Latest news with #Bill83
Montreal Gazette
28-05-2025
- Health
- Montreal Gazette
Young doctors worry Bill 106 will make more early-career physicians leave
News The Quebec government's bill to change how doctors are compensated fails to address serious flaws in the health system and could make it even harder to retain young professionals, according to early-career physicians and medical students. The president of the Association des jeunes médecins du Québec, which represents young doctors, characterized the Health Ministry's goal to strengthen access to health care as 'noble.' 'The problem that we're noting is that this isn't the best approach from our perspective as practitioners,' Dr. Chakib Setti said Tuesday night during committee hearings into Bill 106. Health Minister Christian Dubé's bill proposes tying up to 25 per cent of a doctor's salary to various performance objectives in an effort to see them take on more patients. About 1.5 million Quebecers do not have a family doctor or regular health-care professional. While Dubé and Premier François Legault have staunchly defended the plan, several medical federations and doctors argue the bill could push physicians out and leave patients behind. Quebec was already facing a problem before the latest legislation, according to Setti. He said up to 50 per cent of young doctors are currently considering settling elsewhere. 'We think there are a lot of young doctors at risk of leaving, unfortunately. Not leaving the public system, but the province,' he said. In the hours after Bill 106 was tabled, four colleagues said they had had enough and will be leaving the province, Setti said in an interview with The Gazette earlier this month. That came after 28 physicians told him they planned to leave due to Bill 83 requiring new doctors trained in Quebec to practice for five years in the public system or face fines. The AJMQ and the Fédération médicale étudiante du Québec, which represents medical students, both worry Bill 106 won't fix some of the long-standing issues in the health system. They pointed to a shortage of other health professionals — a problem one family doctor previously testified falls on his shoulders. In one example, Setti said some patients have no choice but to turn to doctors instead of psychologists because they can't afford the fees. Maxence Pelletier-Lebrun, president of the FMEQ, said if the bill goes ahead as is, more Quebecers may have access to a family doctor 'but only on paper.' 'They won't be able to see a doctor when they need it because their doctor will be crushed under the number of patients that largely exceeds their environment's capacity,' he said. Fewer clinical services even as docs 'work a lot' Economist and HEC Montréal professor Pierre-Carl Michaud and his team were asked by the Health Ministry to look at doctors' compensation and medical services. The report, tabled this month, concluded a 'sustained growth in compensation, accompanied by stagnation or even a decline in the availability of medical services' after analyzing figures from 2010 to 2023. 'We can find that, at once, doctors work a lot, which was found in the report. But at the same time, they are doing fewer medical services than before,' Michaud said during the hearings Wednesday. The brief submitted was also titled what roughly translates to: 'Physician compensation in Quebec: The status quo is no longer an option.' The report highlighted how both family doctors and specialists reported working an average of 46 weeks in 2021. But RAMQ data from the same period showed family doctors reached a 'minimum billing threshold' during 37 weeks on average and 32 weeks for specialists. 'This implies that about one in four weeks worked was not dedicated to fee-for-service medical care,' the report said. 'Physicians likely engage in significant non-clinical activities, as the number of weeks reported in the censuses far exceeds the number of weeks with clinical (fee-for-service) activity recorded in RAMQ data.' Michaud and his team found the trend in the supply of medical services 'is likely insufficient to meet the growing needs of the population.' Calls for calm amid letters to patients Earlier Wednesday, opposition politicians addressed reports that some doctors and clinics reached out to patients directly. Some patients were reportedly told access to their family physician could be 'compromised' if Bill 106 becomes law. 'Honestly, sending letters to your patients, I find it skirts the ethical border,' Liberal health critic André Fortin told reporters, but he said concerned doctors have 'worthwhile arguments' that deserve to be heard. Dubé, for his part, said he didn't like threats. He has asked the Collège des médecins to investigate if clinics were co-ordinating efforts. The timing of the bill has also come under scrutiny as it was tabled during ongoing contract negotiations with two of Quebec's federations representing doctors. Dubé recently hadn't ruled out invoking closure, but he said during a scrum Tuesday afternoon that Bill 106 won't be adopted this session and he would like for discussions to continue. Parti Québécois MNA Pascal Paradis said Wednesday that the tone 'needs to be lowered' and there should be a 'frank discussion' about the bill. 'It's time to listen and engage in dialogue to find the best solutions for Quebecers.' This story was originally published May 28, 2025 at 4:11 PM.
Montreal Gazette
17-05-2025
- Politics
- Montreal Gazette
Libman: Ruling is not the same as governing — and it's costing Legault
'To rule is easy, to govern difficult' is a quote attributed to the writer and philosopher Johann Wolfgang von Goethe. Newly elected governments take power fresh with their political agenda and series of objectives, promising to bring about positive change from the previous regime. But it doesn't take long for the perils of reality to set in, with a multitude of competing interests and challenges. Every society is composed of individuals with a diversity of opinions, beliefs, values, experiences and aspirations. Generating consensus on almost any major issue is extremely difficult. Every decision spawns detractors, and in this age of social media, criticism and opposition can sound much louder. Before long, a party or leader that embodied change or renewal falls out of favour, and electors again clamour for change. Justin Trudeau was swept into power in 2015 in a red wave of enthusiasm. His glamorous honeymoon eventually soured, and he was compelled to resign. Premier François Legault was elected in 2018, offering a 'third-way' to Quebec's traditional federalist-separatist polarization, promoting an economic nationalism within Canada and no more referendums. His popularity soared at first during the pandemic, but nearly seven years after his election, 63 per cent of Quebecers now want a change in government, according to this week's Léger poll. Support for his Coalition Avenir Québec has shrunk to 20 per cent, its lowest since taking power. The Legault government's reign epitomizes Goethe's observation about the distinction between ruling and governing. His administration has plowed forward, investing heavily in shiny projects that seemed promising — such as the Northvolt battery plant project, or digitizing SAAQclic — yet ran into major problems due to a lack of due diligence and responsible oversight. Implementing even the greatest ideas in principle into successful initiatives in practice requires strong governance, effective analysis, skilled leadership and, most important, generating a collaborative buy-in from stakeholders. Instead, this government seems to operate with a 'my way or the highway' approach, which hurts credibility. Take three recent examples in health care: Giving consideration to a plan that would assign family doctors to Quebecers based on varying degrees of a patient's health, to ensure that the most vulnerable have access. Obliging new doctors and specialists, under Bill 83, to practise in the public system for five years after graduation or face stiff financial penalties. Linking doctors' pay, under Bill 106, to various performance objectives, to push physicians to take on more patients. In addressing the doctor shortage, these initiatives may seem like good ideas, but each has its unintended drawbacks. Will healthier Quebecers who become ill have difficulty seeing a doctor? Will future doctors shun Quebec medical schools or just leave after graduation? Do doctors have the resources to take on extra patients — and will this reduce their care of existing patients? Bill 106 is seen by physicians as a shot across the bow during labour negotiations. For such major initiatives, where is the collaborative consultation at the outset to find the best workable solutions? Just trying to blame doctors solves nothing. Recently, Education Minister Bernard Drainville introduced legislation to ban cellphones in and around schools and impose rules of respect and civility. Also good intentions and ideas in principle — but does the implementation go too far, lacking the requisite analysis and initial buy-in by parents and students who may need to communicate during the day? University tuition changes, state secularism and many other laws have been sledgehammered with insufficient advance analysis and consultation with those most affected. It's difficult enough to govern, and unanimous consensus is rare on major initiatives. But if governments don't understand that ruling is one thing, while governing is different — basically 'the art of the possible' — their job becomes even harder, likely hastening their own demise.
Montreal Gazette
13-05-2025
- Politics
- Montreal Gazette
Letters: Bill 83 a poor prescription for health care
Will our politicians ever learn that penalizing never works as well as rewarding? Why do they keep imposing conditions and regulations that end up accomplishing the opposite of what they intend? How many times do they have to experience the negative outcomes of their decisions before they question their own logic? The current conundrum is Bill 83, which forces Quebec-trained doctors to work in the public system for five years after obtaining a medical degree — or face hefty fines. I don't see this legislation improving patient care, and it may well result in more young doctors leaving the province. At the beginning of their professional journey, these doctors can easily be enticed to establish their careers elsewhere if they feel cornered and subjected to unreasonable orders. I also expect Bill 83 to further congest overcrowded ERs and increase health care costs. Ella Amir, N.D.G. Pet owners lose crucial YUL service Re: 'Airport expansion is a good thing' (Letters, May 10) As one involved in international animal transport for over 50 years, I find the closure of Manoir Kanisha — the saviour of animals stranded or in temporary care — unconscionable. The demolition of the pet boarding facility on the grounds of Trudeau airport is likely to have huge international repercussions. For 35 years, pet owners from around the world and airlines relied on Manoir Kanisha to import and export pets safely through conflicting country regulations. Now, the privileges of 24-hour pickup, veterinary attention, exercise, comfort, feeding, release from travel crates and contact with worried owners are no longer available. With this decision, YUL has lost its international standing of Heathrow, Frankfurt, Charles de Gaulle, JFK and other airports offering pet services. Sharon E. Cregier, Montague, P.E.I. Turning the tide against ageism Re: ' Wise to the benefits of male bonding ' (Extra, May 10) Bravo to Susan Schwartz for her feature about the male bonding of gentlemen who have reached or, hopefully, will soon reach 90 years of age. All too often, people of a certain age are perceived as having become victims of planned obsolescence and, therefore, categorized as yesterday's person. It is imperative that one be reminded that ageism remains inculcated in the very nature and culture of our society and, thus, sanctions prejudice beyond the pale. As time travellers, an appreciation of meaningful relationships brings forth the promise of a fulfilling tomorrow. Brahms E. Silver, Côte-St-Luc Choosing Charles sends a message Re: ' Quebec flipping out on word the King is coming ' (Chris Selley, May 7) It is sad that some critics in Quebec don't seem to see history beyond 1759. King Charles's scheduled visit to open Parliament is a case in point. They see it as a reminder of British rule. However, because Canada's sovereignty is directly and unbelievably threatened these days by our neighbour to the south, I am sure the King's presence is an intentional reply to this threat. Charles's throne speech will remind the world, and the U.S. in particular, that Canada is part of the Commonwealth and as such is not to be considered a piece of real estate to be coveted, grabbed or exploited by anyone. Vera Bondy, Westmount Submitting a letter to the editor Letters should be sent by email to letters@ We prioritize letters that respond to, or are inspired by, articles published by The Gazette. If you are responding to a specific article, let us know which one. Letters should be sent uniquely to us. The shorter they are — ideally, fewer than 200 words — the greater the chance of publication. Timing, clarity, factual accuracy and tone are all important, as is whether the writer has something new to add to the conversation. We reserve the right to edit and condense all letters. Care is taken to preserve the core of the writer's argument. Our policy is not to publish anonymous letters, those with pseudonyms or 'open letters' addressed to third parties. Letters are published with the author's full name and city or neighbourhood/borough of residence. Include a phone number and address to help verify identity; these will not be published. We will not indicate to you whether your letter will be published. If it has not been published within 10 days or so, it is not likely to be.
Montreal Gazette
12-05-2025
- Health
- Montreal Gazette
Hanes: Legault government is playing hardball with doctors. Again.
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.
Montreal Gazette
12-05-2025
- Health
- Montreal Gazette
Hanes: Family doctor recruitment in Quebec has improved. And now the bad news ...
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.'
