Canadian Medical Association

Doctors have once again found themselves front and centre in the news in Québec. The hot topic this time is the bonus family physicians will no longer receive from the Québec government for taking on doctorless patients. Unsurprisingly, there have been heady debates on all sides regarding the best way to increase or at least maintain access to care.Unfortunately, the arguments tend to eclipse the root causes of a national issue that has no piecemeal solutions.

A profession under siege

FMRQ president Dr. Cédric Lacombe recently pointed out that the negative portrayal of family physicians by some politicians has made the profession less attractive to young graduates. I have to congratulate him on his clear-eyed reading of the situation, which many of my colleagues and I share. People seem to be depicting family physicians as the source of everything that’s wrong with the healthcare system, when all they want to do is help their patients.

Unfortunately, certain systemic obstacles stand in our way. Despite the technological advances of the past few decades, the administrative burden on family physicians has only grown, to the point where it makes a sizeable dent in the amount of time we can spend seeing patients. At my clinic in Val-d’Or, once I’ve seen all of my patients for the day, I have to stay at the office for another three hours to fill out paperwork. Add to that the current shortage of 1,300 family physicians, an ageing population with more complex care needs, and the retirement en masse of family physicians and you have the perfect storm for a crisis in primary care.

An ill-informed move

As if that weren’t enough, while family physicians are bending over backwards to meet demand, over in Ottawa, the Trudeau government included a measure in its last budget to increase the capital gains tax. For family physicians, it was a slap in the face.

To wit: because of the nature of the services they provide, family physicians who practice in a clinic have very limited options beyond incorporation. The work we do involves a great many expenses, since we have to set up our own clinics, pay our employees, and purchase our medical supplies and equipment, among other things. And let’s not forget that physicians don’t have pension funds and have to pay for their own benefits.

The fact that, unlike for individuals, the federal government won’t apply a lower rate to the first $250,000 in capital gains earned by medical professional corporations means that any gains earned over the course of a physician’s career are taxable. The Canadian Medical Association has pushed hard over the last few weeks to get the federal government to revisit its decision and exclude medical professional corporations from the new measure, since it could have serious consequences for what access to care, which is already compromised.

Although it may seem far-fetched to some, there’s a very real chance that new family physicians will choose practices with lower start up fees, such as hospital settings, instead of opening their own medical clinics, which are the main gateway to the healthcare network. Rural areas would be particularly hard hit. Family physicians are an essential component of any strong primary care network. We go into this profession to help and care for others. Our governments have a responsibility to help us do that.

Dr. Jean-Joseph Condé, Francophone spokesperson and CMA board representative for Quebec Tough Times for Family Medicine and Patients

This commentary was originally published in Le Soleil.

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