Doing Less with More: Why Quebec Lags in Access to Doctors

By C.D. Howe Institute Claude E. Forget —— Bio and Archives May 27, 2014

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Toronto, - Despite having more family physicians per capita than many other jurisdictions, Quebec lags Ontario and Western Europe when it comes to access to primary care, according to a report from the C.D. Howe Institute. In "The Case of the Vanishing Quebec Physicians: How to Improve Access to Care," author Claude E. Forget, former Quebec Minister of Health and Social Services, calls for primary care reforms that focus on providing more care in communities and clinics, rather than in hospitals.

"Quebec, over the past decade has failed to improve patient access to primary-care services," notes Forget. "Quebec has an adequate supply of family physicians but needs to shift the location of primary care away from institutions toward care in neighbourhoods." According to Forget, the problems include Quebec physicians having the shortest work week at about 35 hours, compared to 43 in Ontario. Additionally, Quebec has fewer enrolled patients per physician; 1,081 on average, compared to 1,539 in Ontario and 4,279 in the UK. Quebec's numbers are even lower for younger doctors and female doctors. Previous attempts at reform have seen limited success. Most notably, efforts to create family health teams known as Groupe de Médicine Familiale, meant to offer a broad range of primary-care services to registered patients, have been fraught with delays, and existing groups are enrolling a much lower number of patients than desired.

Forget outlines three criteria that are necessary in order to improve access to primary care in Quebec:

1. A better balance between primary care and the rest of the health-services system.
2. Compensation in primary care through fee-for-service must give way to more per-patient payments.
3. Physician and associated personnel must be trained to work as a team, within well-defined protocols.

The author concludes that a renewed, determined effort at primary-care reform, with stronger financial incentives, as well as a commitment from both governments and providers is required. "Such a model could be extended in the future to allow primary-care givers greater budgetary control to purchase some basic services on behalf of their patients. Physician buy-in and a willingness to provide more primary care in the community as opposed to hospitals are key ingredients of a successful transition." Claude E. Forget has had, over several decades, multiple involvements in health services policy development and analysis. This includes a period in government as deputy minister, as well as Minister of Health and Social Services in Quebec.