Good afternoon.
I'm a family doctor, and I represent the Fédération des médecins omnipraticiens du Québec, or FMOQ.
First of all, I'd like to thank the House of Commons Standing Committee on Health, and in particular Mr. Luc Thériault, member of Parliament for Montcalm, for allowing us to make a few comments on the state of the physician workforce in family medicine in Quebec.
The FMOQ is a professional union representing some 10,000 family doctors practising in the Quebec health care system. It is a representative body recognized by the Quebec government to negotiate the conditions of practice with the minister of health and social services. However, it isn't only a union, but also an important player in the planning and organization of general medical care in Quebec, as well as the largest continuing medical education enterprise in family medicine in Quebec.
The FMOQ and its members play a central role in the smooth operation of Quebec's health care system. We saw this during the health crisis related to the coronavirus pandemic. We demonstrated that our organization is an indispensable and necessary partner for policy‑makers and network managers.
The pandemic revealed that FMOQ and its members responded to all levels of intervention. They were able to proactively and with great initiative reorganize front‑line services quickly, while actively supporting second‑line care for patients and the various services offered in institutions. Whether in front line medical clinics, emergency rooms, hospital units, intensive care units, long‑term care facilities, local community service centres, home care, palliative care, whether in home or in institutions, or in work related to medical assistance in dying, whatever the practice setting, Quebec family doctors have risen to the occasion. They continue to be so today and will do so tomorrow. They stand in solidarity with the needs of the people.
In Quebec, family doctors cover both primary and secondary care. Across Canada, they are more likely to practise secondary care. The additional effort required by the state of health emergency for family doctors has certainly had an impact on them. This effort has resulted in an increase in the number of days worked and, consequently, in palpable exhaustion in the field. It has been physically, psychologically and professionally stressful to deal with a steady pace of work and to be constantly adapting, both in terms of the coverage of care, where the demand was constantly changing with the pandemic, and within the medical teams, where the unexpected absence of staff due to isolation because of COVID‑19 put all professionals in rapid adaptation mode on a constant basis.
The practice of medicine during the pandemic was in some respects disrupted. To give just one example, the rapid introduction of telemedicine into everyday practice has brought about lasting and rapid changes. Unfortunately, to support all these efforts with the public and to coordinate all these changes professionally, our workforce is not at an optimal level. On the contrary, many are missing. As we have said many times in recent months, there is currently a shortage of more than 1,000 family doctors in Quebec to meet all the needs.
There are many reasons for this shortage. In addition to the upheaval and fatigue that the pandemic has caused in the workforce in recent years, there has been a significant increase in the burden of medical‑administrative tasks. This has led to a decline in the attractiveness of the profession for new aspiring doctors.
For your information, the Canadian resident matching service promotes a system for applying for, selecting and matching postgraduate medical training positions across Canada. Again this year, graduates are turning away from family medicine in favour of other medical specialties, and this is very important in Quebec. Just over 90 family medicine positions in Quebec remained vacant after the first round of matching. We must never forget that an unfilled position in family medicine can have a negative impact on access to primary care for more than 30 years. For us, this situation is as sad as it is alarming. Family medicine in Quebec urgently needs to be valued by medical students. Too many people, including some at the highest levels, have unfortunately denigrated this profession over the years, which has produced the results we know.
In terms of workforce, there is a shortage of at least 1,000 family doctors in Quebec. That's a significant shortage. Over the past seven years, including the last two years in particular, several positions have remained vacant.
In addition, there is less primary care activity in Quebec than in the rest of Canada. Family doctors in Quebec are more versatile than family doctors elsewhere in Canada. About 50% of them work in at least two practice settings. The number of family doctors per 100,000 inhabitants is lower in Quebec than in the rest of the country.
According to the latest available data for 2020‑2021, there are approximately 9,800 family doctors in the Quebec public system, and more than 7,500 of them offer primary care services. In addition, 3,737 caregivers take care of patients in hospitals, 2,453 work in emergency rooms, 2,303 work in nursing homes and long‑term care facilities, or CHSLDs, and more than 117 work in obstetrics, where there were at least 34,000 deliveries in 2020‑2021. Others work in various sectors, such as palliative care, rehabilitation, and so on.
It's important to consider the versatility of Quebec family doctors, whose contribution to the caseload of family doctors in institutions is between 35% and 40% compared to about 20% in Ontario, if we want to get an accurate picture of the family doctors in Quebec who are available on the front lines. We also want to emphasize that difficulties in accessing specialized investigations and wait times for consultations and surgeries result in over‑consultation. For example, patients may consult with their family doctor several times to adjust the dosage of an analgesic or while waiting for surgery or assessment. This, in turn, increases the workload of family doctors.
Furthermore, particularly in remote areas of Quebec, the state of family medicine doctors, while far from optimal, has been relatively stable in recent years. However, some regions such as Abitibi‑Témiscamingue, Chibougamau and the Magdalen Islands, stand out. In fact, these geographic areas have a harder time recruiting doctors than others.
There are also rural areas, which are currently the worst geographic areas in this regard. Family doctors who practise in rural areas are often late career doctors who have devoted most of their practice to their communities. There is very little medical succession in these rural communities, which are not always so far from an urban centre. Many young doctors are reluctant to start their careers in such isolated settings. Many sub‑territories have significant recruitment issues. With respect to indigenous communities, in recent years—