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Medical Workforce Planning : les plans rgionaux deffectifs mdicaux PREM

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... recruitment in universitary regions, their surroundings and Mauricie/Bois-Francs ... University regions and their surroundings have already filled every positions ... – PowerPoint PPT presentation

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Title: Medical Workforce Planning : les plans rgionaux deffectifs mdicaux PREM


1
Medical Workforce Planning les plans
régionauxdeffectifs médicaux (PREM)
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
  • Jean Rodrigue, m.d.
  • Direction de la Planification et de la
    Régionalisation

2
Objectives
  • Achieve a better distibution of general
    practitioners (GP) throughout the Québec
    territory
  • For the FMOQ
  • Maintain for every GP the right to set his/her
    practice wherever he/she wants in Québec
  • Allow every GP to move from one region to
    another, knowing that the main flow is from
    remote regions to urbanized areas.

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
3
Challenge reconcile every GPs rights with
patientsright to have access to medical services
  • 2004 PREM achievement levels
  • Mauricie/Centre-du-Québec 77
  • Outaouais, Abitibi 84
  • Montréal 91
  • Estrie and Québec 97

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
4
Prior to 2002
  • Distribution of GPs was influenced by
  • Financial incentives for remote and isolated
    regions (15 to 40 raise on earnings, daily
    allocation for CME and various premiums)
  • Financial disincentives for urban regions and
    their surroundings (30 decrease on earnings for
    the first 3 years of practice)
  • Professional, familial and personal interests

5
2002
  • Shortage in many regions due mainly to
  • Decreased cohorts of new physicians who
    cannotcompensate for losses
  • Rapid population growth in suburban regions
  • The 2002 crisis when 12 ERs faced a break in
    services
  • The threat of a billing number announced by the
    Health Minister

6
Workforce planning strategy
  • Measures taken under bill 142
  • Rules of practice setting and mobility settled by
    an agreement
  • Joint actions (FMOQ Health ministry RDGM) to
    evaluate GP workforce and needs in each region
  • Improvement of negotiated incentives in remote
    and isolated regions
  • Abolition of the punitive decree for the first
    three years of practice ( - 30 of earnings)
  • Regional department of general medicine

7
Legal rules under the law regarding health and
social services (LSSS) (1)
  • PREM must specify, for each region and subregion,
    the actual and the expected medical workforce in
    health centers (PEM) and in private offices

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
8
Legal rules (LSSS) (2)
  • A health center cannot accept an additional
    physician if its medical workforce plan (PEM) is
    full unless authorized by the regional agency,
    under penalty of cancelling that nomination
  • Health centers must respect growth objectives
    specified by the minister of Health

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
9
PREM 2004 results
  • Good recruitment in universitary regions, their
    surroundings and Mauricie/Bois-Francs
  • Disastrous recruitment for Outaouais, Lanaudière
    and most of the remote regions,
  • No exception to the PREM has been accepted
  • Third year residency was not a motive for
    exemption

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
10
2005 Medical workforce growth approach
  • Fill the previous year losses for each region
  • Taking into account expected GPs from other
    regions
  • Adding positions for new GPs if necessary
  • Allow net increase for various regions depending
    on
  • Gap between ressources and needs
  • Recruitment achieved in 2004

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
11
2005
  • Québec expected total net increase (new GPs
    losses)
  • 61 GPs

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
12
2005 PREM growth objectives universitary regions
Positions reserved by the minister of Health
for GPs from other regions. To be considered as
such, a GP must have completed a year in another
region under the Quebec health insurance regimen
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
13
Calculation of a year of practice
  • 12 months
  • Practice under the Quebec health insurance
    regimen with position in the PREM
  • Monthly earnings of 4 000 or if less, minimum
    of 2 000 on 10 or more billing days.
  • Allowing 2 months for holidays and CME

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
14
2005 PREM growth objectives
Reserved positions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
15
2005 PREM growth objectives intermediate regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
16
2005 PREM growth objectives remote regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
17
2005 PREM growth objectives isolated regions
FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
18
PREM 2005 preliminary results
  • University regions and their surroundings have
    already filled every positions for new GPs,
    including Lanaudière
  • Mauricie/Bois-Francs, Outaouais,
    Saguenay/Lac-St-Jean and Bas St-Laurent have
    improved their recruitment
  • Difficult recruitment for most of the remote
    regions
  • Family medicine residents were unhappy about the
    way PREM were managed and the FMRQ made
    suggestions to improve the rules of application

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
19
PREM 2006
  • Since the expected number of new GPs will be
    similar to 2005, the number and the distribution
    of PREM positions in each region will not vary
    significantly in 2006

20
Specific agreementregarding compliance to PREM
  • Effective since January 1st, 2004
  • Concerns all GPs
  • To have his main practice setting in a given
    region, a GP must obtain from the RDGM of that
    region a notice of compliance to the regional
    workforce plan (PREM)

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
21
Notice of compliance to a PREMavis de conformité
  • Requires that GP must sign an agreement to do 55
    or more of his activities in that region, on
    the basis of billing days.
  • Valid for two years and renewable automatically,
    unless notified by GP
  • Note in remote and isolated regions, to
    benefit of all incentives, a GP must do 75 of
    his activities in those regions

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
22
Obtaining a notice of compliance (1)
  • GP must fill a formulaire dadhésion and send it
    to the regional department of general medicine
    (RDGM), indicating probable date of practice
    setting
  • RDGM decides to give or not the notice within two
    months of reception

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
23
Obtaining a notice of compliance (2)
  • GP confirms acceptance within one month,
    indicating probable date of practice setting
    within 7 months of the RDGMs decision
  • If deadlines are not respected, notice of
    compliance is lost
  • Given particular circumstances, a GP may be
    granted a 6 month delay to set practice

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
24
Setting a practicewithout a notice of compliance
  • Private practice earnings are reduced by 30 for
    each trimester when there is no notice of
    compliance
  • Such GP would be forbidden the request for a
    notice of compliance within this region for a
    given period (delay for request)
  • Such GP would not be allowed to practice in a
    health center within that region

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
25
Delay for request of a notice of compliance in a
given region
  • 3 years, if GP moves his practice in another
    region where he obtains a notice and respects it
    during that period
  • OR
  • 5 years, if GP maintains his practice in the
    region where he sustained 30 reduced earnings
  • Note the notice will be given by the RDGM only
    if PREM positions are available

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
26
Non compliance of 55 practice
  • GP receives a notice from the RAMQ around
    september 1st of the following year
  • Private practice earnings are reduced by 30 for
    the year involved, from April 1st to March 31
  • In special circumstances, exemption of the 30
    reduction can be given by the joint committee
    FMOQ-MSSS

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
27
Part-time practice in another region
  • A GP may practice up to 45 in one or more other
    regions without any other PREM notification
  • Part-time dépannage activities are not considered
    in the calculation of billing days regarding the
    notice of compliance
  • Québec region and Eastern Townships have been
    designated as  restricted part-time practice
    regions 

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
28
Restricted part-time practice regions
  • If a GP starts a part-time practice in Québec
    region or Eastern Townships, his private practice
    earnings in those regions will be reduced by 30

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
29
Praticewithin the confines of dépannage
  • A GP may choose to restrict his practice to
    dépannage instead of setting practice in a region
  • He must then request from the joint committee
    FMOQ-MSSS a notice of compliance to the PREM
    dépannage
  • In such case, he must do 95 of his activities,
    in term of billing days, within the confines of
    dépannage

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
30
Mobility (1)
  • Any time, a GP may request and obtain a notice of
    compliance from another region, evidently if PREM
    positions are available in that region
  • PREM are evaluated annually and new positions are
    available each year

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
31
Mobility (2)
  • To be considered as  coming from another
    region  a GP must have practice for at least one
    year in Québec with a position in the PREM
  • A GP who practices outside Québec for more than
    three consecutive years may be considered on his
    return as a new GP

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
32
Mobility (3)
  • GPs can obtain the right to set their pratice in
    a region even if there is no position available
  • GP leaving a remote regions after a continuous
    period of practice of 3 years or more, with 75
    or more of their billing days in those regions
  • GP with 20 years of practice or more
  • GP leaving some intermediate regions after a
    continuous period of practice of 5 years or more

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
33
Temporary replacement (1)
  • An health institution can accept the appointment
    of a physician if it is intended solely to
    provide for the replacement of a physician whose
    appointment has been duly accepted by the board
    of directors but who is absent or temporarily
    unable to practise.
  • (Act respecting health services and social
    services, art. 243.1)

34
Temporary replacement (2)
  • This application for appointment is not subject
    to the provisions relating to the institution's
    medical staffing plan nor to the PREM
  • This temporary appointment is valid only for the
    duration of the absence or inability to practise
    of the physician concerned and, notwithstanding
    any inconsistent provision of this subdivision,
    may not be the subject of an application for
    renewal.

35
Temporary replacement, PREM and AMP (1)
  • Temporary replacement is permitted even if there
    is no PREM position available
  • The GP who  replaces  will not suffer any
    reduction of his/her earnings from the
    replacement activity
  • HOWEVER
  • A GP who accepts such a replacement appointment
    without a PREM position may be subjected to
    sanctions regarding either PREM or AMP

36
Temporary replacement, PREM and AMP (2)
  • PREM
  • Replacing GP will face a 30 reduction of
    earnings from office practice and
  • Will be subjected to a 3 or 5 years delay before
    applying for a notice of compliance in that
    region
  • AMP
  • Replacing GP may face a 30 reduction of all
    his/her earnings, if his/her activities are not
    in sectors 1-4 of AMPs and are not recognized as
    AMP by the DRMG

37
PREM 2006 ???
Draft proposal
  • Rules will be known in June 2005
  • PREM positions will be announced at the beginning
    of October
  • Since then, every request for a notice of
    compliance will be treated on the PREM 2005
    basis, approval if there is positions available,
    refusal if not.

38
PREM 2006 ???
Draft proposal
  • Each DRMG will set out its priority activities by
    health institututions and AMPs (including
    primary care activities)
  • Initial period to apply for a notice of
    compliance will last two weeks and every request
    made during that period will be considered
    received on the same date

39
PREM 2006 ???
Draft proposal
  • Subsequent request will be considered on first
    come, first served basis
  • If the number of request on a given day exceed
    the number of positions available, there will be
    a selection committee

40
Can a GP make simultaneous requestin various
regions ?
  • Yes, but
  • Delays of acceptance must be respected for each
    request
  • Such GP may occupy 2 positions for a short period
    and reduce positions available for his colleagues

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
41
When can a GP request a positionwithin a health
center ?
  • Simultaneously or after his request for a notice
    of compliance to the PREM. However, to formally
    obtain that position within a health center in a
    given region
  • A GP must have his notice of compliance to the
    PREM of that region
  • This health center must have an available
    position within its medical worforce plan (PEM)

FÉDÉRATION DES MÉDECINS OMNIPRATICIENS DU QUÉBEC
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