Reflections on Bill 2 following negotiations between the FMOQ and Quebec ministry

After listening to the Quebec Federation of General Practitioners (FMOQ) presentation on Dec. 12 and reviewing the other participants' questions—which were very relevant and useful—I would like to share some thoughts that are common among many frontline family physicians.1. What good is it to know the collective amounts when we have no specific information about our average personal compensation level in a family medicine group (GMF) when we take on a family medicine patient? General practitioners in British Columbia have been guaranteed by their union that they would maintain the same level of income when switching to capitation.Since the beginning of this crisis, the FMOQ has failed to provide us with individual average figures regarding the significant drop in GMF income, insisting instead on the 15% collective penalty, even though we were going to suffer a drop in income of more than 50% under Bill 2. Fortunately, doctors know how to count, and many have denounced this 50% drop and even more.Read: Quebec family doctors voting on new deal after province backtracks on reformsGMFs will not close because of a 15% cut, but because of a 50% cut that makes care unprofitable. Many family physicians want the FMOQ to now provide “the real figures”—the average individual income of physicians (for each hour worked) who provide GMF care. These figures will enable us to decide whether or not to continue practising in GMFs.2. By constantly talking about increasing the overall budget, we give the impression that we always want more money. This does not reflect the need to better distribute the current budget among ourselves.3. We have not obtained any guarantee or promise from the FMOQ that we will maintain the same income if we take on GMF patients with the new remuneration and if we work just as hard: this vote is therefore a blind vote.4. The FMOQ is insisting on taking on an additional 500,000 patients in GMFs by June 2026, including 180,000 vulnerable patients. Once again, and we are fed up with this. It is putting pressure on overworked GMF physicians and not on the physicians, particularly numerous in Quebec, who practice little or not at all in GMFs, home support services (SADs), and long-term care centres in order to devote themselves to hospitalization in urban and semi-urban areas. The equivalent of 1,500 additional full-time physicians (too many compared to other provinces) in hospitals in Quebec puts enormous pressure on those who remain, those who provide care. Why not ask these hospitalists to share the care of the 500,000 patients? How is it that hospital doctors are the only ones not to suffer major cuts under Bill 2? Is it because they have been best defended by the FMOQ for the past 15 years?And why not ask our specialist colleagues to take on some of the hospital tasks that their specialist colleagues perform in other provinces, in regions well-stocked with specialists? GMF doctors are fed up with this pressure from the FMOQ, when they are the ones who give their all and more to frontline care.5. The FMOQ is not talking about access to frontline care, but rather about “individual and collective registration” of patients with a physician or group of physicians: Yet we know very well that this registration does not guarantee access to a physician. We have already been operating on a capitation basis with our flat fees (approximately 30%) for years: Registering more patients is “profitable” even if we don't have time to see them when needed. We would like the FMOQ to focus instead on genuine access to family doctors rather than registration, which offers no guarantee of seeing a doctor when needed. Otherwise, doctor bashing and public dissatisfaction with our services will increase.Read: Bill 2 update: No more coloured stickers or volume-based penalties6. Does the FMOQ realize that the GAP system for patient access is a source of frustration among our teams due to the absence of a sense of long-term individual responsibility toward patients and the increased remuneration despite this absence?7. Physicians who care for vulnerable patients in GMFs, at home, and in long-term care facilities do not feel represented by the FMOQ. These are demanding patients, and caring for them is challenging. While 24-hour shifts are busy and very poorly paid, the work of these physicians reduces emergency room visits and hospitalizations: Could these demanding practices be promoted to the FMOQ? And to the ministry?8. CLSC clinics have been emptying for years due to their weak representation within the FMOQ, even though these doctors focus particularly on vulnerable populations (disadvantaged families, children with complex needs, geriatric home care, palliative care, etc.). When will the FMOQ be able to better represent these doctors, whom the public health system so desperately needs?9. Is palliative care still being overlooked? 10. Home care for patients with severe loss of autonomy registered with CLSC health centre services is not truly valued, even though these doctors prevent numerous hospitalizations, travel, and work with limited technical resources for “hospital-level” cases. This is absurd: A serious shortcoming that must be corrected in the distribution of our overall budget. We would like the FMOQ to recognize the burden of this practice, as well as that in long-term-care facilities.Read: The FMOQ and the Quebec government have reached an agreement in principle11. Many point out that we did not need Bill 2, which became Bill 25. In fact, we are already capitation-based at 30%. It would have been enough to model physicians' income by reducing procedures and increasing the capitation portion. In addition, the proposed hourly rates are very low and should be increased. That said, this is an opportunity to rethink the entire remuneration system based on frontline care and case management. This is what the public and the government are asking for, and thus the incentives to move away from our current hospital-centric approach in Quebec general practice.Dr. Geneviève Dechêne has been a family physician in Verdun, Que., for 42 years and is a pioneer in palliative care. She established a medical team that provides on-call, 24-hour-a-day, in-home palliative care services in Verdun.The opinions expressed in this article are those of its author and do not necessarily represent those of the Canadian Healthcare Network or its parent company. This article has been translated from its original French and first appeared on our sister site Profession Santé.

Reflections on Bill 2 following negotiations between the FMOQ and Quebec ministry

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