Medical Workforce Planning : les plans rgionaux deffectifs mdicaux PREM

1
Medical 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

2
Objectives

• 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
3
Challenge 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
4
Prior 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

5
2002

• 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

6
Workforce 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

7
Legal 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
8
Legal 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
9
PREM 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
10
2005 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
11
2005

• Québec expected total net increase (new GPs
  losses)
• 61 GPs

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
12
2005 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
13
Calculation 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
14
2005 PREM growth objectives
Reserved positions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
15
2005 PREM growth objectives intermediate regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
16
2005 PREM growth objectives remote regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
17
2005 PREM growth objectives isolated regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
18
PREM 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
19
PREM 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

20
Specific 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
21
Notice 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
22
Obtaining 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
23
Obtaining 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
24
Setting 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
25
Delay 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
26
Non 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
27
Part-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
28
Restricted 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
29
Praticewithin 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
30
Mobility (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
31
Mobility (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
32
Mobility (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
33
Temporary 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)

34
Temporary 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.

35
Temporary 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

36
Temporary 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

37
PREM 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.

38
PREM 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

39
PREM 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

40
Can 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
41
When 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