MONTREAL — The Court of Appeal has ruled that the GP distribution plan and method used by the minister are valid. Dr. Mark Roper and his lawyer, Me Julius Gray, therefore failed to convince the judges that there was a real injustice against the people of Montreal.

In an emailed response to The Canadian Press, Mr. Gray said he was disappointed and mentioned he was considering going to the Supreme Court.

In the judgment signed by Judges Stephen W. Hamilton, Martin Vauclair and Frédéric Bachand, the court upholds the first instance decision of Judge Dominique Poulin. We also underline the “cautious” nature of the Supreme Court’s ruling.

In that of Mr. Gray and Dr. Roper’s argument is that Montreal is at a disadvantage compared to most regions of Quebec because of the method used to create the Medical Workforce Distribution Plans (PREM).

All family physicians practicing under Quebec’s public plan must have a declaration of compliance allowing them to practice in a region designated by the Ministry of Health and Social Services (MSSS). This approval comes with the obligation to spend “at least 55% of your billing days” in this zone.

The numbers from Dr. Roper said Montreal has the worst primary care physician registration rate at 68%. Quebec’s target is 85%. Despite this gap, the minister uses his discretion from year to year to deprive the metropolis of new doctors in favor of other regions.

For comparison: Montérégie has the second worst rate at 75%. The regions best served according to this criterion are Saguenay–Lac-Saint-Jean with 91% and Gaspésie-Îles-de-la-Madeleine with 89%.

The complainants claimed the system used was “unreasonable” and even violated the Canadian Charter of Human Rights and Freedoms.

However, the Court of Appeal judges came to the same conclusions as Justice Poulin, namely that the insufficient number of frontline GPs “is not due to the allocation of staff made by the Minister, but rather to the insufficient number of doctors to meet the need at the provincial level.

In defense, Me Amélie Bellerose, representing Quebec’s attorney general, rightly argued that family doctors do not just provide frontline advice. In remote areas the reality is even more stark. This forces the minister to deploy more resources in these regions, even if the number of patients registered with a general practitioner is higher.

“Nothing is lost, nothing is created,” she said as she opened her presentation to the appeals court Thursday morning. “We also need doctors in CHSLDs, in emergency rooms, in the short term,” she added.

Me Bellerose recognized that the method was not perfect and could be improved. She even described the complainant’s approach as “noble” as it stemmed from a desire to improve health care.

However, the reality remains that the inability to offer more general practitioners to the people of Montreal is due to the shortage of doctors.

“We make do with what we have. What we have are family doctors who do CHSLD, obstetrics and emergencies,” she stressed, concluding that there is a gap between supply and need across the territory.

In his application, Dr. Roper also noted the fact that when calculating staffing distribution, neither the registration rate nor Montreal’s actual patient pool was taken into account if we limit ourselves to population.

However, the judges recalled that in this situation it is not the role of the courts to replace legislative, executive or administrative power.

In the government camp, we reiterate that the Minister annually develops the distribution of family doctors, taking into account the wishes and needs of all institutions.

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