Medical students shying away from family practice under Bill 20: poll
Poll of medical students and residents show that many are reconsidering studying family medicine since Bill 20 was announced last November.
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QUEBEC
When it came to choosing a medical specialty, Valérie Charbonneau ticked off family medicine.
A resident at Pierre-Le Gardeur Hospital in Terrebonne, she made general practice her first choice two years ago because she hoped it would give her the most time with her patients, she said — time to get to know them, explain which pill to take, when and why.
But Charbonneau said she might have picked differently had she known about the bill Quebec introduced last fall, which would slash income for family doctors unless they meet a patient quota and other obligations.
“With the quotas and all that, it’s clear that my relationship with patients, the time I spend with them, my ability to care for them, they will be affected,” she said.
Charbonneau and her old classmate Jordan Volpato, a resident at Cité-de-la-Santé Hospital in Laval, had a hunch they weren’t the only ones worried about the patient quotas in Bill 20, so they emailed a questionnaire to students of Quebec’s four medical schools.
Of the students who intended to go into family practice, 46 per cent said they wouldn’t have made it their top choice after Bill 20.
Two-thirds of the 289 respondents were from Université de Montréal, and the rest were from Université Laval. McGill and Sherbrooke students were invited to participate, but didn’t reply. The poll’s margin of error was 4.75 per cent.
Charbonneau and Volpato said the results were representative enough to show the prospect of patient quotas is discouraging some students from specializing in family medicine.
“When they ‘sell’ us the idea of family medicine in the faculties,” Charbonneau said, “the big draws for students are the patient-doctor relationship, the ability to follow up.”
“What came up in dozens of comments is the fact that they won’t have that relationship with patients anymore.”
Family medicine hasn’t always been a popular choice among aspiring doctors. In 2008, Quebec medical schools and the Fédération des médecins omnipracticiens campaigned to recruit more students into general practice. The effort included rounds of “speed dating” between family doctors and students, said Jean-Pierre Dion, a spokesperson for the FMOQ.
The ratio of GPs to specialists climbed from 42-58 in 2010 to about 50-50 last year.
“Now that (Health Minister) Gaétan Barrette is on the scene, he’s doing the opposite of all that,” Dion said. “Students will do everything to choose another career.”
Although the Fédération médicale étudiante du Québec (FMEQ) doesn’t have any polls of its own on Bill 20, its president, Serge Keverian, said there is a concern that “disinterest for family medicine is growing across the four faculties because of coercive measures in the bill.”
Because spaces in each specialty are limited, some students may have no choice but to go into family practice. But Keverian warned of a “potential exodus” of med students to other provinces.
Before the bill makes its way through committee, three of Quebec’s four medical schools, including McGill’s, plan to hold a one-day strike on March 30. Université Laval med students are expected to have a strike vote this week, Keverian said.
The FMEQ and Quebec’s medical residents federation are urging Quebec to go back to the drawing board.
Joanne Beauvais, Barrette’s press attaché, said the government isn’t concerned the reform will turn students away from general practice. “In the last few years, students have shown a lot of interest and more and more enthusiasm for family medicine,” she said in an email Monday.
The results of the student survey would have been different, she added, if it had been taken after the health ministry released a working paper last Thursday describing the bill’s quotas and penalties.
The document includes a weighting system for patients to give priority to the more vulnerable. A healthy patient equals 0.8 patients, for example. A patient receiving palliative care counts for 25.
Joseph Dahine, president of the Fédération des médecins résidents du Québec, said he thinks patients won’t like being given a number to fill a quota.
“We don’t think it’s a human way of considering medicine,” he said.
A few months away from finishing her residency, Charbonneau agreed. “I don’t know how they did these calculations,” she said.
“For me, a patient is a patient regardless of their condition.”
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