Rural Quebec physicians have faced a number of political challenges in the past 5 years, in additional to usual clinical and geographic challenges. The Liberal Minister of Health, Gaetan Barrette, has built additional controls of family physicians into the health system, rendering recruitment even more difficult, and requiring new physicians to apply for and finalize their intended place of work 9 months before the usual July 1st graduation period. He has also instituted fusions of establishments, thereby creating immense geographic areas controlled by a single administration, whereby the emphasis is naturally on the larger institutions, and the smaller rural institutions have since lost their sense of control. This also includes fusions of laboratory services, whereby there is going to be a centralization of laboratory services, leaving small rural hospitals dependant on transporting samples to the regional site.
There has been a politically active organization developed, called ROME (Regroupement des medecins Omnipraticiens pour une Medecine Engage), which, along with FMOQ (Federation des Medecins Omnipraticiens du Quebec), has been maintaining pressure on the government, and educating the population about the consequences of the various pressure tactics.
Of course, in addition, Dr. Barrette has denigrated family medicine as a whole, contributing to the general demoralization of the specialty. This probably contributed to the shocking lack of match for 64 position in family medicine residency for Quebec in 2018, mostly at Universite de Laval.
Clinical challenges have been highlighted by the ongoing tuberculosis epidemic in Nunavik, and a significant return of syphilis both in Nunavik as well as the urban centres. In the James Bay area physicians and the population are working together closely to try to mitigate the effect of the massive prevalence of diabetes on the Cree population.
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