Tension continues to mount between Quebec family physicians and the provincial government. This new growth comes on the heels of new vocations legislation brought in to assist the 1.5 million Quebecers without a family physician as of now. In early May, the Quebec government released a new bill. Its intent is to expand patient access to care and recruit more physicians into accepting patients. The legislation sets an ambitious goal: ensuring every resident has access to a health professional by the summer of 2026.
To do this, the new legislation proposes a new performance-related pay scheme for doctors. Under this plan, part of doctors’ pay will be linked to specific performance indicators, including appointment numbers and surgical procedures. Early on, the government proposed that as much as 25 percent of doctors’ pay be based on these performance metrics. After pushback from the medical community, this number has been lowered to no more than 10 percent.
Both Quebec doctors and medical federations have voiced fierce opposition to both the new payment structure and the bill itself. Addressing the perceived quality problem, they cite several studies demonstrating that prioritizing volume over quality would result in harmful shifts in patient care. The Italian College of Physicians and the Federation of Italian Medical Specialists are calling foul. They argue that these reforms would flood healthcare providers with patients and force thousands of physicians to flee to other provinces.
Compounding the problem has been the government’s hard line to deter any united front from the medical establishment. Doctors involved in such “concerted actions” are subject to harsh civil and criminal penalties. They can be fined up to $20,000 per day for mass walkouts from classes or for moving outside the province. This new threat further highlights the government’s willingness to make sure it calls the shots on how its healthcare agenda gets rolled out.
Premier François Legault, who had previously vowed during his 2018 election campaign to provide universal access to family doctors, later acknowledged the challenges in fulfilling that promise. The situation has recently attracted notice from other nearby provinces. Even Ontario’s Premier Doug Ford has recently poked fun at the problem. He called upon Quebec physicians to get in touch with him directly to discuss job opportunities in Ontario. Ontario and New Brunswick are openly raiding Quebec doctors. Industry reports indicate more than 100 license applications have been made by Quebec practitioners seeking greener pastures.
The ripple effects of this legislative effort go beyond healthcare access today. The possibility of drastic overhaul of the way physicians are paid has raised alarm bells within the medical community. Most of all, they worry about the long-term impact on healthcare quality. Physicians are already making choices in real time. For many, moving is becoming an enticing option—a way to flee the squeeze of the federal government’s recent moves to ramp up enforcement.
