Quebec doctors warn Dubé's bill on remuneration could push physicians out, hurt patients

Montreal Gazette

27-05-2025

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Dr. Isabelle Gaston said she never used to think about retirement, but that has changed since the Quebec government unveiled its health-care bill that could tie doctors' salaries to their performance.
The family physician became widely known after her two young children were killed by her ex-husband Guy Turcotte in 2009. After their deaths and enduring two trials, she remains active in her field and works in a CLSC.
She said she is among thousands of doctors with a reduced workload who still want to take care of their patients 'despite their restrictions.' On paper, her schedule is part time, but her hours often exceed what is considered a full-time job in Quebec, she added.
'Sometimes we don't choose our hardships,' Gaston said at the province's legislature Tuesday. 'But when you have a heart, you say to yourself: I will take on less and I will slow down, but I will do it well.'
Gaston was among health-care professionals and federations speaking before committee hearings into Bill 106, which proposes linking up to 25 per cent of a doctor's pay to various performance objectives in an effort to see them take on a greater number of patients.
Her testimony came as the Fédération des médecins omnipraticiens du Québec, which represents family doctors, tabled its brief against the proposed law. It charges the government 'is making a serious — and historic — error if it believes it can resolve the issue of access to health care by unilaterally imposing an authoritarian bill based on mistrust, coercion and punishment.'
Health Minister Christian Dubé characterized Bill 106 as 'essential,' saying his goal is to ensure all Quebecers are cared for in a health-care setting by the summer of 2026. It was tabled in early May as contract negotiations were underway with two of the province's federations representing doctors.
In his opening remarks Tuesday, Dubé said the idea is to encourage doctors 'not to work more, but to work differently.'
But Dr. Benoît Heppell called on the government to provide more resources. He pointed to a lack of nurses, social workers and other health professionals on the front lines, saying he could provide 650 additional appointments each year.
'It falls on my shoulders,' he said, referring to when there aren't enough other professionals.
Gaston also slammed the plan, saying it would be 'inhumane' if her colleagues face financial repercussions because she can't work more hours. She characterized any discourse implying doctors are 'lazy' as 'hurtful and enraging.'
'Frankly, I don't need this,' she said.
Gaston noted 22 per cent of family doctors are 60 or older, and she is worried Bill 106 will leave vulnerable patients behind.
'Before, I never thought about my retirement,' she said. 'Now I find I think about it way too often for a doctor who is just 52 years old.'
Legault vows not to back down
The Fédération des médecins spécialistes du Québec also came out swinging against the bill Tuesday. FMSQ president Vincent Oliva read a series of statements submitted by specialists, including one who said they were 'defeated' in the wake of the move.
Before appearing at the National Assembly, the Collège des médecins du Québec said in a statement it 'strongly disagrees with linking physician compensation to performance.' The college of physicians is concerned doctors will spend less time with patients if they have to meet quotas.
In the face of pressure from doctors, Premier François Legault vowed to not back down from the changes included in Bill 106.
'The Collège des médecins tells us (the reforms) would be dangerous for patients,' Legault said while arriving for question period at the legislature. 'Listen, there are other provinces that changed the remuneration system for doctors, to link a part of it to taking on more patients. Why would the other provinces be able to and not us?
'What is clear is if we don't change the recipe, the results won't change. If we want an efficient health-care system, we need a (better) way to remunerate doctors.'
Legault said his government has to 'not do what preceding governments did' and must 'resist, to have courage to fight against the unions.'
'This should have been done 20 years ago,' he said. 'Each time, they launched fear campaigns. They send letters to their patients.
'They made the Liberal government back down; they made the Parti Québécois back down. The CAQ will not back down.'