Family doctors in the Outaouais considering their options under Bill 106

Some family doctors in the Outaouais are threatening to pack up and move to Ontario if the Quebec government follows through with plans to legislate how health professionals are compensated, while others are considering early retirement. 

That's according to the president of the association representing about 450 family physicians in the region, and who says the uncertainty and discourse around Bill 106 is pushing doctors away. 

"Some have already decided to leave, unfortunately," said Dr. Guillaume Charbonneau, president of l'Association des médecins omnipraticiens de l'ouest du Québec. "We want to work quickly to make sure that those who are [thinking about leaving] don't go."

Bill 106, tabled in May, would tie up to one-quarter of physicians' pay to their performance in an effort to encourage them to take on more patients.

The bill proposes a mixed model of remuneration for family doctors including "capitation payments" (an annual flat rate per patient based on their level of vulnerability), an hourly rate for time spent with patients, and a fee for service.

Part of each doctor's pay would also be tied to their collective performance based on targets set at the provincial and local levels.

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Those targets aren't specified in the bill, but aimed at improving wait times, absenteeism rates and overall quality of care, according to comments made by Quebec Health Minister Christian Dubé during legislative hearings around the bill. 

'Fast food' medicine

Charbonneau, who practises as a family doctor in Maniwaki, said working under such performance measures can have drawbacks.

"Family doctors don't want to work like a fast food medicine — they want to have time with their patients and do good medicine," he said. "They want to work to improve [care], but not at the cost of quality of medicine." 

Those concerns are echoed by Dr. Mélanie Lacasse, who practises family medicine in the Buckingham sector of Gatineau. She said some physicians in the region are considering early retirement, and at least one doctor she worked with has already made the move to Ottawa. 

"I can't see how it is possible for physicians to continue if they start to increase the amount of work that they want us to do," said Lacasse, who also drew a comparison to fast food. "We won't have the time because they want to take everybody under our care, which is impossible."

She worries the problem could snowball if the bill passes and more physicians leave the profession or the province.

Lacasse and three other doctors from the region who are demanding the withdrawal of Bill 106 met with the minister responsible for the Outaouais, Mathieu Lacombe, in June to discuss the subject.

Lacombe didn't answer questions from Radio-Canada, but Lacasse said the minister was sensitive to their concerns. 

A spokesperson for the Quebec health minister's office told Radio-Canada in French that they will be spending the summer analyzing feedback on the bill and discussing any necessary improvements.

Dr. Pierre Villemaire, who's nearing retirement, said he'll be watching closely.

"I'm waiting to see how I'll survive emotionally to all this, and whether I can keep on going, whether I need to slow down more quickly because I'm exhausted," he said. 

Villemaire, a family doctor for 30 years, said he worries about the future of family medicine in the province. 

"I think Bill 106 is a small part of a big, big issue. Health care on the Gatineauu side is just horrible," he said. "It's been going downhill for the last 25-30 years, and we're not getting ahead anywhere."