Months after trying to forcibly assign family physicians to all Quebec patients under the coercive but now defunct Bill 2, the government says that doctor-centred model of care “no longer responds adequately to the growing needs of the population.”
Even with a “blitz” underway to sign up 500,000 orphan patients by the end of June, including a goal of registering 180,000 in March deemed vulnerable, Quebec is now poised to move in a different direction.
Under the new policy unveiled by Health Minister Sonia Bélanger last week, Quebec will no longer seek to match patients with a family physician. Instead, the local CLSC will be the first point of access, AI will help triage appointments, patients will be assigned to a multidisciplinary milieu and a “professional” — who may or may not be a doctor — will coordinate their care.
The devil is in the details of the Politique gouvernementale sur les soins et services de première ligne.
A deep read of the 95-page document shows that the CAQ government is abandoning the doctor-centred ideal that has been the foundation of primary care and preventive medicine for decades.
“In Quebec, health care and services have historically been developed around family doctors,” the policy reads. “The current model of registration to a single professional no longer responds adequately to the growing needs of the population and puts significant pressure on family doctors to increase the volume of registered patients or the rhythm of their consultations. This model has not succeeded in meeting the needs of the entire Quebec population, creating inequity and leaving a significant number of people without adequate access to health and social services.”
Making CLSCs the gatekeepers of health care also walks back two decades of focusing on physician-owned, independently run family medicine groups (known as GMFs in French) as the front door to primary care.
Individual registration with doctors developed alongside the GMF model in Quebec, which dates to 2002. From 18 family medicine groups, then to 387 in 2024, 83.4 per cent of Quebecers are assigned to doctors who work in GMFs.
Their definition of accessibility is: Instead of calling your doctor’s office directly, we will remove your doctor’s office and we will remove your doctor.
Dr. Michael Kalin
Santé Kildaire
“Despite its strengths, the GMF model today seems ill adapted to regional realities,” the document states. “It also remains structured around the capacity of family doctors to register (patients), rather than on the real and evolving needs of the population.”
The Coalition Avenir Québec government is also suddenly veering away from the last quarter-century of health reforms, including one of its own. After fusing CLSCs to eliminate duplication in administration in the early 2000s, gutting management and merging institutions into CIUSSSes a decade ago, and creating Santé Québec to centralize operations in an arms-length agency just over a year ago, the new policy will require expanding the capacity of CLSCs, adding a whole new layer of bureaucracy.
In the eyes of Dr. Michael Kalin, a physician and owner of Santé Kildaire, the government is levelling down after failing to fix what really ails health care.
“They talk about accessibility. What could be more accessible than calling your family doctor’s office directly? Their definition of accessibility is: Instead of calling your doctor’s office directly, we will remove your doctor’s office and we will remove your doctor,” he said. “The policymakers here are living in a bubble. They’re naive to the realities in the territories and the communities. … I agree whole-heartedly that primary care should be delivered in teams. But the naive conclusion that diluting family medicine will provide better outcomes, this, I believe is the Achilles heel of this policy. They’re replacing family doctors with CLSC bureaucrats.”
Quebec is lacking at least 1,500 family doctors after decades of coercive policies that have made family medicine unattractive for new graduates and driven many physicians into retirement, out of the province, or into the private system.
Bill 2, which tried to impose a new pay model and performance targets on doctors (including assigning orphan patients en masse), prompted a stampede for the exits. Many left the province or started seriously looking into quitting Quebec. And many GMFs were pushed to the financial brink, announcing or threatening imminent closure.
The showdown was the nadir of the CAQ government’s antagonistic approach toward doctors — and it backfired when they had to rewrite the law.
So perhaps now they want to give more power to CLSCs because they’re easier to control.
But how will this policy shift play out with patients, who value the doctor-patient relationship, even if they’ve been waiting years to find a physician?
Since it came to power in 2018, the CAQ has toggled between promising all Quebecers a family doctor and acknowledging that it might not be realistic under the circumstances. Before the last election, Premier François Legault and then Health Minister Christian Dubé stepped back from their earlier pledge and proposed something similar to what Bélanger just presented.
In 2022, the CAQ created the Guichet d’accès à la première ligne to help patients who don’t have a family doctor. That system introduced the concepts of a central number to call for an appointment and “collective registration” with a clinic.
It seemed at times that the GAP was just an interim measure, but its ethos is the backbone of the new policy.
In 2024, the CAQ floated a trial balloon based on a study that suggested only the most vulnerable patients should be assigned to a family doctor – and healthy patients cut loose.
The outcry from the public who feared losing their physicians was so fast and furious that Dubé had to swiftly walk back the idea and reassure the population this wasn’t actually going to happen.
To avoid a similar panic, the latest policy explicitly states that anyone lucky enough to have a physician now can “maintain the link” — at least during the transition. But what do patients want long term?
The saving grace for Quebecers who hope to keep or find a family doctor is that the CAQ government is running out of time before the next election to launch more health reforms.
I started at The Montreal Gazette in 2000 as an intern. Since then I have covered the National Assembly and courts, worked on the assignment desk and written editorials, before debuting as city columnist in 2017. When I’m not comforting the afflicted and afflicting the comfortable, I like to ski, read, walk my fur baby and cheerlead at my kids’ various sporting activities (as long as I promise not to embarrass them).