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Impact des mesures incitatives et coercitives sur le lieu de pratique des nouveaux médecins de famille

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Listed:
  • Bernard Fortin
  • Justin Ndoutoumou
  • Josette Gbeto
  • Maude Laberge

Abstract

→ Read the article in the journal PERSPECTIVES Primary care is an essential component of healthcare for the population. In a region with a severe shortage of physicians, the risk of not being able to access appropriate care in a timely manner can lead to severe health problems, particularly among vulnerable individuals. As early as 1975, the Quebec government introduced several measures to influence the choice of region of practice for general practitioners and improve equity in their geographic distribution. Some of these measures are incentive-based. They include bursaries, differential compensation by region, installation bonuses, isolation bonuses, and retention bonuses. Other measures are coercive. In 2004, Regional Medical Workforce Plans (Plans régionaux d’effectifs médicaux or PREMs) were introduced. Under the PREMs, any new physician wishing to install in a region of practice must obtain a compliance notice from the regional department of general medicine where they wish to settle. This notice can only be issued if the PREM target has not yet been met. PREMs were made even more restrictive in 2015. Using a rich and unique dataset, the authors estimate the causal effects of three measures aimed at influencing the choice of region of practice among new family doctors in Quebec between 1975 and 2021. They show that bursaries, differential compensation by region and PREMs appear to have achieved the intended effects. → Lire l'article dans la Revue PERSPECTIVES Les services de première ligne sont une composante essentielle des soins de santé pour la population. Dans une région touchée par une grave pénurie de médecins, le risque de ne pouvoir accéder en temps opportun à des soins appropriés peut engendrer des problèmes de santé sévères en particulier chez les personnes vulnérables. Dès 1975, le gouvernement du Québec a introduit plusieurs mesures pour influencer le choix de la région de pratique des omnipraticiens et ainsi améliorer l’équité dans leur répartition géographique. Certaines mesures sont incitatives. Celles-ci incluent les bourses-contrat d’étude, la rémunération différente selon les régions, les primes d’installation, les primes d’isolement ou encore les primes de rétention. D’autres mesures sont coercitives. En 2004, les Plans régionaux d’effectifs médicaux (PREM) ont été introduits. Selon les PREM, tout nouveau médecin qui veut s’installer dans une région de pratique doit obtenir un avis de conformité du département régional de médecine générale où il veut s’installer. Cet avis ne peut être délivré que si la cible du PREM n’a pas été atteinte. Les PREM ont été rendus encore plus contraignants en 2015. À partir d’un riche ensemble de données inédites, les auteurs estiment l’effet causal de trois mesures visant à influencer le choix du lieu de pratique des nouveaux médecins de famille du Québec entre 1975 et 2021. Ils montrent que les bourses, la rémunération différente selon les régions et les PREM semblent avoir eu les effets escomptés.

Suggested Citation

  • Bernard Fortin & Justin Ndoutoumou & Josette Gbeto & Maude Laberge, 2025. "Impact des mesures incitatives et coercitives sur le lieu de pratique des nouveaux médecins de famille," CIRANO Project Reports 2025rp-02, CIRANO.
    • Handle: RePEc:cir:cirpro:2025rp-02
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    File URL: https://cirano.qc.ca/files/publications/2025RP-02.pdf
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    References listed on IDEAS

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