Quebec looks to rejig family practice

Family medicine groups (FMGs) will be introduced in Quebec this fall in an attempt to improve access to FPs. An agreement between the Fédération des médecins omnipraticiens du Québec (FMOQ) and the province calls for a 2-year phase-in of the new program, which initially will involve about 300 doctors in 20 group practices. Establishment of the groups was a principal recommendation in the 2001 Clair Commission report on health care reform in Quebec. It proposed their creation after receiving a similar recommendation from the FMOQ during commission hearings.

Modelled on a similar program in Ontario, the new Quebec groups of 6 to 10 physicians will share the services of 2 nurses and 2 administrative personnel and will provide a range of services and extended hours. Services will include patient assessment, care and follow-up, diagnosis and treatment of acute and chronic problems, disease prevention and health promotion. The groups' services are supposed to complement those already provided by community health centres (CLSCs), hospitals and emergency rooms.

Many Quebec FPs already work in groups. “The main differences are that we introduce the idea of having other professionals in the office and of having the patient register with one physician, while the physician receives a fee for taking charge of the patient's file,” says FMOQ Vice-President Louis Godin.

Godin says the new program won't solve Quebec's shortage of FPs but it should improve access to primary care and also ease pressure on emergency departments. The groups will collaborate with local CLSCs and will be obliged to provide services that regional health boards deem a priority in their area.

The pilot FMGs are located in all health regions. Members of the first 20 groups already know other members of their groups because their private offices are in the same location or because they work together in CLSCs or clinics. The physicians will choose a member to manage the group, who will receive an extra $300 a week.

All FMGs are covered by the same agreement concerning conditions of practice, although some differences between groups may be allowed. They will be paid according to the system used before they joined their FMG: those practising in private offices will receive $69.55 per hour and those who get a fixed salary will continue to receive $91 688 per year, plus benefits.

The FMG system also introduces 2 new payments. Full-time group members will be paid an hourly rate for 3 hours a week to cover time spent attending meetings or doing paperwork. FMG physicians will receive a yearly lump sum for each person registered as a patient; this will be paid twice a year for patients 70 and older. The rate will be $7 per patient for MDs in private offices and $5.50 per patient for those who work in CLSCs or hospital family medicine units. — Janice Hamilton, Montreal