Medical professionals protest against Bill 2 at the Bell Centre in Montreal on Sunday.Graham Hughes/The Canadian Press
Neither an early November snowstorm nor a transit strike could stop thousands of Quebec doctors from descending on Montreal’s Bell Centre, usually home to Canadiens games or Jonas Brothers concerts, for a Sunday rally to denounce a new provincial law that ties physician pay to performance.
The show of force by the province’s medical lobby, er, profession, was just the latest act of defiance in a months-long standoff between Quebec’s 23,000 active doctors and François Legault’s Coalition Avenir Québec government. The conflict has already cost Mr. Legault one cabinet minister and threatens to sap what little is left of the embattled Premier’s support within his own caucus and the public.
For weeks now, the nightly news on every channel has featured stories of outraged doctors threatening to leave the province because of the CAQ’s new law. A Léger poll released this week found that 73 per cent of Quebeckers are worried they will. The same poll showed that 61 per cent want Mr. Legault to step down as CAQ Leader before the next election in 2026. Only 23 per cent think he should stay on.
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La Fédération des médecins spécialistes du Québec, the group representing the province’s 12,600 specialists, has been saturating the airwaves with an advertising campaign using the tagline “C’est malade” or “It’s sick,” a reference to the province’s health care system. The television ads depict dilapidated hospitals where doctors cancel surgeries because of equipment failures.
That Mr. Legault waited until late into his second mandate to tackle the politically thorny issue of doctors’ pay, rather than at the height of his popularity a few years ago, has not helped his cause – no matter how laudable that cause is.
The idea of tying a portion of physician pay to a series of performance indicators was one of these founding principles of the CAQ when Mr. Legault created the party in 2011. Many health experts agree it is a sound one. It is how the CAQ government plans to go about it that has put Quebec doctors on a war footing, however.
Under Bill 2, which the CAQ adopted last month by invoking closure to cut off debate in the National Assembly, Quebec will become one of the last provinces in Canada to move away from a fee-for-service system to a hybrid model that mixes fee-for-service, capitation (or fees based upon patient loads and case complexity) and performance targets to determine doctors’ pay.
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The most contested aspect of the law involves a provision to hold back 15 per cent of the current $9-billion the province spends on doctors under the fee-for-service system. Henceforth, about $1.2-billion will be distributed annually among physicians who meet performance targets that include increasing patient loads for family doctors or reducing the time between when patients are referred by their family doctor and the moment they see a specialist.
Quebec Prime Minister François Legault at the provincial legislature on Tuesday.Jacques Boissinot/The Canadian Press
In a stunning development, former Parti Québécois premier Lucien Bouchard, who is now representing the specialists’ lobby in negotiations with the government, last week accused Health Minister Christian Dubé of kiboshing a proposed deal that would have instated performance bonuses for doctors, rather than withholding pay for doctors that fail to meet certain targets. Mr. Legault, a former businessman recruited by Mr. Bouchard to enter politics in 1998, was forced to publicly deny the charge levelled by his “ex-friend Lucien.” One columnist called the clash Oedipal.
The fact is that Quebec doctors remain among the best paid in Canada. According to a recent HEC Montréal study, the average compensation of full-time general practitioners was $414,000 in Quebec in 2023, or the highest in Canada when cost-of-living adjustments are included. Specialists earned an average of $548,000. Even when accounting for Quebec’s higher income taxes, the province’s doctors pocket more on a take-home basis than their Ontario counterparts.
The threat of a mass exodus of doctors from Quebec appears to be highly exaggerated. According to a CBC report, about 260 Quebec doctors have applied to practise in Ontario since Oct. 23. While that’s an increase compared with previous months, Quebec doctors are hardly stampeding toward the border.
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It is not just because most francophone physicians are attached to their language and culture. Most Quebec doctors understand that the grass is not necessarily greener elsewhere. Across Canada, the public health care system is under extreme duress. Doctors work in underequipped and understaffed hospitals.
That is cold comfort for Mr. Legault, however. He suffered a devastating personal blow when social services minister Lionel Carmant, a close friend who was among the original 12 signatories on the CAQ’s founding manifesto, quit the CAQ cabinet and caucus after his doctor daughter published an op-ed in Le Devoir denouncing Bill 2.
The Premier has insisted that his government will push ahead with its long-overdue plan to reform doctors’ pay. Even though it could cost him yet more caucus resignations, voters, and, ultimately, his job.