Here’s how to solve the family physician shortage | Letters To Editor
Quebec has a serious shortage of GPs despite an incredible need. About 850,000 people have registered and are officially on a waiting list for a general practitioner. However, if we include those who are not on an official waiting list, an estimated 1.5 million Quebecers do not have a family doctor. This deficiency can and must be remedied immediately.
GPs are the primary medical point of contact for most of the population, providing early diagnosis and treatment of disease, screening for heart disease and cancer, and screening. GPs also provide other healthcare services, including emergency departments, critical care, hospital stays, and long-term centers.
Without it, acute illnesses go untreated or are delayed because patients are waiting for appointments or queuing in already-crowded emergency rooms. In the long term, early diagnosis of treatable diseases is delayed or left untreated until they may be too advanced for successful treatment.
Studies have shown that the cost to the taxpayer of patients visiting the emergency room is five to ten times greater than visits to a general practitioner’s office. In addition, patients treated by GPs have better survival rates, are hospitalized less often, and take less medication.
A 2019 study conducted by researchers at Stanford University School of Medicine and Harvard Medical School showed that an increase of 10 primary care physicians, including general practitioners, per 100,000 people was associated with a 0.9 percent reduction in cardiovascular mortality and a 1 percent reduction in cancer mortality and a 1.4 percent decrease in respiratory mortality.
In another 2021 study, Harvard Medical Researchers found that individuals living in U.S. counties with shortages of acute primary care physicians had a reduced average life expectancy, ranging from 311 to 629 days, depending on the shortage. The study concluded that increasing the number of primary care physicians in these underserved counties would improve life expectancy.
How can this doctor shortage be remedied?
A short-term solution could be to give physicians additional bonuses and/or tax credits for admitting new patients. So if 4,000 doctors each agreed to accept 50 new patients, that would reduce the waiting list by about 200,000 patients a year — or a million and a half patients over 7.5 years. If twice as many registered, the shortage would be solved in less than four years!
In addition, GPs over 65 should be encouraged to work longer after retirement until new graduates can replace them. Possible incentives could be additional tax credits and salary bonuses.
A recent solution proposed by the Quebec government has limited utility. It is suggested that a patient who does not have a GP could have telephone access to a team of healthcare providers. Unfortunately, this is only a stopgap solution and does not replace the invaluable services of a general practitioner.
If the average GP hires about 700 patients, that means Quebec currently lacks 2,100 GPs to care for 1.5 million orphaned patients. In addition, around 150 general practitioners retire every year. One study even estimated that Quebec will need an additional 3,000 GPs over the next 10 years to meet the needs of the population.
A longer-term solution is to increase the number of places for medical students in classrooms. As of 2023, there will be 969 admissions across Quebec’s four major medical schools. The reality is that many medical school graduates don’t become primary care physicians. In fact, even the target for GP assistant positions, around 50% of graduates, is often not reached. Just over 400 medical students enroll in a family medicine program each year.
Therefore, in order to increase the actual number of primary care physicians, the number of medical school graduates entering general practice must be increased to fill the shortage every year for the next seven to ten years. Accordingly, at least 400 additional medical school admissions per year must be made available for prospective general practice students to fill current and future anticipated shortages. Conclusion: Annual admissions to Quebec’s four medical schools should increase from 969 to 1369.
Incentives must also be put in place to encourage medical graduates to become general practitioners rather than pursuing higher-paying specialties.
In order to train more doctors in family medicine, experienced doctors must be willing to teach and train. Where can we get this cohort of teachers? One way is to encourage retired and pre-retired doctors.
Where can this money come from?
These recommendations require significant government funding at a time when resources are tight for provincial governments. Provinces have asked the federal government to contribute at least 35% of every health dollar invested, but to date the federal government has refused to do so. Ottawa needs to stand up and be accountable to the citizens of Quebec and the rest of Canada.
Ensuring a family doctor for everyone requires an investment in people and resources. This not only saves money in the long term, but also saves lives.
Together we must provide GPs for all Quebecers. All of our lives depend on it!
dr Paul Saba