Quebec family doctor vs. French general practitioner: what are the differences?

As a family physician and medical director of French origin, having completed my schooling and practiced in France before settling in Quebec, I realize that although the roles of the family physician in Quebec and the general practitioner in France are similar, there are several differences in their practice. These distinctions are mainly linked to the structure of the respective healthcare systems, the responsibilities of physicians, and access to care. Here's a comparison of the two professions to help French people better understand the Quebec system.

Training and qualifications

-Quebec: In Quebec, family physicians follow a five-year university curriculum, followed by two years of residency in family medicine, for a total of seven years of training. They become "family doctors" after passing the Collège des médecins du Québec examination. Unlike in France, Quebec doctors do not have to defend a thesis to obtain their diploma.

-France: In France, general practitioners undergo six years of study, followed by a three-and-a-half-year internship in general medicine. At the end of this period, GPs must defend a thesis to obtain their diploma and their right to practice. The term "general practitioner" designates a versatile practitioner capable of caring for patients of all ages and conditions.

Access and practice

-Quebec: Family doctors are at the heart of Quebec's healthcare network, and access to their care can be difficult. Registering a patient with a family doctor via the Guichet d'Accès à un Médecin de Famille (GAMF) can take several months, even years. Quebec family doctors often practice in family medicine groups (GMF), where they work as a team with other healthcare professionals. They provide long-term follow-up for their patients, and coordinate care with specialists if necessary. What's more, Quebec doctors often also work in other settings, such as emergency rooms,hospitalization, CHSLDs (Centres d'hébergement et de soins de longue durée) or other environments, which can reduce their availability in clinics.

-France: French GPs are more readily accessible, and the majority of French people have a GP referral. They can consult a GP without going through a lengthy registration process. Consultations often take place in private practice, and patients are free to change GPs at any time. In addition, French GPs often work more flexible hours, sometimes including home visits.

Compensation system

-Quebec: Family doctors in Quebec are generally remunerated via a billing system to the Régie de l'assurance maladie du Québec (RAMQ), which covers consultations. This means that services are free for patients insured by RAMQ. Some doctors may also work in private clinics outside RAMQ, but this is less common.

-France: In France, the payment system is mainly based on the "tiers payants" system, whereby the patient pays part of the consultation and the other part is reimbursed by Social Security and the mutual insurance company. GPs can choose to practice in sector 1 (agreed fees), sector 2 (free fees, partially reimbursed), or sector 3, where fees are completely free and not reimbursed by Social Security, although this sector is very rare.

Role in prevention and follow-up

-Québec: Family doctors play a central role in prevention in Québec. Monitoring chronic diseases such as diabetes, hypertension and cardiovascular disease is an important part of their practice. FMGs facilitate this follow-up through interdisciplinary collaboration with other professionals such as nurses or nutritionists.

-France: In France, GPs also play an important preventive role, although they are often called upon more for one-off consultations than for long-term follow-up. However, they can refer patients to specialists if necessary, without having to go through a centralized system as in Quebec.

Emergency management

-Québec: Family doctors in Québec are often overwhelmed by demand, and cannot always provide same-day emergency care. Patients must then turn to walk-in clinics or hospital emergency rooms. Waiting times in these settings can be long, making the situation difficult for patients.

-France: In France, GPs can more easily manage routine emergencies, thanks in particular to home visits and the flexibility of rapid appointment scheduling. However, more serious emergencies are immediately referred to hospital via the emergency call system, 15.

Conclusion

The role of the family doctor in Quebec and that of the general practitioner in France share a common mission: to provide quality primary care to the entire population. However, access to care, practice methods and remuneration systems differ significantly. For French people living in Quebec, these distinctions can create challenges in navigating the Quebec healthcare system. It is therefore important to understand the particularities of the Quebec model in order to better adapt and maximize access to care.

The Allodocteur.ca clinic is trying to make family medicine more accessible and faster by offering same-day home visits, as is common practice in France, to meet the immediate care needs of its patients. You can make an appointment with us today on Allodocteur.ca for a home consultation.