Vulnerable patients may not receive proper care under Quebec plan, warns Collège des médecins
The president of the Collège des médecins du Québec (CMQ) is worried vulnerable patients are being disadvantaged in the agreement to register 500,000 patients with family doctors or family medicine groups (GMFs) by the end of June.
Dr. Maril Gaudreault said the December agreement between Quebec and the federation representing family doctors, the Fédération des médecins omnipraticiens du Québec (FMOQ), raises ethical concerns surrounding patient selection. Gaudreault cited a recent newsletter from the FMOQ to its members that he said instructs physicians to prioritize “true orphans” for registration with an individual family doctor, potentially excluding vulnerable patients who had been assigned to GMFs as a temporary measure.
“The current agreement does not seem to promote the proper care of vulnerable patients,” Gaudreault said in an interview on Wednesday.
The deal between the FMOQ and the government — reached after months-long disagreements — stipulates that 500,000 patients must be registered with a family doctor or GMF by June 30. Of them, 180,000 are to be vulnerable patients “presenting major or moderate health problems,” according to the Quebec government’s website. The other 320,000 will come from the province’s family doctor wait-list.
The agreement changes the way doctors are paid, incentivizing them to take on more patients. Gaudreault said the bonus for enrolling “true orphan” patients to an individual doctor is higher than patients already associated with a GMF, which could limit access to appropriate care for the latter. Patients who are registered with GMFs have access to a group of doctors rather than one in particular.
“It should be noted that a patient registered collectively does not benefit from the oversight and continuity of care essential to their health condition, unlike a patient registered with a specific family doctor,” Gaudreault wrote in an op-ed on the subject published Tuesday in La Presse. “The FMOQ directive appears to result in real discrimination against fragile patients who are collectively registered.”
Gaudreault estimates there are about 85,000 vulnerable patients registered with GMFs in the Montreal area, including 5,000 who are considered “highly fragile.”
Asked Thursday if the 180,000 spots set aside for vulnerable patients in the deal is enough to encompass those who require special care in Quebec, regardless of whether they’re already affiliated with a GMF, Gaudreault admitted “it’s possible.” But he said that either way, the directive has created discomfort among physicians who manage wait-lists since it contravenes rules related to priority, which are based on “vulnerability and clinical needs.”
“Those physicians also referred to the Code of Ethics (of Physicians),” Gaudreault said Wednesday. “Specifically to Section 63, which states that priority access to care must be based solely on medical necessity. In this case, they felt that another factor was … affecting their decisions and creating discomfort.”
Physicians were the ones who alerted the CMQ to the situation, he said.
Asked to share the newsletter with The Gazette, Gaudreault declined, suggesting the FMOQ be asked instead. The FMOQ did not respond when asked for a copy of the newsletter. Earlier Wednesday, the group declined an interview request, replying by email that it would like to meet with the CMQ to “better understand its public reaction.” Gaudreault confirmed the CMQ will connect with the FMOQ.
In a statement in February, the FMOQ said it had agreed to accelerate the registration of the 180,000 vulnerable patients (identified by the Régie de l’assurance maladie du Québec) by March 31, “to allow them to obtain an initial consultation with a family physician more quickly.”
“Following this initial clinical assessment, they will be taken on individually to ensure longitudinal follow-up tailored to their needs, based on their health status,” Dr. Marc-André Amyot, family physician and president of the FMOQ, wrote at the time.
Health Minister Sonia Bélanger, meanwhile, said in a statement Wednesday that she expects that patients already registered with GMFs and deemed vulnerable “will be cared for individually and receive all the care to which they are entitled, in full compliance with the rules of medical ethics.”
Gaudreault said Bélanger appears to have understood the concerns, but last he heard “there is no change in the way of assigning and managing waiting lists.”
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