29-05-2025
Opinion: Our family clinic might not survive Quebec's latest health reform
Op Eds
I'm a family doctor in the West Island and have been serving my community for over 30 years.
I am also the lead physician in our GMF (Groupe de médecine de famille), teach family medicine residents at the Jewish General Hospital, and work in long-term care.
Like many family doctors in Quebec, I wear multiple hats — not because I'm 'lazy,' as some government rhetoric might suggest, but because the system demands it.
I entered medicine understanding the long hours and sacrifices required. What I didn't anticipate was the persistent erosion of professional autonomy and the vilification of physicians with every new wave of health care reform.
Policies like the '70 per cent rule' — when GPs choosing to work on Montreal Island were paid 70 per cent of their billings in the first three years — AMPs (Activités médicales particulières.) and PREMs (Plans régionaux d'effectifs médicaux) have historically penalized physicians rather than supporting them, pushing many to leave Quebec or exit public practice altogether.
Despite these challenges, I stayed. I joined a small practice in Pierrefonds in 2000, and in 2008, helped transform it into a GMF.
We've since built a high-functioning, multidisciplinary team including nurses, nurse practitioners, a dietitian, a pharmacist and a social worker.
We're proud of our 94 per cent fidelity rate — meaning nearly all our patients get their front-line care from us — and of the fact we offer advanced access (appointments within 24–48 hours) and stay open 68 hours a week.
We've achieved all this even as most of our doctors also work in other areas like palliative care, teaching, long-term care and so on.
But now, Bill 106 threatens to undo everything we've worked for. I fear that this time, my clinic may not survive.
The bill proposes a sweeping reorganization of how doctors are paid and how patients are assigned.
Bureaucrats with no clinical training will assign patients using a simplistic 'colour code' system, removing the ability of doctors to manage their patient rosters based on actual capacity and clinical complexity.
It's a superficial fix that does nothing to address the true crisis: Quebec is short 2,000 family doctors, and a quarter of those still practising are nearing retirement age.
This bill also fails to invest in the support systems we need. There's no funding for additional psychologists, physiotherapists or dietitians. There's no plan to improve access to imaging or specialist consultations.
Instead, Bill 106 focuses on shifting names on lists and monitoring 'stats' that don't reflect patient realities.
Perhaps the most dangerous component is the so-called '25 per cent supplement.' In reality, it's a punitive measure that withholds a quarter of doctors' pay until we meet government-imposed collective performance targets.
These targets are often impossible to meet because they rely on systemic factors outside our control— like the availability of specialists or support staff. In a clinic like ours, if some doctors meet them but others don't, we all lose that income.
Since clinics are funded through a portion of physician income, this effectively puts our clinic's financial viability at risk.
If passed, I expect this bill will accelerate retirements and drive more physicians out of the public system.
It will not improve access to care — it will worsen it.
My colleagues and I are exhausted by constant restructuring that ignores the realities on the ground. We are ready and willing to collaborate on real solutions. But collaboration requires listening, not legislating by force.
The people of Quebec deserve better. They deserve a health system that values front-line providers, supports multidisciplinary care and invests in sustainable access. Bill 106 is not that solution.
If it passes, the cost won't just be felt by physicians — it will be borne by every patient who loses their family doctor and every community that loses a clinic like mine.
Orly Hermon is a family doctor and lead physician at the Medistat medical clinic in Pierrefonds.
