A troubling plan — but is it a sign of the future?

Opinion

Hey there, time traveller!
This article was published 30/11/2024 (306 days ago), so information in it may no longer be current.

This may be the future of health care in Canada. If so, it’s going to scare a lot of people.

Last month, Radio-Canada revealed that the Quebec government is considering changing Quebecers’ rights to have a family doctor. According to the report, “only patients with complex or chronic conditions such as cancer, mental health issues, cardiovascular disease or diabetes, would be assigned a family doctor.”

Those in good health or with minor health problems would lose their family doctors, and would instead be assigned to a provincial service “that is currently meant to give Quebecers without a family doctor access to medical appointments.” Under the terms of that service, patients are only allowed to discuss one health issue per visit, and it could be a year or more between visits.

The proposed strategy is based on a government-commissioned report that found that, of the 2.1 million Quebecers who did not have a family doctor in 2022-23, approximately 500,000 had major or moderate health problems. In order to address that problem, the report recommends transferring up to 1.5 million annual appointments from patients who have a doctor to patients who do not.

That Radio-Canada report was followed by other news reports earlier this month that revealed that the Quebec government is willing to use the “notwithstanding clause” in the Charter of Rights in order to force doctors trained in Quebec universities to begin their careers in the province’s public system.

In defence of the plan, Quebec Premier François Legault told reporters that his government is considering forcing Quebec medical school graduates to either practise in the province for an unspecified period of time or reimburse the government for the cost of their education. The government estimates that the cost can be as much as $800,000, including residency.

The plan would obviously impair the ability of doctors to leave Quebec, and that’s the government’s objective.

“We’re short of doctors,” Legault told Radio-Canada. “The doctors we train at taxpayers’ expense must practise in Quebec.”

According to that Radio-Canada report, only 60 per cent of family doctors who had recently graduated in Quebec were still practising in the province in 2022. Another 775 doctors have left the province’s public system in the past year to work exclusively in the private sector.

That leads to a CBC Radio report from last week, which discussed the mass movement of Quebec doctors from the public system to a private system, in which the patient pays for the appointment.

Dr. Bernard Ho, vice-chair of Canadian Doctors for Medicare, told the CBC that what’s happening in Quebec is “a concerning trend that we’re seeing not only in Quebec but across the country as well of private pay family medicine.”

He added that to varying degrees, “physicians in all provinces except for Ontario have the right to opt out of their publicly funded insurance program.”

Take a moment to chew on all that, then imagine how devastating it would feel to have your family doctor (assuming you have one) taken away from you by your provincial government because you are apparently too healthy. Now imagine if you could only see your doctor if you paid a fee out of your pocket.

We are often told that many illnesses, including cancer, have better outcomes if they are detected and treated early.

The proposed Quebec approach would make that virtually impossible, by denying ostensibly healthy patients regular tests, and by ensuring that they only get to see a doctor when they are already symptomatic.

For many patients, that’s too late for treatment to make a difference. Given the growing incidence of cancer in younger adults, the approach could be a killer.

Ironically, the proposed approach in Quebec could drive even more patients to the private system, and even more doctors right behind them to meet that growing demand. That’s because those citizens who have had their doctor taken away from them, and who have the ability to pay for their medical services, can’t be expected to willingly jeopardize their own health by waiting in line for tests and treatment that may come too late.

Regarding Legault’s plan to force young doctors to work within the public system or pay big bucks back to the government, it’s easy to understand the motivation to prevent Quebec education dollars from being used to train doctors who never practise there.

The problem is that restricting the mobility of Quebec’s med school grads will inevitably result in other provinces doing the same, and that will lead to medical schools eventually only accepting students from within their provinces. That may ultimately create more problems than it solves.

Finally, most Canadians will be shocked to learn that private health care is an option for them, providing they can afford it and, in some cases, are willing to travel to get it. It creates the possibility that the quality of the health care you receive depends on the size of your bank account.

That may sound unfair, but the reality is that has always been the case. Canadians have been travelling to out-of-province facilities such as the Mayo Clinic for years.

It’s far from clear if the Quebec proposals will be fully implemented, but this much is clear: In our over-worked and under-staffed health care system, you can’t blame citizens for putting themselves and their families first if they can afford to.

Whether that’s good or bad for our public system, and the patients it serves, remains to be seen.