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.
“The more she was shaking, the more we were panicking,” said Mesquita. The couple lives in Ste-Agathe-des-Monts, a small town in the Laurentians.
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.
In the central and northern parts of the city, the percentage of residents signed up with a family physician hovers around 65 per cent — by far, the worst in the province.
Quite simply, there’s a shortage of doctors, said Dr. Michel Vachon, president of the Montreal Association of General Practitioners.
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.
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.
Dr. Louis Godin, president of Quebec’s federation of general practitioners, hopes the doctors and the province can reach an agreement. In his view, coercion won’t work, in fact, it may actually make the situation worse.
“If the government chooses this, we will probably see some doctors leave their practice for retirement,” said Godin. “Some doctors will decide to change their practice for a different thing. We will have a very bad atmosphere on the ground.”
In the long term, Godin says the province needs to find ways to train more family physicians to resolve the shortage, but that requires capacity: If there are more students, more doctors are needed to train them.
Then there’s the question of waning interest in family medicine.
For the 2020-2021 school year, the federation says there were 502 family medicine residency spots available in Quebec, but 72 remained vacant. Compare that to approximately 450 speciality positions where only one spot remained empty.
Godin said he’s never seen a year with so many unfilled positions.
“You understand the difficulty,” said Godin.
He thinks some medical students may be drawn to other specialties because of the pressure placed on family physicians to do mandatory shifts in emergency rooms, CHSLDs or rehabilitation centres.
Then there’s the way the province distributes new family doctors.
The permit system, known as PREMs, or plans régionaux d’effectifs, determines how many doctors can practise in a specific region. But many people have called it unfair.
Montreal-based civil rights lawyer Julius Grey filed a court challenge earlier this month to have the system suspended and declared unconstitutional.
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.
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.