Quebec’s government has promised that everyone in the province will have a family doctor by the summer of 2026.ROGER LEMOYNE
Quebec doctors have been without a contract since March, 2023, and in recent months negotiations have become increasingly bitter. Even mediation failed.
So, on Friday, the government of François Legault brought down the hammer, adopting legislation that not only imposes a contract that significantly changes how physicians are paid, but threatens large fines against individuals and organizations who protest.
The most controversial element of Bill 2 – entitled “An Act mainly to establish collective responsibility with respect to improvement of access to medical services and to ensure continuity of provision of those services” (quite a mouthful!) – is that it will allow the province to claw back payments to physicians if targets are not met.
For example, the province will be able to set targets for the number of patients doctors treat and reduce payments by up to 15 per cent if they are not achieved. (A rehash of legislation introduced in May.)
The government has promised that every Quebecker will have a family doctor by the summer of 2026. And so, it will allow regional health authorities to assign orphan patients to practices, whether physicians like it or not. (Currently, 1.5 million Quebeckers don’t have a family doctor, including 200,000 patients deemed “vulnerable.”)
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Specialists, for their part, could see their pay reduced if targets for surgical wait times or ER wait times are not attained. Specifically, Bill 2 says 97 per cent of surgeries must be completed within a year of assessment, which will be hard to do given there are 147,000 patients on surgical wait lists in the province.
The new law also says that 75 per cent of ER patients must be seen within 90 minutes, that the median wait time cannot exceed four hours, and that the median wait time on a stretcher while awaiting admission should not exceed 14 hours.
Notably, clawbacks will be based on collective numbers, regardless of individual performance.
The contract will also impose capitation on family physicians – meaning they will be paid a fixed fee per patient, depending on the severity of their condition – and allow them to claim an hourly wage for administrative tasks. Some fee-for-service billings will be rolled back.
Finally, if medical associations, or even individual doctors respond with, for example, work slowdowns, or urge their colleagues to leave the province, they can face whopping fines, ranging from $4,000 to $500,000 a day.
Physicians say they are not opposed to the targets but have firmly rejected the pay-for-performance approach, principally because they don’t believe they have the resources to deliver the level of care demanded.
In response, the province says it will invest $50-million into adding support staff for family docs, $120-million into improving the clunky patient-doctor matching system, and $400-million into building eight new operating rooms and bolstering available operating times. That’s petty cash in a $62-billion-a-year system.
Rarely has a government taken such sweeping action to end a labour dispute, or done so in such a belligerent, ham-fisted manner.
To say that physicians are outraged would be a gross understatement. One medical leader called it a “declaration of war.” Others preferred: “Soviet-style,” “authoritarian,” “ridiculous,” and “unconstitutional.”
Unsurprisingly, the two main medical professional associations in Quebec, one representing family physicians and the other specialists, immediately launched legal action, saying the law violates their Charter rights.
The government, for its part, has insisted that the way doctors are paid is outdated and must change. (And they’re right about that.)
But provincial Health Minister Christian Dubé has gone much further, suggesting many doctors aren’t pulling their weight, and that doctors have too much autonomy and not enough accountability.
Those are important issues to address, especially since doctors are well paid from the public purse.
But when has an employer ever achieved better productivity at gunpoint? When has muzzling health professionals ever benefited patients?
Bill 2 will almost certainly result in an exodus of doctors to other provinces, and a jump in retirements – despite the government’s threat to hunt them down and fine them. And let’s not forget the province has already forced new medical-school graduates to practice in Quebec for at least five years or face fines equivalent to the cost of their education.
How can the province’s remaining doctors be anything but disheartened by the bullying?
The Legault government seems obsessed with increasing the volume of patient visits and exerting control over doctors. Neither of those things will improve quality of care.
As always, the biggest losers in this dispute will be patients.