‘ Exodus’ of family medicine graduates feared over Bill 20

Number of residencies done outside of the province on the rise this year

Medical students, residents and educators are sounding the alarm about how Bill 20 might have an impact on recent gains that have been made — and which the government has pushed to achieve — in boosting the number of graduates choosing family medicine.

In fact, at a time when Quebec is desperate for more family practitioners, it is feared that the widely criticized law may undo much of the progress that has been made during the last few years to promote family medicine.

“There is a real danger of ( this progress) unravelling,” said Howard Bergman, chair of the depart- ment of family medicine at McGill University. “It may not affect the numbers this year, but there is real concern about the class coming up.”

In its brief to Health Minister Gaétan Barrette, the Fédération médicale étudiante du Québec ( FMEQ) said there is a concern the bill could cause “an exodus of our members to other Canadian provinces.”

Already, said FMEQ president Serge Keverian, medical students at the Université Laval are reporting that twice as many as last year opted to do residencies in family medicine outside of Quebec.

“These are significant numbers,” said Keverian. “There is no question the bill brings a negative and coercive tone to family medicine.”

This is the time of year when students are looking for matches in their preferred fields and, while it’s too soon to say if requests for family medicine in Quebec have dropped because of the bill, there are worries.

“We are concerned about the fate of family medicine and are unsure about how this year’s match process will go,” said Pooja Aysola, president of the Association of Residents of McGill ( ARM).

“We are really concerned for the future of family medicine. More unfilled spots this year would signal that the bill is making family medicine less desirable at a time when Quebec needs it most.”

The first iteration of matches is in but the final results, after the second iteration, will only be known on April 14.

In recent years, Quebec has made a concerted effort to boost the number of students choosing family medicine. Medical schools throughout the province — in fact, throughout the country, as this is a national objective — have adapted their curricula show that family medicine isn’t undervalued, while provinces have moved to increase the number of residencies available in the field to address the shortage of family doctors.

In 2000, only 30 per cent of residents in Quebec were in family medicine, and the goal has been to boost that to 50 per cent by this year.

The province was on track to do that — before the introduction of Bill 20.

According to numbers provided by the department of health and social services, the number of residents in family medicine in 201011 was 336, or 42 per cent, and it has been climbing steadily every year. In 2014- 15, there were 425 residents in family medicine representing 49 per cent of the class.

ARM’s brief says many stakeholders, including the Quebec government itself, have been working in recent years to make family medicine more attractive to meet the needs of an aging population. “Paradoxically, Bill 20 will make family medicine in Quebec a less attractive career choice, and over time reduce the number of family physicians in the province,” it concludes.

Bergman said McGill has really striven to emphasize the field as a medical discipline and is one of the few schools in the world to offer a master’s degree in family medicine.

A questionnaire sent to students at Quebec’s four medical schools, outlined in Thursday’s Montreal Gazette, showed that 46 per cent of students said they wouldn’t have made family medicine their first choice after the introduction of Bill 20.

Nebras Warsi, president of Medical Students’ Society of McGill University, said the bill has revived the old “negative perceptions of family medicine” that McGill’s new curriculum, introduced two years ago, had tried to remove.

“Are people going to remain interested in family medicine? I don’t know,” said Warsi. With limits on time they can spend with patients, students feel family doctors are unwanted and “that’s not a great environment if you’re trying to recruit more people for one of the specialties we need the most.”