind eye to.
Even more worrisome: A large number of young doctors are opting to skip the RAMQ. Of those with less than five years of training, 162 are privately trained. This is six times more than ten years ago.
Some graduates go straight into private practice without working in a public setting. Taxpayers are the turkeys in the joke, as they fund their expensive courses with their taxes — the highest in North America — without entitlement to service.
The social contract is broken. It’s time to seriously think about two-tiered medicine.
On the one hand, we must recognize that the exodus of doctors to the private sector is a symptom of the malaise that is eating away at the public network, which discourages doctors from working there.
For example, young doctors complain about the restrictions imposed by the Regional Medical Personnel Schemes (PREM), which force them to accept a position in a region that is not suitable for them. Are there soft ways to ensure equitable distribution of services across the province? One solution is to recruit more students from the regions and encourage them to return there, especially for internships throughout their studies.
But on the other hand, Quebec can keep a lid on the private medicine pot, which is very limited in other provinces. For example, in British Columbia, private doctors cannot charge more than public doctors.
The longer Quebec waits to slow down the two-speed drug, the more complicated it will be to put toothpaste back on the tube.
Health Minister Christian Dubey knows something about this. She is determined to rid Quebec of the private placement agencies that have bled its public network of nurses. But this summer, the flying team he was supposed to send to the North Coast to pick up from agencies took off slowly.
Tightening the screws on private doctors is also not easy. But if Quebec remains idle, Ottawa risks threatening to cut its health transfers. To be eligible for these transfers, provinces must provide free and accessible public services to all people for all necessary care. Canada Health Act.
It’s not uncommon for Quebecers to be dumped by their doctor… unless they’re taking thousands of dollars out of their wallets.
* Young and healthy patients are billed at $2,200 per year (which includes an annual follow-up exam and two other visits during the year). Prices rise to $3,200 for those over 65 or those with chronic illnesses, and $4,300 for those over 80 because packages include more visits.
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