Quebec’s family doctors have joined medical specialists in stopping teaching activities in a dispute with the provincial government over Bill 106 that continues to fester. The controversial legislation illegally implements a blended payment scheme for doctors province wide. This unique model blends capitation payments, hourly rates and fee-for-service structures to better support healthcare delivery. This ongoing controversy creates an environment of uncertainty about the limited consumer access to care that may result from this dispute. Medical and public health experts continue to justifiably express outrage at what unfolded.
Compensation Negotiations between the Fédération des médecins omnipraticiens du Québec (FMOQ) and the Fédération des médecins spécialistes du Québec (FMSQ) have reached an impasse. Health authorities in Ontario are currently decrying and calling for a rapid advance of the implementation of Bill 106. Health Minister Christian Dubé has been very adamant that the bill continue to be a top government priority. The proposed regulatory amendments would overhaul the scheme that underpins how family physicians are paid. Together with fostering innovation in healthcare delivery, this initiative will help lower wait times in communities across the province.
The Mixed Remuneration Model
Bill 106 to establish a new mixed remuneration model to provide more holistic payment model for physicians. This model provides capitation payments, providing an annual global amount for each patient according to their vulnerability level. It features an average hourly rate and conventional fee-for-service reimbursements. Although the federal government expects these changes to improve quality in healthcare, many physicians have their doubts.
Dr. Marc-André Amyot, president of the FMOQ, has been one of the bill’s biggest critics. He cautioned that it could undermine patient access to family physicians. He pointed out that we need to evaluate family doctors’ contributions beyond just clinical appointments.
“The minister says we are the highest paid in Canada. Well, if that’s true, let him prove it to the arbitrator and we’ll accept a pay cut,” – Dr. Marc-André Amyot
However, as negotiations continue to languish, the FMSQ has made the unprecedented decision to suspend all teaching activities for undergraduate medical students. This extends to the pedagogical work – not just in teaching, but supervising clinical placements – that is key to training the next generation of the healthcare workforce.
Ongoing Negotiations and Disputes
Now, with the negotiations at an impasse, both federations have responded by getting tougher on the government. The FMOQ has called off mediation efforts and is now pursuing arbitration as the only way to resolve legitimate concerns. The FMSQ soon joined, making its own announcement about withdrawing from the mediation talks on Thursday.
We know Health Minister Dubé is committed to his vision. He has the noble aspiration of making sure every Quebecer has a family doctor or family medicine clinic at their fingertips. He stated, “We had put commitments for family medicine groups on the table. We are still willing to negotiate. Our goal remains that all Quebecers be cared for by a family doctor or a clinic.”
Despite these promises made by the government, medical experts are increasingly frustrated with the negotiation process. Dr. Vincent Oliva, spokesperson for FMSQ, stated unequivocally that they are not going back to the negotiating table. He stated that the situation today does not allow for any more conversation.
“We have made it clear to our counterparts that we will no longer play in this bad movie that always ends the same way,” – Dr. Vincent Oliva
Implications for Medical Education
The teaching stoppage by family docs and specialists has sent shockwaves among med students across Quebec. With graduation approaching in June, many students worry about the potential impacts of the ongoing dispute on their education and future careers in medicine.
As this provision plays out, the FMSQ will likely consider “phase two” of pressure tactics on October 20. The future of healthcare in Quebec depends on how each side answers. Their capacity to do so and effectively resolve these simmering conflicts will be key.
