Quebec Family Physician vs French General Practitioner: What are the differences?

As a family physician and medical director of French origin, having completed my studies and practiced in France before settling in Quebec, I have noticed that although the roles of the family physician in Quebec and the general practitioner in France are similar, several differences mark their practice. These distinctions are primarily linked to the structure of the respective healthcare systems, the responsibilities of the physicians, and access to care. Here is a comparison between these two professions to enlighten French citizens who wish to better understand the Quebec system.

Training and Titles

• Quebec: In Quebec, the family physician follows a five-year university curriculum, followed by two years of residency in family medicine, for a total of seven years of training. They become a "family physician" after passing the exam of the Collège des médecins du Québec (CMQ). Unlike in France, the Quebec physician does not need to defend a thesis to obtain their degree.

• France: In France, the general practitioner follows six years of study followed by three and a half years of internship in general medicine. At the end of this period, the general practitioner must defend a thesis to obtain their degree and the right to practice. The term "general practitioner" refers to a versatile practitioner capable of managing patients of all ages and conditions.

Access and Mode of Practice

• Quebec: The family physician is at the heart of the Quebec health network, and access to their care can be difficult. Registering a patient with a family physician via the Guichet d’Accès à un Médecin de Famille (GAMF) can take several months or even years. Quebec family physicians often practice in Family Medicine Groups (GMF), where they work as a team with other healthcare professionals. They ensure long-term follow-up for their patients and coordinate their care with specialists if necessary. Additionally, it is common for the Quebec physician to also work in other settings such as emergencies, hospitalization, CHSLD (Long-term care and support centres), or other environments, which can reduce their availability in the clinic.

• France: The French general practitioner is accessible more quickly, and the majority of French people have a referring general practitioner. They can consult a general practitioner without going through a long registration process. Consultations often take place in private practices, and patients are free to change their general practitioner at any time. Furthermore, French general practitioners often have more flexible hours, sometimes including home visits.

Remuneration System

• Quebec: The remuneration of family physicians in Quebec is generally established via a billing system to the Régie de l’assurance maladie du Québec (RAMQ), which is the Quebec health insurance, covering medical consultations. This means that services are free for patients insured by RAMQ. Some physicians may also work in private clinics outside of RAMQ, but this remains rarer.

• France: In France, the payment system is mostly based on third-party payment, where the patient pays a portion of the consultation and the other part is reimbursed by Social Security and mutual insurance. General practitioners can choose to practice in Sector 1 (contracted rates), Sector 2 (free fees, partially reimbursed), or Sector 3, where fees are completely free and not reimbursed by Social Security, although this sector is very rare.

Role in Prevention and Follow-up

• Quebec: The family physician plays a central role in prevention in Quebec. The follow-up of chronic diseases such as diabetes, hypertension, or cardiovascular diseases is an important part of their practice. GMFs facilitate this follow-up through interdisciplinary collaboration with other professionals such as nurses or nutritionists.

• France: In France, the general practitioner also ensures important preventive follow-up, although they are often sought more for one-off consultations than long-term follow-ups. However, they can refer their patients to specialists if necessary, without having to go through a centralized system as in Quebec.

Emergency Management

• Quebec: Quebec family physicians are often overwhelmed by demand and cannot always provide same-day emergency care. Patients must then turn to walk-in clinics or hospital emergencies. Waiting times in these contexts can be significant, which sometimes makes the situation difficult for patients.

• France: In France, the general practitioner can more easily manage common emergencies, notably thanks to home visits or the flexibility of quick appointment booking. However, more serious emergencies are immediately directed to the hospital via the emergency call system, 15.

Conclusion

The role of the family physician in Quebec and the general practitioner in France shares a common mission: providing quality primary care to the entire population. However, access to care, practice modalities, and remuneration systems differ significantly. For French people settled in Quebec, these distinctions can create challenges in navigating the Quebec healthcare system. It is therefore important to understand the particularities of the Quebec model in order to better adapt and maximize access to care.

The Allodocteur.ca clinic strives to make family medicine more accessible and fast by offering same-day home visits, as is frequently practiced in France, to meet the immediate care needs of its patients. You can book an appointment with us today on Allodocteur.ca for a home consultation.