Why do family physicians perform fewer home visits in Quebec than they did several decades ago?

As a family physician and medical director of French origin, having practiced in France and Quebec, I have observed the marked differences in medical practices on both sides of the Atlantic. One of the most striking concerns home visits, once a common practice in Quebec, but which have become rare today. This article explores the reasons behind this decline and the implications for patients.

A change in the organization of medical work

In the 1960s and 1970s, it was not uncommon for Quebec family physicians to devote a large part of their week to home visits. Several organizational factors have contributed to the decrease in these practices:

• Centralization of care: The Quebec healthcare system has been structured around clinics, hospitals, CLSC, and GMF (Family Medicine Groups). These structures were designed to group medical resources, but this has reduced physicians' flexibility to travel.

• Shared schedules: Quebec physicians often work in multiple contexts (emergencies, hospitalizations, CHSLD, clinics). This versatility reduces their availability for home consultations, unlike the traditional model where physicians moved more freely.

A question of remuneration

The fee-for-service remuneration model of the Régie de l’assurance maladie du Québec (RAMQ), the Quebec health insurance, has also played a major role:

• Lower remuneration for home visits: Although RAMQ offers fees for home visits, these are often considered less profitable than consultations in a clinic, where a physician can see several patients in the same amount of time.

• Travel time and costs: A home visit requires dedicating time to travel and incurs costs (transportation, parking), which is not compensated by the current rate.

More complex demands and an aging population

The Quebec population has aged, and health problems have become more complex:

• Need for specialized equipment: Clinic consultations allow access to immediate diagnostic devices (blood tests, X-rays, etc.), which is impossible to replicate at home.

• Time required to evaluate severe cases: Physicians today must manage cases requiring prolonged consultations or multiple follow-ups. Home visits are perceived as less suitable for chronic cases requiring complete management.

An evolution in patient expectations

Patients themselves turn to home visits less often, favoring care accessible in modern clinics:

• Immediate availability: With the emergence of walk-in clinics and telemedicine, it is often faster to obtain care outside the home.

• Less familiarity with this service: Newer generations are less accustomed to this mode of care, which reduces the demand for this type of practice.

What remains of home visits today?

Some physicians, such as those at Allodocteur.ca, strive to reintroduce home visits by drawing inspiration from the French model, where they remain accessible and regular. We believe that this service is essential to meet the needs of vulnerable patients or people who have difficulty moving.

In conclusion, the decline of home visits in Quebec is explained by organizational, financial, and practical factors. However, initiatives like those of Allodocteur.ca aim to make these consultations more accessible, faster, and less anxiety-inducing. Our family physicians registered with the CMQ = Collège des médecins du Québec offer same-day availability for home visits, as is still widely done in France.

How to book an appointment with Allodocteur.ca?

It couldn't be simpler! You can book an appointment:

• Online on our site: www.allodocteur.ca

• By phone: Call us at (438) 800-8810 and leave a message to be called back quickly.

• Directly via our online chat service during business hours.

With Allodocteur.ca, our goal is to offer you consultations that are less anxiety-inducing and adapted to your pace of life. Book an appointment and rediscover the advantages of home visits, just as in France.