To unclog emergencies in France, more than a thousand doctors move daily to patients needing an emergency consultation, for already fifty years. In Quebec, small similar initiatives exist, but they are struggling to establish themselves without government support.
“With the aging population, doctors in offices are overwhelmed, as are emergencies. For the benefit of patients, we could no longer do without SOS Doctors’ home services, “said Dr. Pierre-Henry Juan, president of the federation which specializes in emergency home medical visits in France.
It all started in 1966, says Juan in an interview with The duty, when a doctor – Dr. Marcel Lascar – noticed the need to offer such a service to the population. “He learned that one of his patients had died of a heart attack over the weekend, having failed to reach a doctor on call. That same weekend, Dr. Lascar had managed to reach a plumber in 15 minutes to repair a water leak at his home. “
More than 50 years later, the SOS Doctors federation has 1,200 emergency doctors spread over the territory, ready to answer emergency calls, 24 hours a day, 7 days a week. Doctors charge 35 euros (50 dollars) for day consultation, 10 euros (15 dollars) more than in the office. Surcharges apply depending on the day, time or place. “But patients can be reimbursed up to 70% by social security. And if they have a good mutual, it reimburses the remaining 30%, “says Dr. Juan.
In his view, these home interventions are essential for the elderly or people with multiple disabilities. And they are also useful for the rest of the clientele, helping to unclog emergency rooms and relieve busy schedules for doctors in the office. “France has long been known for having a lot of doctors, but we have fewer and fewer, and those who remain are overwhelmed, because the need for medical care has increased with the aging of the population,” he explains. .
And the situation is affected by the number of calls that SOS Doctors receive. While 60% of procedures take place at night, weekends or holidays, calls for daytime emergency visits during the middle of the week have increased by 40% in 10 years.
In Quebec
On this side of the Atlantic, getting an “emergency” medical consultation remains a challenge, especially in winter during the flu season: walk-in clinics are running out of space and emergencies are overflowing. Home care is offered, but especially for “very sick patients who are unable to move to the office or who are in accommodation,” said the Ministry of Health by email.
A few doctors have embarked on emergency home care, which is offered to everyone, but the experiment is far from being as popular and successful as in France.
Since 1982, in Saguenay, doctors from the Jonquière-Médic service have visited patients to avoid waiting in the emergency room. However, they went from 12 to 7 doctors. “It is difficult to find motivated doctors to move on the roads, especially in winter. The change in general practitioner compensation in 2016 did not help, “said Louise Tremblay, chair of the board of directors.
The reform of the former Liberal government financially encouraged family physicians to care for more patients and in their offices, but at the expense of walk-in and home visits.
The Jonquière-Médic service is currently surviving thanks to donation campaigns.
Elsewhere, home emergency medicine is more available to the private sector to be profitable. Pierre Renard, for example, practices in the Quebec City and Lévis region. In 2018, this French native wanted to recreate the SOS Doctors system for which he worked for 11 years. “Two years later, I’m still alone,” he says. But I do not despair of finding other doctors ready to live their passion and work with me. ” Its services are offered to everyone, but are not covered by the Régie de l’assurance-maladie du Québec. A basic consultation costs $ 190, tax deductible. “The fact that it is in the private sector is a hindrance for many. But if the government had the will to set up such a system, it would be possible, says the doctor. It would make life easier for many people and it would relieve the emergencies. ”
Not enough doctors
But the spokesperson for the Federation of General Practitioners of Quebec, Jean-Pierre Dion, has some reservations. “In France, they do not have the staffing problem that we know here. There is a shortage of doctors and the number of patients [qu’il est] possible to see in a day at home is really less than in the clinic; it would be counterproductive, ”he says.
And why not send nurses to do home visits instead, suggests Roxane Borgès Da Silva, professor at the School of Public Health at the University of Montreal. “People often need to be reassured by a health professional, face to face, not just on the phone like with Info-Santé. Nurses have the skills and can prescribe. It would be a solution to improve the situation. ”
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