If you could change one thing about your practice, what would it be?

The political climateDr. Samuel Villeneuve, family physician, MontrealIf there is one thing I would change about family medicine, it would be the political climate. It is true that our practices must evolve and that there is room for positive changes. But from one election to another, from one reform to another, each government has "the perfect solution" for family doctors. First, they force us to work in a hospital environment, then they want to take us out of hospitals and force us to do office work only, to finally send us back to the hospital setting. They want us to register en masse (to see patients registered through Quebec's Guichet d'accès à la première ligne program [GAP]), then they want us to see orphan patients, then to go back to seeing patients (through GAP) collectively.It's tiring to always have to re-inform yourself about a new bill, to recreate all the processes for results that amount to the same care for patients. And it's stressful to wonder if in three years our working conditions will be completely turned upside down again.Culture of collaborationDr. Joseph Dahine, intensivist physician, Laval, Que.I have been making the same observation for 20 years: We take it for granted that health professionals will be able to provide care as if by magic, regardless of the context in which they work. However, medicine is a collaborative profession, and relationships must be cultivated. It is absolutely necessary to establish systems of psychological safety at work, so that all members of the team feel confident and can express themselves without fear of being singled out. For me, this is the most important part of my job—it's a value that's dear to me and I try to carry every day in order to transform medical culture. Intensive care is the gold standard of teamwork: we have no choice but to work together to care for patients. My very large team is mobilized every day to save lives, and we must work quickly to respond to critical situations. These bonds we develop, the importance of good coordination within a team and the principles of psychological safety can be exported to all other areas of health. Even outside intensive care, the days when we saw a simple patient arrive, with a simple health problem, are over. Today, the problems are multisystemic and require the intervention of different professionals. We must not make the mistake of working in silos; we need a real culture of collaboration.Lack of local labourDr. Sarah Bergeron, family physician, Nunavik. Que. As a doctor in Nunavik for almost five years, my greatest wish would be to have a more resilient healthcare environment, which would notably involve an increased presence of Nunavimmiut (the Inuit of Nunavik) working in healthcare.Unfortunately, due to numerous issues, the number of Inuit workers is still insufficient and the turnover of so-called “southern” employees is significant in remote regions. Each new start is an immense loss of knowledge and skills for a small network like ours. To respond to the many crises in the network, including lack of access to water or lack of nursing resources, and to promote culturally safe healthcare provision, the involvement of Nunavimmiut is essential. I can only hope that more Inuit are interested in healthcare so we can have a sustainable workplace made by and for the Inuit. Any initiative promoting Inuit empowerment is an initiative to put forward.Fewer rules, more agilityDr. François Marquis, intensive care, MontrealThe bureaucratic aspect is too present in Quebec, and we could do a little cleaning up. I include unionization, ultra-federalism, everything that means that when we want to develop something, it cannot move forward. There are so many structural, accounting and union rules. And no more room for agility. Putting agility back into the system would be my wish. I really think that one of the quick solutions to put in place would be to sit down and analyze what is paralyzing the healthcare system and making it fragile, such as administrative issues.During the pandemic, we were ready to listen to new ideas and try to realize them because we were all in the same boat. In that way, it was wonderful. This dynamism, this willingness to try, to be ready to move without going through hundreds of approvals. This showed us that the health system was capable of doing great things. I am actually a little worried when I hear that we want to structure it more, because it is already a monstrously structured machine. We cannot say that a solution that applies in the East of Montreal will apply to Coaticook. These are not the same issues, the same populations.

If you could change one thing about your practice, what would it be?

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