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health care.

Despite a shortage of doctors across the province, the Quebec government is planning to issue fewer permits than the actual number of graduates in family medicine next year, The Gazette has learned.

A total of 238 doctors are expected to complete their residencies in family medicine and pass their board exams in 2009. However, the government is counting on issuing 220 permits, according to the Quebec Federation of General Practitioners.

The gap stems from a 5-year-old permits policy aimed at making sure young doctors start their careers in short-staffed regions across the province. In the past, the government had issued more permits than there were students in the graduating class. This gave doctors more choice about where to practice, and some regions had a hard time recruiting new doctors.

This year, however, the government has decided to keep a tight lid on permits - in particular, limiting those available in Montreal - to make sure that all regions are able to hire new doctors.

But the policy - known as Plans régionaux d'effectifs médicaux or PREMs - has actually backfired and led to an exodus of mostly anglophone, Quebec-trained doctors quitting the province for Ontario and elsewhere, critics say.

"It's absurd," said Mark Roper, a Westmount family physician and chairman of the medical manpower committee of the Regional Department of General Medicine of Montreal.

"It's almost like they're pushing young doctors out of the province."

Most new doctors prefer to practise in Montreal rather than in small rural communities. Quebec has offered doctors financial carrots to work in the Far North, but it has used the stick to get them to practise in the Mauricie, the Outaouais and other regions.

Before the PREMs, new doctors who decided to stay in Montreal were docked 30 per cent of their billings for the first three years of their careers. Most doctors toughed it out, so the government switched to the more restrictive PREM system.

Each year, the Health Department - in co-operation with the federation of GPs - decides on a certain number of positions for the 15 regions of Quebec.

Newly-graduated doctors must then apply for positions in a number of regions. Most apply to work in Montreal as their first choice, and if they don't get accepted, they are more likely to be hired by another region.

For Montreal, the government has decided to issue only 54 permits even though the city has a shortage of about 300 family doctors. If new doctors decide to stay in Montreal without a PREM position, going into solo practice, their billings will be docked by 25 per cent, not for the first three years but their entire careers.

Figures obtained by The Gazette show that recruitment was actually higher before the PREMs system went into effect in every region except Mauricie. So where have all those young doctors gone?

Quebec has been a net exporter of doctors to other provinces in the past five years, according to the Canadian Institute for Health Information.