The Current - Why doctors are threatening to leave Quebec

Episode Date: November 3, 2025

Doctors are calling a new law passed by the Quebec government draconian and anti-democratic. The bill, which changes how doctors in the province will be compensated, is being defended by Quebec Premier François Legault. The Premier says the changes are going to improve access to healthcare in the province. Doctors in Quebec  disagree — and say the new law is only going to make things worse.

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Hello, I'm Matt Galloway, and this is the current podcast. A controversial new law is pushing hundreds of doctors in Quebec to consider leaving the province. The Quebec government recently passed the legislation two years after negotiations with physicians began. The law changes the way doctors are paid, tying some of their compensation to new performance targets. It also threatens large fines for those who don't comply with. the new regulations, and doctors are speaking out. This bill is essentially a Soviet prison for doctors. This government has decided that the charts of liberty is absolutely irrelevant to it.

That it can tell us how to practice, where to practice, who to treat, who not to treat, how they're going to pay us, how they're going to penalize us. That was Corrine Icartois, a psychiatrist in Quebec last week. Quebec's premier, Francois Lago, has defended. the new legislation. It's unacceptable that we have 1.5 million people not having a family doctors, and it's clear we need to do something in the health care system. And the first thing, the most important thing, is to change the way we pay the doctors. Dr. Lynne Couture is a family doctor in Quebec and the president of the Association of Family Physicians of the Laurentians

La Naudier. She joins us from St. Anne de Plain, a small town just north of Montreal, Kouture, good morning. Good morning. Thank you for having me. It's nice to have you with us. We just heard from Dr. Igarthwa comparing this law to a Soviet prison. Others have called it authoritarian. This is very strong language. Why are doctors so upset over this law? Well, it's because that law actually denies us our right to association and to negotiate our working condition. It actually dictates our working condition, just like the physician we just heard said. And it's also putting in place a denunciation system with a four level. So they're actually hiring people to watch physician, make sure that they see more

and more patients instead of hiring staff to help us do the job correctly and give more people more access. And there are 1.5 million people in the province of Quebec who don't have a family doctor. Under this new legislation, those people are going to be assigned to clinics like yours. How is this doctor-patient dynamic going to change? What's it going to change? Well, we anticipate a lot of chaos because they're just going to appoint patient to our clinics, and we're not having any more, we don't have more people, we don't have more staff to see them. So the thing is that we fear that there's just not going to be any service. to the number that they're dialed.

So people are going to be quite frustrated because they will have been promised that they will have services. In the end of the day, they might not get that service because we're already working at the top of what we can do. And it's not just by sending more people to our clinics that we're going to be able to see more.

We're already doing what we can. So what we need is to get more staff to help us. We do want to work with nurses, with pharmacists, with other healthcare professionals to increase the access for our fellow citizens. We do want that. We're not against that. I mean, we've been calling upon that for years. Yeah, the Quebec government's point is that it wants each person in the province to have access

to a primary health care professional by next summer. but what I'm hearing from you is that you say, this isn't the VIX. This isn't going to do that. Well, in the bill, at no point is there a place where they say that they're going to send us more health care professional. It just makes us responsible for the whole population. That's all. Tell me more about how the law will change the way doctors like yourself are compensated. How will that work?

Well, it's going to be composed remuneration. So there will be part by the hour, and I shall give you the numbers. It will be 2681, and that can be divided in four. Now, tell me how easy it is to divide 26, 81 in four, but that's in the law. On top, you can add the by-visit. So each patient, if I take the most I can do by a visit, it's $16. currently, just to let you know, it's 60, 6. Oh, not 1-6. And most of the physicians right now see like three patients an hour. So if you just come to add those two, it'll be like 70, 481 an hour

compared to what is currently the case, 180 an hour. Then on top of that, you have the collective capitation and the so-called supplement of the 15% that is linked to performance. But let me tell you that capitation we already have, and that is why we're so upset with the government that says that it needed a law to get the capitation because we already have about close to 30% of our revenues that are for the panel of patients that we see when we work in clinics. And that capitation level now will be collective. So that means that my colleague might influence badly

what I'm going to perceive, what I'm going to be paid, and it's actually going to be lower than what we already have. And may I remind you also that we are self-employed? So even though it might seem a lot of money, you have to bear in mind the fact that we have to pay for the rent for the secretaries, the staff, the computers, and all the furniture that we need and use daily in a clinic. So it's not that much. We received a statement from the province of Quebec saying that this law is meant to get every Quebecer access to proper care. You and I have

talked about that already in your views on that. And in the words of the Quebec government, quote, this is not about punishment, but about shared responsibility and that the targets are realistic and take into account the realities on the ground. What do you say to that? Alternative reality. They have not a cue on what's going on in the ground. Right now, people are working their head off. They haven't been listening to nobody. There is a shortage of family physician of 2,000 family physician in the province of Quebec. I know there's a a shortage of family physician everywhere in Canada. But in the province of Quebec, it's 2000.

And even their Ministry of Health, this government does acknowledge the fact that there is a shortage. But the Premier and Mr. Dubay, the health ministry, do not seem to realize that. So when they say that it's realistic, it's attainable, they do not take into account the fact that there's a shortage. Actually, if there was no shortage, we would be seeing all the population and we would be more than happy because that's what we do as family physician. You know, we want to take care of our fellow citizens. That's our goal. You speak of the shortage and one thing that is seemingly a consequence of this new law that doctors are considering leaving Quebec to other provinces like neighboring Ontario, New Brunswick, or retiring early because of this law.

Have you considered your options and perhaps leaving? I believe that all the physicians in the province of Quebec right now are considering their options. For my part, I will not be leaving, and I must say that this law, as I said, has a surveillance system, and that includes what we're talking about right now. So understand my points properly, I am not encouraging any. physician to leave the province? Definitely not because this will actually increase the number of patients without family physician, thus increasing the burden on the remaining physicians in the province. So I am not doing that, of course, because I'm staying also. But I understand that some

physicians, they take, you know, they add their numbers because as I told you, the, the, the, the, the, the, remuneration, the revenue is going down by at least 30% for all the physicians. So, because that's another lie that the Premier is actually saying right now, is saying that the envelope is being frozen. But, you know, I don't know about you, but when I look at $3.03 billion, $3.03 billion, and it goes down to $2.28 billion to me, this is not being frozen.

really going down. That's the envelope from 2024 to 28. So we're facing a cut in there. So yes, what is happening right now, so some people are leaving because, you know, there's been also a campaign dragging the physicians into the mud saying that they were lazy, they were unprofessional, that they were not doing what they had to do and so on and so forth. So So people, most of the physicians are in dismay, devastated, depressed.

Some even went into suicidal states. So we had to address that. So right now, it's quite a sad moment for physicians. So, yes, there are unfortunately some people that leave the province. That is very sad. that's why, you know, when the premier says it's urgent to pass the bill for the 1.5 million patients without family physician, I would say that it's surgeon to put this law on pause and even to withdraw it because the number of a patient without a family physician is on the rise since the law has been passed. Dr. Kuture, we'll have to leave it there, but I appreciate your time this morning. Thank you.

Okay. Dr. Lynne Couture is a family doctor in Quebec and the President of the Association of Family Physicians of the Laurentians-Lanodier region. She was in St. Anne de Plain. For small business owners, there's strength in numbers. Chambers Plan Employee Benefits brings together 32,000 businesses across Canada

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Come by, we'll roll out the red carpet for you. Quebec Premier Francois Lago fired back, saying this was not the time for provinces to take shots at each other. According to the College for Physicians in Quebec, by this past Friday, 125 doctors had completed the process to have the right to practice in Ontario. Dozens more have applied for licenses in New Brunswick. Andre Picard is the health columnist for the Globe and Mail. Andre, good morning to you. Good morning.

There's been a lot of criticism of this new law from doctors, national medical bodies, including the Canadian Medical Association and the College of Family Physicians of Canada have spoken out against us. Help us understand why there's been such a back-class. clash from doctors? Well, I think it's just the imposing of a contract is the hard part and then threatening to find people if they oppose what the government is doing. You know, every government in the country around the world is struggling with how do you pay doctors correctly, how do you get value for money, how do you get all your patients treated?

This is an issue that's happening all over and no one has found the right formula. And I think it's fair to say this isn't the right formula. And the other side of this, of course, is the patient side and for its part, the Quebec government says, look, this is going to help with patient care, help with the number of people who can get access to a primary care team, including a doctor. Doug Ford is rolling out the red carpet saying, you know, come on over because Ontario is short of doctors as well. What is this going to mean for patient care? I think there's nothing good in here for patient care. As you mentioned earlier, about 1.5 million Quebecers don't have a family doctor now across Canada.

It's about 6.5 million Canadians. So this is a big issue. Now is forcing doctors to take on more patients, threatening them with fines if they don't do it. Is that going to improve patient care? I think there's no evidence of that that this really heavy stick is going to solve this problem. Let's talk about some of the politics of all of this.

Quebec Social Services Minister Lionel Carmel stepped down from his position. Last week, he's now going to sit as an independent. He made that move. after his daughter published an open letter in the newspaper Le DeVois saying she, she's a doctor, might leave the province, if the government doesn't, in her words, allow her to practice freely. What kind of friction is this bill creating within the Quebec government? This is a big deal.

This government was already in trouble. It's kind of beset by scandals of all sorts. And this is kind of the final straw, I think, for a lot of people. So they lost, as you mentioned, Lionel Carman, the only doctor in the car, caucus, one of the best friends of the Premier. This is really like a family falling apart. The government could literally fall on this. The government only has about a year before a mandatory election. Their most recent poll said that 75% of Quebecers want them to resign, that they don't like them. So they're in big, big trouble, and this seems to be making it

worse. The doctors in Quebec don't seem to like this, and you say patient care isn't going to improve. Do you see anything positive with this new law? Well, you know, if you look at the law, it's not all bad. We do need to change the way physicians are paid. This bill would improve that. I think the problem is that there's the principal problem here is they've set targets without, we don't have any evidence that these are achievable. So that's the issue. Doctors are not opposed to targets. I think they're probably the wrong kind of targets. We have targets for volume rather than for quality. So there are a lot of doctors with targets all over the world, but they reward doctors for doing better patient care rather than punish them

for not having enough doctors in their practice, enough patients in their practice. We heard Premier Four, Doug Ford of Ontario, encouraging Quebec doctors to come to Ontario. Again, we know that there are shortages of doctors across our country, but what does that kind of play between Ford and Legault? What does it say to you about the state of primary care in our country, where we have provinces fighting over people and care providers? Well, you know, I think what Doug Ford did, he said in retrospect that he was joking, but, you know, it was very inelegant, but it was very stinging. He really wants those doctors, and he's going to get hundreds of them.

So it's working. There's a long history of this. The way, you know, we have provincial, every province is different. They have their own doctor's contract, and traditionally this is what happens. It's one province, gives more money to the doctors. The others say, hey, look, if you don't give us money, we're going to go to the next province. So this is a longstanding strategy. And in this case, it's being turned around.

It's the government's using it rather than doctors. So it's in, you know, turnabout is fair play, I guess. Last month, the Ontario now it's had slashed its waitlist for family doctors in half. This is after the province introduced some changes that were led by former federal health minister, Jane Philpott, who's doing some work to help. address these issues. What did Ontario do? And is that a viable model? You know, I think, as I said, every province is struggling with the right way. I think the big difference between Ontario and Quebec is Ontario is using carrots and Quebec is using sticks. Very fundamentally different approaches. So

Ontario is changing how they pay doctors as well. And the pay differs based on practice models. So, you know, we heard about Dr. Kalma's daughter saying she doesn't have the freedom to practice. In Ontario, really have that. You can choose your model, the one that suits you. You can be on salary. You can get a mixed model. You can be on fee for service. So there's really a lot more choice.

And they've made it more attractive for doctors to practice in Ontario. Whereas Quebec, you know, this law that we're talking about is not the only one. There's another one that said students have to practice in Quebec for five years after graduation. They've brought in a new centralized model for the health system called Santee. Quebec. There's a lot going on in Quebec that's upsetting doctors and making it more difficult to practice, whereas on Ontario, it's getting a lot smoother. So it's much more attractive. Another jurisdiction where we might look to that looks like it has some success is British Columbia. It made changes to the pay structure for family doctors. It's brought more doctors to that

province as well. What is it about BC's approach that's attracting more physicians? Yeah, so BC has targeted family doctors. They have something called a longitudinal model. So they pay doctors $105 an hour, and then they can supplement that with some fee for service. They give them bonuses at the year end if they meet targets. So again, it's more carrots. This has been very successful. BC has drawn a lot of doctors. But the interesting thing is visits are down.

So you're not getting more volume, but presumably you're getting more quality. And again, that's the big debate around the world. How do you use doctors in the best way possible? And I suppose the other thing that everyone's trying to strike, provinces and others, is that balance between incentivizing doctors and making the system work for patients? Yes, balancing incentives, cost. The reality is a lot of research shows that when you pay family doctors more, they work less. They care about lifestyle.

They're not, you know, people say, oh, doctors are greedy. They're driven by money. In fact, the research shows that's not true, that they want a lifestyle, they want a decent income. cover their overhead. But again, how do you incentivize when people say, hey, I've got a comfortable living here, a nice practice, I'm not going to do more. Do you think the law in Quebec is going to stand? Premier Lagos seems to be very, very pig-headed about this. There's a lot of history behind this. As with everything in Quebec, there's history. It goes back to 2003. He was the Pepsi-Kibiqua health minister. He imposed a tough contract on doctors. The Premier overruled him. He

was humiliated. He's been waiting 20 years for revenge, and this is his revenge. So I don't see him budging. Andrew Picard, always good to get your perspective. Thank you very much. Thank you. A pleasure. Andre Picard is the health columnist with the Globe and Mail. He is in our Ottawa studio. You've been listening to the current podcast. My name is Matt Galloway. Thanks for listening. I'll talk to you soon. For more CBC podcasts, go to cbc.ca slash podcasts.