Craig McCullough, a family physician in Montreal, said he and other doctors are considering working in another province.Boris R. Thebia/The Globe and Mail
Quebec doctors are up in arms over a new provincial law reforming physician pay, with many threatening to leave the province or quit the profession unless the government backs down.
Bill 2, as it’s known, would link doctor pay more closely to the number of patients they enroll, especially vulnerable ones, along with other performance markers.
Specialist and family physicians in Quebec argue that it amounts to a dramatic pay cut that will also hamper their ability to provide adequate care.
The controversy around the law has already led hundreds of Quebec doctors to apply for licenses to practice in Ontario, among other provinces, and a corresponding war of words between Ontario Premier Doug Ford and Quebec Premier François Legault.
Mr. Legault’s government invoked closure, a parliamentary tactic to end debate, in order to pass the bill in the early morning of Saturday, Oct. 25, after weeks of protests that included physician federations refusing to train medical students.
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The sense of crisis was heightened with the resignation from caucus last week of Social Services Minister Lionel Carmant, who is a neurologist by training. Doctors say they have been left feeling scapegoated even as the government vows to push ahead.
“It’s a political move to shift the blame for the failings of their system on to us,” said Craig McCullough, a family physician in Montreal and assistant professor at McGill University.
The crux of the reform is a shift from a largely fee-for-service system to a mixed model that puts more weight on capitation, or up-front payment based on how many patients doctors take on. Another tranche will be based on certain collective performance targets such as reduced wait times that Health Minister Christian Dubé said would need to be discussed.
The new pay scheme is meant to encourage family physicians to take on more patients (they will also be required to register more) while encouraging medical professionals to collaborate in order to move through their increased patient load.
About 1.5 million Quebeckers currently don’t have a family doctor, according to the health ministry, with particularly large gaps in Montreal.
But doctors say they risk being pressured to rush through consultations, and that not enough allied professionals like nurse practitioners and psychologists are available in Quebec to effectively manage more cases.
At least five of the twenty-five doctors in Dr. McCullough’s clinic are already considering working outside of the province, including him. “I would be silly not to,” he said. “At this point anyone who has that possibility has at least one foot out of the door. The Quebec government is asking us to do more for less and they’re not giving us the tools to practice medicine better.”
Some Quebec doctors have even been reported in local media to speak to Mr. Ford personally, after the Ontario Premier encouraged them to call his cellphone and said his province would happily put them to work.
Mr. Legault, for his part, seemed wounded by the move, calling it “unacceptable” and a “stab in the back.”
Mark Roper, director of the Queen Elizabeth Family Medicine Group, said Quebec doctors feel slighted by Bill 2.Boris R. Thebia/The Globe and Mail
If Quebec doctors flee the province en masse, it will likely be over working conditions and anger at the government rather than pay, said Olivier Jacques, a professor of public policy at the University of Montreal’s school of public health. By some estimates, the average after-tax income of Quebec doctors is about 25 per cent higher than those of their counterparts in Ontario, he noted.
Moving to a capitation model, where pay is linked to patient enrolment rather than services provided, is long overdue and more common across the country, added Prof. Jacques. It is the “conflictual” way the government has passed its reform that risks eclipsing the law’s benefits, he argued.
The bitterness of the face-off between doctors and the government was personified by the resignation of Mr. Carmant, whose wife and daughter are physicians strongly opposed to the law. When Mr. Carmant, a personal friend of Mr. Legault, stepped down last Thursday, he acknowledged that he had been forced to choose between his party and his family.
Tensions have flared so badly that the government included a provision in Bill 2 imposing fines of up to $20,000 a day for doctors who took “concerted” measures to undermine the reform, such as work slowdowns or stoppages.
Beyond possible pay cuts, doctors feel slighted by the law, said Mark Roper, director of the Queen Elizabeth Family Medicine Group, where Dr. McCullough works. The requirement to take on more patients makes them feel they’re being called “lazy,” and that they have been left out of the decision-making process, he said.
“We’re having all these discussions, and the law was passed last week,” said Dr. Roper. “That’s putting the cart before the horse.”
The Ministry of Health did not respond to a request for comment.
With a report from Laura Stone