Can't find a doctor? Civil rights lawyer set to take on 'unfair' permit system penalizing Montrealers

Civil rights lawyer Julius Grey is going to court to challenge the way Quebec's Health Ministry decides where family doctors in the province can hang up their shingle.

Julius Grey going to court to challenge how Health Ministry decides where doctors can hang up their shingle

Julius Grey says a court challenge to be filed in Quebec Superior Court later this summer will argue Quebec's system for allocating doctors' permits is unfair to Montrealers, 40 per cent of whom have no family doctor. (CBC)

Civil rights lawyer Julius Grey is going to court to challenge the way Quebec's Health Ministry decides where family doctors in the province can hang up their shingle.

Grey says the system the government uses to allocate doctors to work across the province discriminates against patients in Quebec's largest city.

"The system is regionally unfair," said Grey. "It produces [an] egregious effect especially unfavourable to Montreal — and to all the population, really — and that is open to challenge."

Unable to recruit replacements, busy clinic closes

Before a doctor can set up a practice in Quebec, they require a permit, referred to by the French acronym PREM — for plans régionaux d'effectifs médicaux.

The PREM system is aimed at equitably distributing doctors across the province.

But many people in the health care network — from the professors of medicine who train medical residents only to see them leave the province for want of a permit, to those newly graduated doctors themselves — say the system is unfair.

One week ago, a busy medical clinic in Montreal's Milton Park neighbourhood closed after more than 40 years of operation.

Five of the 10 doctors working at La Clinique médicale de la Cité retired, and the clinic was not allocated any new PREMs to enable it to recruit doctors to replace them.

Clinique Médicale de la Cité, located at the corner of Park Avenue and Léo Pariseau Street, had to close because it was unable to replace retiring doctors. (CBC)

The closure of the clinic, which first opened in 1976, leaves 12,000 patients in Montreal with no family doctor, according to Dr. Mark Roper, head of primary care at the McGill University Health Centre. Roper said that brings to 47,000 the number of people in that part of the city without a physician.

"Without a family doctor, a population's mortality increases by three per cent," said Roper. "A family doctor makes over 2,000 diagnoses a year."

The Ministry of Health says it recognizes the medical needs in Montrealers, as it does the medical needs of people living in the 17 other administrative regions of the province.

In a statement to CBC News about the closing of the clinic in Milton Park, the ministry said it accorded almost a quarter of all new PREMs to the Montreal region in 2018.

'Calculations are flawed'

Roper says the method the government uses to calculate the number of PREMS it will issue, and where they will be allocated, is harming Montrealers.

"The calculations are flawed, and the restrictions are resulting in severe problems in primary care access," said Roper.

Dr. Mark Roper says the data used to calculate doctor allocations for Montreal is flawed, and as a result, Montrealers have a difficult time finding a family physician. (Elias Abboud/CBC)

Roper says there are regions outside of Montreal where most people are registered with a family doctor, but they're still being allocated new PREMS — and gaining new doctors.

In Montreal, he says, it's the opposite scenario. Four out of ten Montrealers have no family doctor, he says.

"You've got areas that are at 62, 63 per cent — like downtown Montreal, like NDG and Côte Saint-Luc and Montreal West," said Roper. "Something is terribly wrong."

Charter violation?

Grey says there are two lines of legal argument he is considering pursuing: "whether it's consistent with the Canada Health Act and the Quebec medicare system," for a start, said Grey.

"The other is a Charter one: whether it puts at risk life, liberty, security of the person."

He said the court challenge is still at a preliminary stage, however. It is to be filed with Quebec Superior Court later this summer.

Grey said he has not yet determined on whose behalf he will file the legal challenge. But Roper says it will be on behalf of "a group of patients and clinics in the Montreal area."


Elias Abboud


Elias Abboud is a journalist at CBC Montreal.