Hanes: Legault government is playing hardball with doctors. Again.

Montreal Gazette

12-05-2025

In the first few hours after Premier François Legault dropped the bombshell that his government would present surprise legislation Thursday to impose a new remuneration model on Quebec doctors, Dr. Chakib Setti got emails from four colleagues saying they've had enough and they'll be leaving the province to practise.
That's on top of the 28 physicians who have already told the president of the Association des jeunes médecins du Québec in recent weeks that they're moving away because of Bill 83. Adopted late last month, that law contains clauses to force Quebec-trained doctors to practise in the public system and remain in the province — or face hefty fines.
'Instead of solving the problems in the system, with this law we're trying to lock young doctors in a prison,' said Setti, a family physician in east-end Montreal. 'If you're trying to stop someone from leaving, it's because you know if they were free they'd be gone.'
But Legault's plan to 'stir things up' by foisting a new pay scheme on doctors just days after Quebec family practitioners unanimously rejected a contract proposal that contained many of these controversial measures is a whole new game of hardball, even for a government that has long resorted to sticks rather than carrots in its dealings with doctors.
Bill 106, which was tabled Thursday, proposes to divvy up compensation for doctors into different categories. Part will be based on their patient loads, part will be an hourly rate, and part will depend on meeting certain performance indicators. The list of medical services that presently determine physicians' pay will be whittled down from more than 6,000 activities to fewer than 10. And patients will be colour-coded — green, yellow, orange and red — depending on their level of vulnerability.
The federations representing general practitioners and specialists denounced the government for short-circuiting negotiations, which have dragged on since their last contract expired in April 2023.
Health Minister Christian Dubé said discussions will continue. The law, he said, will establish the grand principles for the new compensation scheme, but the details will be hammered out at the bargaining table.
Dubé said he has to move ahead quickly to ensure all 8.5 million Quebecers are either assigned to a family doctor or affiliated with a medical clinic by the summer of 2026 (a few months before the next provincial election). Right now, only six million Quebecers are lucky enough to have a general practitioner and one million have been signed up to a clinic they can call if they have a health issue. But 1.5 million have neither of those because of a shortage of professionals.
'It's really the taking charge (of patients) that will facilitate access,' Dubé said. 'This is the last big block that we need to put in place to make sure that the health system functions properly.'
Just prior to the last election, the Legault government abandoned its promise of ensuring all Quebecers have a physician. But a version of that pledge is back on the table with Bill 106 after some major reforms to the health-care system. These include creating Santé Québec to manage daily operations and introducing laws that assert increasing control over doctors.
Dubé framed Bill 106 as completing the work started by Claude Castonguay, considered the father of Quebec's health-care system, half a century ago.
Legault saluted his government for having the 'courage' to do something he has wanted to do for 23 years — a reference to his stint as health minister in a Parti Québécois government two decades ago.
But some of the measures Legault instituted then are cited today as major grievances that have deterred young physicians from entering family medicine in the first place, driven increasing numbers of practitioners to private clinics or out of the province, and hastened the retirement of older colleagues.
Quebec is the only province that requires family doctors to obtain permits that restrict where they practise, down to the postal code, known as Plans régionaux d'effectifs médicaux. Legault introduced PREMs when he was health minister to evenly distribute physicians among regions. But they have become an obstacle to recruiting doctors.
Quebec is also unique in demanding family doctors fulfil extra duties, known as Activités médicales particulières, working in emergency rooms, long-term care homes and birthing centres. These AMPs mean family physicians in Quebec spend less time seeing patients in their clinics than their counterparts elsewhere in Canada.
Dr. Michael Kalin, a family physician in Côte-St-Luc, said the latest heavy-handed moves by the government follow a pattern of unfairly shifting the blame for problems in the public system onto the shoulders of doctors.
'Quebec is 2,000 family doctors short as a result of failed policies over the last two decades,' he said. 'The government needs to learn that attacking family doctors will never improve patient care. It will accomplish the opposite.'
Kalin described the mood among his colleagues as 'alarmed, upset, disappointed, fearful.' He compared the government telling doctors to take on more patients when there is a shortage of physicians to telling a hockey team to let in fewer goals when they don't even have a netminder.
'We are extremely frustrated that the government would consider penalizing doctors when it is the government policies themselves that are impeding these outcomes,' he said. 'So if the government is saying we must meet a certain number of appointments per year but we lack the number of physicians to meet this target, it seems unreasonable to be penalizing us for that.'
Expecting doctors to meet new quotas is not going to result in greater access or better care, Setti said — especially for vulnerable patients who need more of a doctor's time.
'We don't want to do fast-food medicine,' Setti said. 'We don't want to tell the 87-year-old patient in the wheelchair, 'Sorry, buddy, you have to come back another time and take the adapted transport, because I only have a few minutes to spend with you and the minister says I have to see a certain number of patients today.' It's ridiculous.'
Creating more bad blood with doctors, who are already as demoralized as they are stretched thin, could backfire for the government.
At a time when many physicians south of the border are looking to come north because of the political climate there, Setti said he was struck to learn some Quebec physicians are looking at opportunities in the United States.
'Imagine: American doctors are ready to leave the U.S., but Quebec doctors are so frustrated they'd rather go to the U.S.,' he said. 'It's serious.'
This story was originally published May 8, 2025 at 3:43 PM.