Why do family doctors make fewer house calls in Quebec than they did decades ago?
As a family physician and medical director of French origin, having practiced in France and Quebec, I have observed the marked differences in medical practices on the two sides of the Atlantic. One of the most striking concerns home visits, once a common practice in Quebec, but now rare. This article explores the reasons behind this decline and the implications for patients.
A change in the organization of medical work
In the 1960s and 1970s, it was not uncommon for Quebec family doctors to devote a large part of their week to home visits. Several organizational factors have contributed to the decline in these practices
-Centralization of care: Quebec's healthcare system is structured around clinics, hospitals, CLSCs and GMFs (Groupes de médecine de famille). These structures were designed to pool medical resources, but this has reduced doctors' flexibility to travel.
-Shared schedules: Quebec physicians often work in a variety of settings (emergency rooms, hospitalizations, CHSLDs, clinics). This versatility reduces their availability for home consultations, in contrast to the traditional model in which doctors moved around more freely.
A question of remuneration
The Régie de l'assurance maladie du Québec (RAMQ) fee-for-service model has also played a major role:
-Less remuneration for home visits: Although the RAMQ offers fees for home visits, these are often considered less profitable than clinic consultations, where a doctor can see several patients in the same timeframe.
-Travel time and costs: A home visit requires time for travel and generates costs (transport, parking), which are not compensated for by the current rate.
More complex demands and an aging population
The Quebec population has aged, and health problems have become more complex:
-Need for specialized equipment: Clinic consultations provide access to immediate diagnostic equipment (blood tests, X-rays, etc.), which is impossible to reproduce at home.
-Time needed to assess heavy cases: Today, doctors have to manage cases requiring prolonged consultations or several follow-ups. Home visits are perceived as less suitable for chronic cases requiring comprehensive management.
Changing patient expectations
Patients themselves are turning less often to home visits, favoring accessible care in modern clinics:
-Immediate availability: With the emergence of walk-in clinics and telemedicine, it's often faster to obtain care away from home.
-Less familiarity with this service: New generations are less accustomed to this mode of care, which reduces demand for this type of practice.
What's left of home visits today?
Some doctors, such as those at Allodocteur.ca, are working to reintroduce home visits based on the French model, where they remain accessible and regular. We believe this service is essential to meet the needs of vulnerable patients or those with mobility difficulties.
In conclusion, the decline in home visits in Quebec can be explained by organizational, financial and practical factors. However, initiatives such as Allodocteur.ca aim to make these consultations more accessible, faster and less anxiety-provoking. Our family doctors registered with the CMQ = Collège des Médecins du Québec offer same-day home visits, as is still widely done in France.
How do I make an appointment with Allodocteur.ca?
It couldn't be easier! You can make an appointment :
-Online at www.allodocteur.ca
-By phone: Call us at 438-942-8479 and leave a message for a prompt call-back.
-Live via our online chat service during business hours.
With Allodocteur.ca, our goal is to offer you consultations that are less anxiety-provoking and adapted to your lifestyle. Book an appointment and rediscover the benefits of home visits, just like in France.
