No Annual Check-Ups for Healthy Quebecers Age 5& Up: A Sickening Decision. Literally.

As reported by the Montreal Gazette & CBC News, healthy Quebecers ages 5 and over will no longer be able to get an annual check-up with their doctor as of June 1st, 2016.

Please note that since the original publication of this article, it has been clarified that this applies to appointments with Family Doctors, not pediatricians. While this is good news for children who are followed by pediatricians, the reality is that MANY children are followed by family doctors.  To put it into perspective, I spoke with one family doctor alone whose patient list includes 2,500 children. How many other thousands of children will be unable to see their doctor annually?  The problem is HUGE.  

(Please note that this blog post has been updated to reflect the new information.)

Apparently there is no evidence that annual check-ups help to ensure a ‘healthy’ patient’s overall health and it is felt that the government will be able to save money by abolishing the annual check up.

According to the Gazette article, until now doctors were paid $80 for each annual physical exam.  Under the new plan, doctors will be paid $92.15 for a periodic exam with a “vulnerable” patient and $41 for a ‘follow-up’ visit with a patient who is not considered ‘vulnerable’.

While I am by no means a doctor or health administrator, there is something intuitively wrong with this decision, on so many levels.

• There is no alternative regular check up period.  Not 2 years, not 3 years.  So long as you are healthy, you are not deemed to need regular check ups. Really???
• When I asked Montreal-area physician Dr. Leslie Solomon what she thought of the decision, in particular with regards to children, she responded that

“Children 5-18 years old are at a time of rapid development. Eliminating the check up risks missing crucial abnormalities and anticipatory guidance opportunities. The children of Quebec are our future. Taking short cuts to save a few dollars now will lead to disasters in the future.”

• To complicate matters further, children ages 14-17 are presumably permitted to make decisions about their own health care and to consult privately with their doctor. While I by no means advocate risky teen behaviour, it is a reality. What happens when the teen who is not considered ‘vulnerable’ needs to ask their doctor questions about their risky behaviour or how to get help with it?  What is the protocol to get an appointment? After all, they are not really ill…  Will the teen even feel comfortable with their doctor considering the visits over the years have been extremely limited?
• What happens to a ‘healthy’ child who turns 18 years old?  If they were lucky enough to have been followed by a pediatrician until their 18th birthday, what happens now that they are 18 years old and considered ‘healthy’? How does a ‘healthy’ 18 year old go about getting a family doctor if they have no need to be checked?  Do they have to become ill in order to see a doctor?  Do they automatically become a patient of that doctor’s practice once they have been seen due to illness or does that only happen if they are somehow deemed “vulnerable”?
• Under this system, how will someone who is not considered ‘vulnerable’ even be associated with a particular physician? If they haven’t seen their doctor in 5 years, or 10 years, will their file remain active?
• Is the intent that only ‘vulnerable’ patients will have doctors and everyone else will see clinic & Emergency Room doctors on an as-needed basis?
• How is ‘vulnerable’ defined anyway?  Does anyone remember when H1N1 vaccines were being given to ‘vulnerable’ people first?  Suddenly everyone and their brother-in-law needed puffers….Will we see a similar phenomenon of more people with ‘chronic conditions’?
• Is there no appreciation for the fact that a doctor forms a bond with his or her patient and that the patient in turn trusts his or her doctor? That knowing your patient allows you to give a more personalized level of care?
• In an article entitled The Case FOR the Annual Check-Up, Dr. Michael Kalin of Santé Kildare cites some of the research (The Cochrane Study) that was used to come to the conclusion that annual check-ups do not reduce rates of illness or mortality. I invite you to visit his article for a better understanding of that research, but in a nutshell, it seems that the research is old and that trials were predominantly performed in Europe…so are the results necessarily applicable here in Canada?
• While Dr. Kalin understands that “Annual check-ups, like everything, need to evolve.” He also states (correctly, imho) that:

” Preventative medicine should be personalized – but it needs to be planned. Air Canada (hopefully) does not wait for the airplane to make funny noises before checking it out. Routine maintenance is neither a luxury nor superfluous – it is common sense.”

To me, not checking in regularly with your doctor intuitively seems like not doing a routine maintenance-check on your body, and without some of the basic routine testing, when will patients become aware of a problematic change in blood pressure, or that their cholesterol is elevated?

While there are clearly studies that show otherwise, ( you can find studies to substantiate anything), it still feels that ultimately a system that cuts preventative care will result in more issues going undiagnosed and more sickness down the road, which is why I find the whole thing to be Sickening.  Literally.

Furthermore,  I altogether fail to see how this initiative will actually have the effect of cutting spending.

Again, I am not a health administrator, so I guess I must be missing something.  Under this new plan, presumably when a doctor sees a ‘healthy’ patient who insists on an annual “follow up” appointment, the doctor will not be able to give as comprehensive a check up as he or she would have in the past. As an example, the doctor might see 2 “follow ups” rather than 1 comprehensive annual check-up, earning $82 vs. the prior $80, so more or less keeping earnings level but seeing more patients. (Note that seeing a ‘vulnerable’ patient will yield $92.15, which is slightly more than 2 ‘follow ups’ at $82…but one might also argue that doctors will then have the incentive to see 3 “follow ups” per hour. I don’t mean to presume that doctors are operating strictly on financial motivation, but realistically, they need to maintain or increases their earnings…especially those who have administrative costs & overhead that increase each year).  Again, I haven’t done enough research to speak with authority on it, but perhaps this is Minister Barrette’s way of getting more patients seen by every doctor… I just don’t see how it will save money….and even if it did, it seems a short term gain for a long term pain…penny wise & dollar foolish as the expression goes.

Finally, even if it is a spending issue, those dollars were provided by us, the tax-paying citizens of Quebec. Healthcare is not exactly where most of us would look to cut spending.

My husband sometimes call me his ‘little socialist’ because I do believe that we have an obligation to care for those among us who are at a disadvantage. That said, I don’t love the idea that healthy & able-bodied contributing members of society will be less entitled to the very healthcare services being paid for by their hard-earned tax dollars.

What do you think of this news?  How does it make you feel?  I’d love to hear from you.

If you are reading this article and you happen to work in healthcare / health administration and have answers to some of these questions, please reach out. I would love to better understand what is about to be implemented and I am sure that most of my readers will, as well.

Wishing everyone a day where you are absolutely NOT in need of medical attention.

Tanya