Title: Medical Workforce Planning : les plans rgionaux deffectifs mdicaux PREM
1Medical Workforce Planning les plans
régionauxdeffectifs médicaux (PREM)
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
- Jean Rodrigue, m.d.
- Direction de la Planification et de la
Régionalisation
2Objectives
- Achieve a better distibution of general
practitioners (GP) throughout the Québec
territory - For the FMOQ
- Maintain for every GP the right to set his/her
practice wherever he/she wants in Québec - Allow every GP to move from one region to
another, knowing that the main flow is from
remote regions to urbanized areas.
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
3Challenge reconcile every GPs rights with
patientsright to have access to medical services
- 2004 PREM achievement levels
- Mauricie/Centre-du-Québec 77
- Outaouais, Abitibi 84
- Montréal 91
- Estrie and Québec 97
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
4Prior to 2002
- Distribution of GPs was influenced by
- Financial incentives for remote and isolated
regions (15 to 40 raise on earnings, daily
allocation for CME and various premiums) - Financial disincentives for urban regions and
their surroundings (30 decrease on earnings for
the first 3 years of practice) - Professional, familial and personal interests
52002
- Shortage in many regions due mainly to
- Decreased cohorts of new physicians who
cannotcompensate for losses - Rapid population growth in suburban regions
- The 2002 crisis when 12 ERs faced a break in
services - The threat of a billing number announced by the
Health Minister
6Workforce planning strategy
- Measures taken under bill 142
- Rules of practice setting and mobility settled by
an agreement - Joint actions (FMOQ Health ministry RDGM) to
evaluate GP workforce and needs in each region - Improvement of negotiated incentives in remote
and isolated regions - Abolition of the punitive decree for the first
three years of practice ( - 30 of earnings) - Regional department of general medicine
7Legal rules under the law regarding health and
social services (LSSS) (1)
- PREM must specify, for each region and subregion,
the actual and the expected medical workforce in
health centers (PEM) and in private offices
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
8Legal rules (LSSS) (2)
- A health center cannot accept an additional
physician if its medical workforce plan (PEM) is
full unless authorized by the regional agency,
under penalty of cancelling that nomination - Health centers must respect growth objectives
specified by the minister of Health
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
9PREM 2004 results
- Good recruitment in universitary regions, their
surroundings and Mauricie/Bois-Francs - Disastrous recruitment for Outaouais, Lanaudière
and most of the remote regions, - No exception to the PREM has been accepted
- Third year residency was not a motive for
exemption
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
102005 Medical workforce growth approach
- Fill the previous year losses for each region
- Taking into account expected GPs from other
regions - Adding positions for new GPs if necessary
- Allow net increase for various regions depending
on - Gap between ressources and needs
- Recruitment achieved in 2004
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
112005
- Québec expected total net increase (new GPs
losses) - 61 GPs
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
122005 PREM growth objectives universitary regions
Positions reserved by the minister of Health
for GPs from other regions. To be considered as
such, a GP must have completed a year in another
region under the Quebec health insurance regimen
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
13Calculation of a year of practice
- 12 months
- Practice under the Quebec health insurance
regimen with position in the PREM - Monthly earnings of 4 000 or if less, minimum
of 2 000 on 10 or more billing days. - Allowing 2 months for holidays and CME
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
142005 PREM growth objectives
Reserved positions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
152005 PREM growth objectives intermediate regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
162005 PREM growth objectives remote regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
172005 PREM growth objectives isolated regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
18PREM 2005 preliminary results
- University regions and their surroundings have
already filled every positions for new GPs,
including Lanaudière - Mauricie/Bois-Francs, Outaouais,
Saguenay/Lac-St-Jean and Bas St-Laurent have
improved their recruitment - Difficult recruitment for most of the remote
regions - Family medicine residents were unhappy about the
way PREM were managed and the FMRQ made
suggestions to improve the rules of application
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
19PREM 2006
- Since the expected number of new GPs will be
similar to 2005, the number and the distribution
of PREM positions in each region will not vary
significantly in 2006
20Specific agreementregarding compliance to PREM
- Effective since January 1st, 2004
- Concerns all GPs
- To have his main practice setting in a given
region, a GP must obtain from the RDGM of that
region a notice of compliance to the regional
workforce plan (PREM)
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
21Notice of compliance to a PREMavis de conformité
- Requires that GP must sign an agreement to do 55
or more of his activities in that region, on
the basis of billing days. - Valid for two years and renewable automatically,
unless notified by GP - Note in remote and isolated regions, to
benefit of all incentives, a GP must do 75 of
his activities in those regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
22Obtaining a notice of compliance (1)
- GP must fill a formulaire dadhésion and send it
to the regional department of general medicine
(RDGM), indicating probable date of practice
setting - RDGM decides to give or not the notice within two
months of reception
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
23Obtaining a notice of compliance (2)
- GP confirms acceptance within one month,
indicating probable date of practice setting
within 7 months of the RDGMs decision - If deadlines are not respected, notice of
compliance is lost - Given particular circumstances, a GP may be
granted a 6 month delay to set practice
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
24Setting a practicewithout a notice of compliance
- Private practice earnings are reduced by 30 for
each trimester when there is no notice of
compliance - Such GP would be forbidden the request for a
notice of compliance within this region for a
given period (delay for request) - Such GP would not be allowed to practice in a
health center within that region
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
25Delay for request of a notice of compliance in a
given region
- 3 years, if GP moves his practice in another
region where he obtains a notice and respects it
during that period - OR
- 5 years, if GP maintains his practice in the
region where he sustained 30 reduced earnings - Note the notice will be given by the RDGM only
if PREM positions are available
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
26Non compliance of 55 practice
- GP receives a notice from the RAMQ around
september 1st of the following year - Private practice earnings are reduced by 30 for
the year involved, from April 1st to March 31 - In special circumstances, exemption of the 30
reduction can be given by the joint committee
FMOQ-MSSS
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
27Part-time practice in another region
- A GP may practice up to 45 in one or more other
regions without any other PREM notification - Part-time dépannage activities are not considered
in the calculation of billing days regarding the
notice of compliance - Québec region and Eastern Townships have been
designated as restricted part-time practice
regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
28Restricted part-time practice regions
- If a GP starts a part-time practice in Québec
region or Eastern Townships, his private practice
earnings in those regions will be reduced by 30
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
29Praticewithin the confines of dépannage
- A GP may choose to restrict his practice to
dépannage instead of setting practice in a region - He must then request from the joint committee
FMOQ-MSSS a notice of compliance to the PREM
dépannage - In such case, he must do 95 of his activities,
in term of billing days, within the confines of
dépannage
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
30Mobility (1)
- Any time, a GP may request and obtain a notice of
compliance from another region, evidently if PREM
positions are available in that region - PREM are evaluated annually and new positions are
available each year
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
31Mobility (2)
- To be considered as coming from another
region a GP must have practice for at least one
year in Québec with a position in the PREM - A GP who practices outside Québec for more than
three consecutive years may be considered on his
return as a new GP
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
32Mobility (3)
- GPs can obtain the right to set their pratice in
a region even if there is no position available - GP leaving a remote regions after a continuous
period of practice of 3 years or more, with 75
or more of their billing days in those regions - GP with 20 years of practice or more
- GP leaving some intermediate regions after a
continuous period of practice of 5 years or more
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
33Temporary replacement (1)
- An health institution can accept the appointment
of a physician if it is intended solely to
provide for the replacement of a physician whose
appointment has been duly accepted by the board
of directors but who is absent or temporarily
unable to practise. - (Act respecting health services and social
services, art. 243.1)
34Temporary replacement (2)
- This application for appointment is not subject
to the provisions relating to the institution's
medical staffing plan nor to the PREM - This temporary appointment is valid only for the
duration of the absence or inability to practise
of the physician concerned and, notwithstanding
any inconsistent provision of this subdivision,
may not be the subject of an application for
renewal.
35Temporary replacement, PREM and AMP (1)
- Temporary replacement is permitted even if there
is no PREM position available - The GP who replaces will not suffer any
reduction of his/her earnings from the
replacement activity - HOWEVER
- A GP who accepts such a replacement appointment
without a PREM position may be subjected to
sanctions regarding either PREM or AMP
36Temporary replacement, PREM and AMP (2)
- PREM
- Replacing GP will face a 30 reduction of
earnings from office practice and - Will be subjected to a 3 or 5 years delay before
applying for a notice of compliance in that
region - AMP
- Replacing GP may face a 30 reduction of all
his/her earnings, if his/her activities are not
in sectors 1-4 of AMPs and are not recognized as
AMP by the DRMG
37PREM 2006 ???
Draft proposal
- Rules will be known in June 2005
- PREM positions will be announced at the beginning
of October - Since then, every request for a notice of
compliance will be treated on the PREM 2005
basis, approval if there is positions available,
refusal if not.
38PREM 2006 ???
Draft proposal
- Each DRMG will set out its priority activities by
health institututions and AMPs (including
primary care activities) - Initial period to apply for a notice of
compliance will last two weeks and every request
made during that period will be considered
received on the same date
39PREM 2006 ???
Draft proposal
- Subsequent request will be considered on first
come, first served basis - If the number of request on a given day exceed
the number of positions available, there will be
a selection committee
40Can a GP make simultaneous requestin various
regions ?
- Yes, but
- Delays of acceptance must be respected for each
request - Such GP may occupy 2 positions for a short period
and reduce positions available for his colleagues
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
41When can a GP request a positionwithin a health
center ?
- Simultaneously or after his request for a notice
of compliance to the PREM. However, to formally
obtain that position within a health center in a
given region - A GP must have his notice of compliance to the
PREM of that region - This health center must have an available
position within its medical worforce plan (PEM)
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC