Bill 2, adopted under a gag order by the Quebec government in late October, ties part of physicians’ salaries to performance targets, a shift many doctors warn will strain an already fragile primary-care system.

With the National Assembly shutting down Dec. 13 for its winter break until Feb. 2, doctors are racing to get Bill 2 amended before the Dec. 12 cutoff.

Some clinics say the financial pressure is so severe that they may be forced to shut down, with roughly 40 across the province considering closure.

One of them is a Côte Saint-Luc clinic run by Montreal family doctor Dr. Michael Kalin, who also serves as a local coordinator for the Département Territorial de Médecine Familiale de Montréal (DTMF).

CityNews spoke with Dr. Kalin about the potential fallout of Bill 2 and what it could mean for both physicians and patients.

What is Bill 2 and how is it going to affect primary care?

Bill 2 fundamentally changes everyone’s relationship to family doctors. Right now, 1.5 million Quebecers don’t have a family doctor. We’re missing 2,000 family doctors in the whole province, 500 in Montreal. The government has decided that instead of finding a family doctor for every citizen, they’re going to assign everybody to a clinic. So people will no longer be assigned or affiliated with a doctor, they’ll be associated with a clinic. This is a fundamental change because now you may have a nurse or a nurse practitioner or maybe a social worker who will be in charge of your primary care, your point person. That doesn’t mean there won’t be a doctor involved in your care, but it will no longer be one patient per family doctor.

For those who have a family doctor, are they at risk of losing them?

On April 1st, patients will no longer be registered to a doctor, they’ll be registered to a clinic. If you have a doctor, you’ll be affiliated to that doctor. If you don’t have a doctor, you’ll be associated with the clinic. It’s very confusing. But the problem is this: as clinics are being asked to see more and more patients, your access to your doctor will get more difficult. If your doctor has a population of 1,000 or 2,000 patients, he or she may be asked to see far more patients. So on paper, people may have access, but in reality, people may have a much harder time actually seeing a doctor.

How many doctors are looking to leave? Are we at risk of losing them to other provinces? 

Hundreds of doctors have looked at other provinces, including Ontario and New Brunswick, maybe even other countries. It’s a big, big risk. As I mentioned, we’re really short on family doctors already. We have to understand that other provinces have a sweeter deal, perhaps they’re doubling the salary of a family doctor, while in Quebec, there’s more and more regulations. This new law puts in place a 15% penalty on performances, things that are really outside of our control. I can’t control the number of people who are going to call my office. There’s only so many I can see in a day. But we will be penalized on a regional and even a provincial basis. So Montreal doctors may be penalized for what’s going on in the Gaspésie. It’s ridiculous. We have to realize that we want to make the profession attractive and in Quebec, family medicine is just not very attractive, unlike other provinces. So the grass is greener elsewhere, and we run the risk of hemorrhaging doctors to other places.

Many people have spoken out about their clinics now being at risk of closing down. Are you worried? 

Absolutely. We’re one of those clinics. Right now, clinics are funded in two ways. You see, we’re private businesses. We’re PPPs, private public partnerships. I pay the rent of the secretaries here. I have a lease. I buy the equipment. So we get some funding from the government, but the majority of our pay, of our overhead, is subsidized by the doctors who work here. So if you cut doctors’ salaries significantly, it means the clinic has less funds to operate with. At the end of the day, it’s all about a spreadsheet. We have to make sure we’re not operating in the red. We do this because we love it, but we can’t run a deficit.

Something that people have found confusing and maybe don’t understand is the color-coded system. What does that mean for someone as a patient and how their doctor is going to care for them? 

Well, Bill 2 changes the way doctors will be funded. And instead of being paid per patient every time you come, patients are assigned a value, a price value. And that’s based on a color. Green is healthy. Fifty-seven percent of the population will be healthy. And the government attributes $9.16 per year to your health. That’s it. And this is the core of the problem: how can you really provide care for $9.16 for 57% of the population? Other people will maybe be yellows, oranges, or reds. And who determines this? Well, it’s not your doctor, it’s going to be bureaucrats. It’s going to be Santé Québec. And this has a lot of privacy concerns. And I think people are unaware of this, that really, Santé Québec has become this big, big body, this big bureaucracy with a lot of autonomy. It’s almost Orwellian and a bit scary. And I think patients need to recognize how their rights are going to be affected by this, their privacy. Because it’s not only impacting doctors and our autonomy to practice, it affects patients too.