Quebec seeks to regulate doctors' salaries to encourage them to take on more patients
Compensation bill tabled amid negotiations with medical federations
Health Minister Christian Dubé tabled a bill on Thursday that would give the Quebec government the authority to regulate how health professionals are compensated, with the goal of getting them to take on more patients.
Bill 106, officially titled An Act mainly to establish the collective responsibility and the accountability of physicians with respect to improvement of access to medical services, would have family doctors be compensated by capitation payment, that is to say, through a fixed payment based on the number of patients they take on and the care provided.
Doctors would also receive an hourly rate for time spent with patients, such as for physician-patient interactions through family medicine groups (GMFs) and at clinics.
At a news conference on Thursday, Dubé said the bill would link the compensation of family doctors and specialists to their "collective" performance.
Bill 106 does not outline individual performance indictors for physicians.
"I am very, very aware that we're making an important cultural change," Dubé told reporters.
The proposed law comes in the middle of negotiations to renew the framework agreement for doctors.
On Saturday, the Fédération des médecins omnipraticiens du Québec (FMOQ), which represents family doctors, rejected Quebec's offer to change their compensation model.
The Legault government wants up to 25 per cent of family doctors' compensation to be tied to their performance. It also wants to introduce colour codes for patients.
Dubé refused to say whether the law would be adopted before the end of the government's negotiations with Quebec medical federations.
Healthy patients assigned to a doctor can keep them
Bill 106 also seeks to formalize the colour-coded "vulnerability levels" system used to assess the severity of patients' conditions.
Dubé said patients who have been assigned a family doctor or a family medicine group would not lose their access to their care provider, regardless of their vulnerability level.
"There is a code right now. What I'm saying is that we're putting an update to the actual code to make sure that the people who are really vulnerable are being seen," he said.
About 1.5 million Quebecers don't have a family doctor and about 900,000 are waiting to be treated by a specialist, Dubé said on Thursday.
The broad strokes of the bill, which were leaked to the media on Wednesday, had been very poorly received by physicians, with some describing the proposed law as a way to undermine ongoing talks between the government, the FMOQ and the Fédération des médecins spécialistes du Québec (FMSQ).
Dr. Antoine Groulx, one of three experts commissioned by Dubé in January to produce a report examining access to primary care, told Radio-Canada's Tout un matin on Thursday morning that the content of the bill does not reflect the recommendations submitted to the minister in March.
After Dubé's news conference, Dr. Vincent Oliva, president of the FMSQ, called the proposed law a "surprise bill" that has sparked anger among specialized doctors.
"We are witnessing a political spectacle, a minister who tabled a bill because he is drowning," he said, noting that the minister didn't deliver the resources he had promised.
"Our hospitals are old," Oliva said. "We're left with a health-care system that is on its knees, pretty much the worst health-care system in North America, although we used to have a good health-care system."
He added that doctors want to work and treat patients and repeated that they lack resources to provide adequate care.
Dr. Marc-André Amyot, president of FMOQ, likened Bill 106 to "magical thinking" and said, the government is turning a blind eye to the real problems in the health network.
"The population doesn't deserve that bill. It doesn't deserve a war between the government and family doctors," Amyot said.
Dr. Laura Sang, a general physician based in Saint-Hippolyte, Que., in the Laurentians, said framing the bill as a means to hold doctors accountable paints doctors in a negative light.
"It doesn't acknowledge the struggles we face," Sang said.
Implementing the bill might specifically disadvantage physicians who can't maintain or increase their current workload due to medical issues or other personal reasons, which could lead to doctors leaving the province, she added.
Running health sector 'like a business'
André Fortin, Quebec Liberal Party health critic, said the bill is "completely illogical and counterproductive."
"If we tell doctors, 'your compensation is based on what all doctors in Quebec have done,' honestly, I think there will be some who won't see the light at the end of the tunnel," he said.
Québéc Solidaire health critic Vincent Marrissal told reporters Thursday morning that Premier François Legault had an "odd fixation" with performance indicators and is attempting to run the health sector "like a business."
"Nobody is against efficiency, but why does this government always start a new war with physicians? It's counterproductive," Marissal said, noting that he hasn't read the bill yet.
He also urged Legault not to negotiate with doctors in public.
"At the end of the day, you have to negotiate in good faith, and the [premier] is doing just the opposite," Marissal said.
During a media availability on Wednesday, Legault said tabling the bill would be "non-negotiable."
"We will never have an effective health-care network until all Quebecers are taken care of by family medicine groups, starting with family doctors," he told reporters.
Legault added that he believes "two-thirds of doctors take care of Quebecers, but there is one-third who need to do more."
Dubé said in a social media post published on Wednesday that he is working to ensure "100 per cent of Quebecers" are cared for by the summer of 2026.
With files from Cathy Senay, Vanessa Lee, Véronique Prince, Jérôme Labbé and La Presse Canadienne