When I started practising family medicine in Quebec nearly 40 years ago, it was a profoundly human profession. I followed my pregnant patients through their pregnancies, helped deliver their babies, and then cared for those children as they grew.
I admitted patients to hospital, co-ordinated their care, and was there at the end of life — often attending their funerals.
I’ve had the privilege of caring for four generations of the same families. That kind of trust and continuity is something I cherish, and it has defined my career.
But that model of care is under threat.
Quebec’s publicly funded health care system, while built on the ideals of equity and accessibility, is struggling under the weight of bureaucracy and inefficiency.
Family physicians are being asked to do more than ever — more patients, more paperwork, more system navigation — all while our ability to make clinical decisions with autonomy is being chipped away.
Technology, which should streamline our work, often creates more problems than it solves. Electronic records still don’t communicate properly between hospitals, CLSCs and GMFs (Groupe de médecine de famille). Time that should be spent with patients is eaten up by data entry and compliance checklists.
And while the government pushes for greater accessibility —
asking doctors to attach more patients
And be more accessible—there’s insufficient acknowledgment of the complexity of these patients’ needs or the lack of support provided to the doctors who care for them.
New doctors are showing their preferences by where they choose to work.
Many individuals are moving away from comprehensive, long-term practices. Instead, they opt for hospital rotations, urgent care positions, or part-time clinic jobs—understandably so, as the present system proves unmanageable.
Nevertheless, I stand by our work. No application or algorithm can substitute for the level of care that develops over many years. Taking care of a patient whose mother I previously delivered—that goes beyond medicine; it embodies community.
To maintain this level of primary care, simply increasing funds isn’t enough—we require significant restructuring. This involves reducing bureaucratic hurdles, enhancing technological support, upholding doctors’ professional independence, and most importantly, allocating more time for genuine patient treatment.
Primary care is not a cost. It’s the foundation of the entire system. Let’s treat it that way.
George Michaels is a family physician, medical director at at GMF and an assistant professor of family medicine at McGill University.
