Study says overworked private-practice Quebec FPs must change way they practise

It's a bird. It's a plane. No, it's super-doc. A just-released study from the Fédération des médecins omnipraticiens du Québec says that changes to the province's health care system are creating superhuman expectations of overworked, isolated GPs in private practice. It's no surprise, says FMOQ President Rénald Dutil, that FPs in private practice are becoming morose and discouraged.

They currently provide 80% of primary care in the province, and they are assuming more and more clinical responsibilities because of hospital closures and Quebec's new emphasis on outpatient care ("virage ambulatoire"). Yet there is little infrastructure in place to support these doctors.

"Patients are gravely ill, but nonetheless they are being cared for by doctors in private practice, many of whom are working solo," says Dutil. In addition, the fact that 558 Quebec FPs recently opted for early retirement has left thousands of patients without physicians and has increased the workload for the ones who are left. As well, young physicians now entering the field, many of whom are women, do not want to work the long hours of their predecessors. FIGURE

Figure. FMOQ President Dr. Rénald Dutil answers question during press conference

But those aren't the only areas of concern. Dr. Michel L'Heureux, the study author, says that with an aging population of "baby boomers" who increasingly act like "informed consumers," family doctors will have to change their overall approach.

What to do? L'Heureux and his team have issued a set of "strategic guidelines," which propose that FPs change the way they work and allocate their time instead of trying to do more with less. Suggested changes include practising family medicine as part of a "family medicine network" as opposed to practising in individual offices. Quebec FPs have also been advised to formulate a mission statement and business plan, keep pace with new information technologies and assess the satisfaction of the "clientele." The 8 recommendations are strongly worded -"henceforth, the family physician who works in a private practice must" is one example - and they are rooted in the bottom-line directives of management consulting.

There were also suggestions for the FMOQ itself. The federation is supposed to foster the family medicine networks, provide tools and guidebooks to help doctors run their practices, and investigate alternatives to the current fee-for-service system. "How can we encourage doctors to follow their patients in an ongoing way," says L'Heureux, "while their costs are growing and their fees haven't increased in years? The individual doctor is not superman."