Quebec successfully met the ambitious goal of registering 500,000 new patients to family doctors, one month ahead of schedule. While this sounds great on paper, we are not out of the woods yet. There are still many unaddressed issues that could undo much of the progress made in trying to increase patient access to primary care.
First, physicians are exhausted — with 46 per cent reporting high levels of burnout and 37 per cent saying they want to reduce their clinical hours over the next two years, according to the Canadian Medical Association’s 2025 National Physician Health Survey.
Many doctors find it impossible to take on more patients due to the aging population and today’s socioeconomic challenges, which have led to increased patient complexity and vulnerability. Patients often require more frequent care, longer appointment slots, and more time-consuming administrative tasks, such as filling out forms.
To take on more patients, we need more physicians — but this is no simple task.
The political turmoil surrounding health care reform in recent years has made it more difficult than ever to attract medical students into family medicine. This past year, a staggering 151 family medicine residency spots in Quebec were unfilled during the first round of matching.
Smaller family medicine groups (GMFs), particularly in less densely populated areas, face specific challenges to recruiting and retaining physicians, writes Dr. Laura Sang, who practises in the Laurentians. Getty Images / iStockphoto
Physician retention within the public sector is also a concern, with more than 1,000 doctors leaving the public sector since March 2025, when we already faced a shortage of more than 2,000 family doctors in the province.
Unlike in other provinces, physician recruitment hinges entirely on the PTEM system (plans territoriaux des effectifs médicaux). While its original purpose was to ensure an equitable distribution of family doctors throughout all regions, the system restricts the number of doctors who can practise in any given area, which can significantly affect a region’s ability to keep up with physician retirement rates.
The system may also act as a deterrent for new graduates, who may instead go to the private sector or leave the province altogether, further perpetuating the doctor shortage.
This year, in my area of the Laurentians, only 13 positions were available to new family doctors, while the region is known to be missing at least 130.
Family medicine groups (GMFs in French) are the cornerstones of primary care. Funding and resource allocation for GMFs are based on the number of registered patients. In general, to maintain GMF status, a minimum of 6,000 patients — regardless of their complexity and vulnerability status — must be enrolled. So we need enough physicians and allied health care professionals to manage these patients.
Smaller GMFs, particularly those in less densely populated areas, face specific challenges to recruiting and retaining physicians. For example, in the absence of special agreements, all GMFs — irrespective of size — must staff the same minimum number of evening, weekend and holiday hours.
In this context, I have anecdotally seen young doctors leave small clinics for bigger ones because they can work fewer unfavourable hours and have access to more resources. They also want to avoid the stress of potential closure, since larger clinics have a bigger buffer to stay above the 6,000-patient threshold.
As it stands, we have lost two sister clinics. And if two more doctors retire from my clinic in St-Hippolyte, we may have to close as well. Policy reform is essential, and it needs to happen quickly to save clinics like mine.
Fortunately, an independent expert committee conducted extensive research and released a detailed report with its findings and recommendations in January 2026. Among the recommendations: a move toward local governance, and shifting toward interprofessional teams, allowing for better community-based primary care access.
According to the committee’s review of models in countries such as England, decentralized management of health services allows regions to mobilize community resources more effectively and better meet regional needs.
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Moreover, an interdisciplinary team approach has the potential to offer a more comprehensive range of care than a physician-centric model. When physicians are supported by working in an interdisciplinary team, they can effectively manage their workload and minimize the risk of burnout.
Finally, this report also highlights that the “over-registration of patients beyond a clinic’s capacity may undermine timely access and lead to increased wait times and reduced continuity of care.”
Simply incentivizing doctors to take on more patients does not necessarily translate to increased health care access. Health organization and governance changes in line with expert opinion are necessary to keep GMFs of all sizes open and patients off the wait-list.
Laura Sang is a family physician practising in the lower Laurentians.