MONTREAL — Quebecers should expect to see less of doctors and more of nurse-practitioners or other health-care professionals in the coming years, two family doctors and an official of the Montreal health agency told an audience of mainly seniors.
The Cummings Jewish Centre for Seniors (CJCS) and the Centre for Israel and Jewish Affairs (CIJA) held a panel discussion earlier this month on “Why Can’t I Find a Family Doctor in Montreal?” moderated by longtime CBC reporter Loreen Pindera.
Pindera said that close to 40 per cent of residents of the Island of Montreal are believed to not have family doctors (formerly known as general practitioners).
But Martine Bouchard, associate director for primary care and chronic diseases at the Montreal Health and Social Services Agency, said the situation is improving, and the figure today is closer to 33 per cent.
The improvement is due to a Quebec government plan put in place two years ago to encourage family doctors to work together in community-based clinics, sharing patients living in a defined territory who sign up with them. However, she acknowledged that there are waiting lists in Montreal for these Family Medicine Practices, known by their French acronym GMFs, as well as the more specialized clinics that are also part of this reorganization.
Mark Karanofsky, who works at the Herzl Family Practice Centre and the Jewish Eldercare Centre, said that, on average, people see their family doctor three to five times a year. In the years ahead, fewer of those appointments will be with a doctor, and more will be with a nurse-practitioner who is qualified to perform many of the procedures of a doctor, or perhaps with a dietician or pharmacist who is also part of the interdisciplinary team.
“This is a major shift that the public is going to have to get used to,” Karanofsky said. “We can’t afford, as a society, to see a doctor as often as we did years ago. We will have more efficient, but different care – probably better care.”
Similarly, people will likely see less of specialists, such as gynecologists, except when strictly needed, he said. Family doctors and sometimes nurses can perform many things specialists now do, including diagnosis and prescription.
The specialists will be freed up to do what they alone are trained for, Karanofsky said.
The problem with this strategy is that Quebec is still lacking in family doctors and the time they have to see patients is limited. And the province is only beginning to train nurse-practitioners in any significant number.
The province may have enough family doctors, but a number of factors are reducing the amount of time they can practise primary care, Karanofsky pointed out.
Not unusually for a younger family doctor, Karanofsky has six different jobs because of government requirements that he spend part of his time in areas such as chronic and elder care and supervising medical residents.
Karanofsky noted that young doctors today, close to half of whom are female, are not spending long days in their offices as those of an earlier generation did. He is seeing 800 to 900 patients in his primary practice, far fewer than the 2,000 to 3,000 cases carried by his more senior colleagues.
The government also makes it difficult for doctors from elsewhere in Canada to practise in Montreal. The McGill University graduate had to go through considerable red tape to return to his native city after practising in Ottawa for several years.
The other doctor on the panel, Michael Kalin, medical director of Santé Kildare, a GMF in Côte St. Luc, observed that the public is still not aware of the medical services available.
Despite being responsible for a population of 50,000, one of the oldest in Canada, Kalin said that every Monday, his clinic calls the local CLSC René-Cassin asking for the names of people who could use its services.
Despite the kinks yet to be worked out, Kalin is confident the health-care system is going to get much better. “We have phenomenal ideas and exceptional leadership,” he said, “We will likely have a network that is the envy of other places.”
And, he emphasized, private medicine is not the answer. “There are a lot of frills, bells and whistles, but there is only one standard of care. What we have to work on is strengthening equal access for all.”