21.10.22

https://www.cbc.ca/news/canada/montreal/quebec-waiting-list-family-doctors-1.6217030

Patients fear their health will decline while they wait for Quebec family doctor | CBC News

Patients fear their health will decline while they wait for Quebec family doctor

Over 800,000 have no GP, some have been on waiting list for years

Three years ago, when Fatima Mesquita registered for a family doctor, the estimated wait time was 600 days.

It seemed absurdly long.

But her disbelief turned to panic in the summer of 2020 when her partner woke up with uncontrollable tremors in her head and hands.

Eventually her partner, who does not want to be named for privacy reasons, was diagnosed with a neurological disorder. The shaking is now less frequent, but the 50-year-old is plagued by other worrisome problems including insomnia, extreme fatigue, clumsiness and intense dizzy spells.

A few times, Mesquita said she had to rush home because her partner couldn't walk.

"Her legs were completely like jelly," she said. "Every other day, she's not feeling well."

For now, they rely on walk-in clinics in Montreal but that doesn't provide any continuity.

Without the supervision of a family doctor, they have no idea if these symptoms are related to the disorder or another health problem.

"We feel so alone and lost," said Mesquita.

But they are far from alone. In fact, so many Quebecers are in the same situation that Premier François Legault said this week that his government may force doctors to take on more patients

Long waits not unusual

According to the Health Ministry, more than 857,000 Quebecers who are registered on the government's website, known in French as the Guichet d'accès à un médecin de famille, or GAMF, are waiting to be matched with a family doctor.

At the end of August 2021, in the Laurentides region alone, nearly 77,000 people were waiting.

"I just can't understand why this is not treated like the most important issue," said Mesquita.

"Why are people not speaking out about this? It feels like they just gave up."

Gisele Snow understands Mesquita's frustration.

Her family doctor retired in 2015. When she first registered on the GAMF, the wait time was about a year.

Six years have passed.

Snow, 69, is doing her best to stay healthy, but it is a hassle if she needs a few prescriptions renewed.

Snow lives in Saint-Cuthbert, about an hour northeast of Montreal, in the Lanaudière region.

Once, the closest walk-in appointment she could find was a 70-kilometre drive away.

The system is "very, very, very broken," said Snow. "You get that sinking feeling that you're alone and that nobody cares."

Older doctors, older patients

The struggle to find a family doctor is even worse in Montreal.

At the end of August 2021, nearly 169,000 Montrealers were waiting to be matched with a family doctor.

The average wait time ranges from 279 days in the West Island for patients with urgent health problems such as cancer, up to 619 days for people in good health in neighbourhoods such as Verdun.

Just to meet the demand, Vachon believes an additional 400 doctors would be needed in the city, which is unlikely, as there aren't enough students graduating to fill the void.

The problem is also complicated by retirements.

More than a third of doctors who practise in Montreal are over the age of 60 and typically follow older patients who have more health problems and chronic illnesses, said Vachon.

"They are taking more medication, so there are more interactions between the medications," said Vachon, who sees fewer patients now than 20 years ago. "It's more heavy. It takes more time."

On top of that, about one out of every five patients followed by Montreal physicians do not live in the city, said Vachon.

Recently, the province redeployed 30 new family doctors to the 450 area code — the suburbs that surround the island of Montreal — in part to convince some patients to switch to a family doctor closer to home.

But Vachon doubts many people will give up a doctor who has followed them, in some cases, for decades.

"You can't change the way people are going to consult their doctor," said Vachon.

inding solutions

The government's target is to have 83 per cent of Quebecers registered with a family doctor by the end of the year.

It currently sits at just over 80 per cent, so there's work to be done.

In his inaugural speech to mark the start of the second session of the 42nd legislature of the National Assembly on Tuesday, Premier Legault said better access to a family doctor is a priority for his government, even if it means forcing doctors to take on more patients.

After three years of discussions with Quebec's federation of general practitioners, Legault said he, and many other Quebecers, are getting impatient.

"Quebecers expect to be taken care of and to receive primary care services within a reasonable time," said Legault.

In the short term, Godin believes family doctors could be better supported in their practice by more nurses, assistant nurses or even medical assistants.

He'd also like to find ways to both simplify and reduce the administrative workload.

Godin estimates family physicians spend about 15-20 per cent of their time completing paperwork. Even cutting this in half, Godin said, would give doctors more time to see patients.

Different governments have paid doctors bonuses to take on more patients, but it's had mixed results, said Dr. Erin Strumpf, an associate professor in health economics at McGill University.

If doctors already feel stretched or overwhelmed, they may choose patients from the waiting list who have fewer health problems.

Matching patients with a doctor also has to be more than just an administrative exercise. Just because a patient is assigned a doctor, doesn't mean the doctor has time to see them, said Strumpf.

"Maybe we think about virtual visits, maybe we think about, again, expanding the scope of practice for nurse practitioners to be able to see and treat and prescribe for patients with certain conditions," she said.

 

Losing hope

Mesquita hopes the government is serious about improving access.

She and her partner love Quebec, but have considered moving back to Ontario if they aren't matched with a family doctor in the next year or two.

"One day you wake up and you're not feeling well," said Mesquita. "For us, it was like this. One day at breakfast, I was feeding her with a spoon and life wasn't the same anymore."

Mesquita has called the GAMF to see if her partner could be moved up the wait list, but was told her health problems aren't serious enough.

"It's very overwhelming," said Mesquita.

 

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GP : general practitioner: a doctor who provides general medical treatment for people who live in a particular area 

absurdly : in a stupid or unreasonable way, or to an unreasonable degree

tremor : a shaking movement in person's body, usually because of fright, excitement, or illness

diagnose : to recognize and name the exact charater of a disease or other problem by making an examination 

continuity : the sate of continuing over time, esp. without change or interruption

hassle : (a situation causing) difficulty or trouble 

redeploy : to move employees, soldiers, equipment, etc. to a different place or use them in a more effective way

inaugural : An inaugural speech is the first speech someone gives when starting an important new job 

legislature : an elected group of people who have the power to make and change laws in a state or country