Hanes: Family doctor recruitment in Quebec has improved. And now the bad news ...

Montreal Gazette

12-05-2025

There's good news and bad news about the recruitment of new family doctors in Quebec.
First, the positive: the Canadian Resident Matching Service results came out late last month and out of 1,741 new medical school graduates placed in family medicine across the country, a record 484 found spots in Quebec. That's more than the 458 matched last year and the 441 the year before.
A total of 943 residents — including specialists — will begin the final stages of their training in Quebec as of July 1, out of more than 3,000 across Canada.
That means a newly minted cohort of soon-to-be family doctors is preparing to help care for the 1.5 million Quebecers who aren't assigned to either a physician or a clinic.
The less good news is that there could have been more. A further 69 residencies in family medicine in Quebec remain vacant after the annual matching process, out of 94 across Canada.
Dr. Ghassen Soufi, president of the Fédération des médecins résident(e)s du Québec (FMRQ), said he believes this was foreseen during the planning process.
'The way that they structured the positions was going to lead to empty positions in family medicine,' he said. 'So the fact that there are empty positions at the end of the match in family medicine isn't necessarily reflective of the fact people are not interested in family medicine — quite the opposite, in fact, because this year we've had the most number of people choose that specialty.'
Nevertheless, the 69 unfilled spots this year are added to the 70 family medicine residencies that remained vacant last year. Over the past dozen or so years, empty residencies amount to over 700 doctors missing in action on the front lines of health care, amid an estimated shortage in Quebec of 2,000 physicians.
Still, Soufi is looking at this year's match results as a glass half full.
'Overall, the picture that we see is very positive. It's the most resident physicians that are going to be entering residency on July 1 ever. It's around 940 new resident physicians (including specialists) and over half of those — so 484 — will be going into family medicine,' he said. 'Both of those numbers are significant increases from before, owing to multiple factors. But one of the biggest is that the cohorts of medical students are increasing in size, so it's leading down the pipeline to an increase in resident physicians.'
The bad news is that any progress could be in peril.
The government of Premier François Legault is piling new restrictions on top of old ones. It recently adopted a law to force all new medical school graduates to work five years in the public system or face stiff penalties. It is also picking a fight with all doctors by imposing a new compensation model through legislation instead of negotiation that will tie part of their pay to performance indicators.
Bill 83 has the reasonable goal of ensuring the doctors the Quebec government invests in training serve in the public system. But Dr. Chakib Setti, president of the Association des jeunes médecins du Québec (AJMQ), said the law fails to address the real reasons doctors quit the public system in the first place.
'If you had a good system, you wouldn't have to tie down doctors so they can't leave,' Setti said. 'If you have calamitous working conditions, if you have catastrophic working conditions, what will happen? Everyone will want to leave and then you'll have to construct a sort of prison and block everyone from leaving.'
Quebec has struggled to attract family doctors for a number of years because it imposes onerous requirements that exist nowhere else in Canada. These include having to get a special permit, known as Plans régionaux d'effectifs médicaux, or PREMs, that limits where they can practise.
Family physicians in Quebec also have to pitch in a certain number of hours per week at long-term care homes, birthing centres, emergency rooms or with assisted dying — extra duties known as Activités médicales particulières. This is another only-in-Quebec hallmark.
Doctors are also fed up with being vilified by the government while simultaneously leaned on heavily to make up for shortages of other resources in public health care.
These long-running irritants have fuelled an exodus, with medical students choosing other specialties instead, family doctors moving to other provinces, physicians moving to the parallel private system, and older practitioners retiring.
Despite the FMRQ, AJMQ and other groups pleading with the government to abolish PREMs and offer incentives to make family medicine more enticing, successive governments have only tinkered.
Introduced to distribute doctors evenly across Quebec, the PREM system has far outlived its usefulness, especially amid a physician shortage. There are myriad anecdotal examples of how PREMs actually hinder doctor recruitment, Setti said.
He recalled a couple 'who started practising who had PREMs in separate places. One was in Quebec City, the other was in Laval. Unfortunately they couldn't get a permit for both of them to practise in the same region. Do you know what happened? They left Quebec and went to Ontario.
'We've lost a lot of doctors like that. Which is too bad, because whether they both practise in Laval or they both practise in Quebec City, it shouldn't matter — there are lots of patients to see.'
This year, 235 of 603 PREMs for brand new doctors and those who want to transfer regions were untaken after the annual application process (as of April 29, according to the latest Health Ministry data).
'If we get rid of this, not only will the doctors from Quebec stay, others will come,' said Setti. 'There are doctors who want to come from other provinces. We have many examples of doctors who wanted to come but unfortunately never came because they couldn't get the permit to practise in the region they wanted.'
It's also a symptom of a much bigger problem — and one that is about to get much worse with the coercive aspects of Bill 83 and the government throwing down the gauntlet with the new remuneration model.
Setti said at least 32 practising doctors have withdrawn from the AJMQ because they are planning to leave Quebec over the latest measures. And he warned it could also have a trickle-down effect on next year's residency recruitment period.
'The results of next year will be much worse. Because this year it was too late. The students were already in the application process and Bill 83 came after the match (began). But if you look back this time next year, you're going to see hemorrhaging. Not only will we not succeed in attracting, you'll see that we won't be able to keep the doctors that we have,' Setti said. 'Soon, the only way to keep doctors in Quebec will be to attach them with a leash and take away their diplomas.'
Soufi at the FMRQ also has concerns about how Bill 83 will loom over next year's Canadian Resident Matching Service results. The federation holds that it is 'discriminatory' to put the burden of propping up public health care mainly on the shoulders of young doctors. But the law not only requires new doctors to practise in the public system for five years after graduation — which the 'overwhelming majority' already do, Soufi said — it also contains clauses that would obligate them to stay in Quebec.
'We're very fearful of that because the match, for example, is a pan-Canadian organization and the way that medical education is structured and delivered in Canada is pan-Canadian. We have students that come here to study and sometimes they stay, sometimes they leave. We have our own students, our own residents, who get training elsewhere and come back,' Soufi said. 'We think there's a lot of richness to going to train elsewhere and coming back, following this movement of trainees, because we do have a pan-Canadian system, there are expertises that are only available here that people come and get, and vice versa with elsewhere in Canada.'
Indeed, according to the Canadian Resident Matching Service, 28 of 1,980 doctors who trained in other provinces found residencies in Quebec for 2025. Meanwhile, 424 of 1,006 Quebec-trained medical students were matched to a residency elsewhere in Canada for both family medicine and other specialties. The majority of Quebec medical school grads — 582 — found family medicine or specialized residencies within the province.
And if the new dispositions of Bill 83 are applied next year?
'It's never been done in any jurisdiction in North America — this idea of tying education, or the attainment of education, to the obligation to practise in a specific place where you did that education,' Soufi said. 'We think that's a very slippery slope, very dangerous. And we hope that the government doesn't move forward and start applying that.'