The health care landscape in Quebec is facing significant upheaval following the introduction of Bill 106, which aims to overhaul the remuneration system for doctors. On May 8, 2025, Minister of Health Christian Dubé tabled the bill, which proposes linking doctors' pay to performance indicators in a bid to improve access to medical services across the province.
Dubé's initiative has been met with fierce backlash from medical professionals, who view the legislation as a direct affront to their ongoing negotiations regarding practice conditions. The bill stipulates that doctors will not only continue to be paid per act but will also receive hourly wages and a capitation fee, which is a fixed amount based on the number of patients they care for and the complexity of their needs. This multifaceted remuneration approach is intended to encourage doctors to take on more patients, particularly those currently without a family doctor.
Prime Minister François Legault expressed his long-standing desire for such reform, stating, "I have been waiting for the tabling of this bill for 23 years. In 2002, when I was Minister of Health, I opened the first family medicine group (GMF). That was a first step; the second step is to change the way we pay doctors." Legault's comments highlight the government's commitment to ensuring that every Quebecer has access to a health care provider by the summer of 2026, a promise that currently affects about 1.5 million residents who are without a designated doctor.
However, the proposed changes have sparked outrage among medical associations. The Federation of General Practitioners of Quebec (FMOQ) and the Federation of Specialist Physicians of Quebec (FMSQ) have condemned the bill as a "special law" aimed at undermining existing negotiations over doctors' working conditions, which have been stalled for two years. Marc-André Amyot, president of the FMOQ, described the legislation as a "slap in the face," arguing that it ignores the real issues at hand, such as the acute shortage of doctors in the province.
Dr. Vincent Oliva, president of the FMSQ, echoed these sentiments, stating that the bill risks driving away doctors from the public system. He warned, "If they do not want to talk and impose conditions on us, the doctors on the ground will not follow. They will take off their gloves and say: 'I'm going home, I've already given.'" This sentiment reflects a growing frustration among health care professionals who feel that the government is using them as scapegoats for broader systemic failures in the health care system.
In a press conference, Dubé defended the bill, asserting that it is essential for the government to regain management rights over physician remuneration. He emphasized that the bill aims to ensure that all insured persons receive care in first-line practice settings while also promoting the achievement of performance objectives. Dubé noted that the proposed changes would link up to 25% of doctors' remuneration to performance indicators, which he believes is necessary to improve health care access.
Despite the government's intentions, many health care providers remain skeptical. Dr. Alex Lapointe, a family physician, expressed her dismay at the bill's implications, stating that it adds unnecessary pressure to an already strained system. "The decision to rate the accessibility of family doctors, when they are already doing the maximum, is received as a slap in the face," she said. Lapointe pointed out that the current shortage of medical professionals means that even if patients are assigned to a family doctor on paper, their actual access to care may not improve.
Approximately 590,000 of the 1.5 million Quebecers without a family doctor are considered vulnerable, suffering from chronic health issues or major health problems. The government has assured that it will not deprive healthy individuals of their family doctors to accommodate these patients. However, the reality remains that the demand for health care services far exceeds the current supply of medical professionals.
Legault admitted that the pandemic had delayed the government's ability to address the issue of physician remuneration earlier in his term. He acknowledged that the upcoming weeks and months would be challenging as the government navigates the pushback from medical unions. "We have the courage to do it. It’s a big change to the advantage of Quebecers, to the advantage of patients," he asserted.
As the parliamentary session approaches its end on June 6, the future of Bill 106 remains uncertain. The government hopes to pass the legislation before the summer recess, but the likelihood of that occurring is diminishing as opposition mounts. The Liberals have called for special consultations before the bill undergoes detailed study in committee, indicating that significant hurdles remain.
In summary, Quebec's health care system stands at a crossroads as Bill 106 seeks to redefine how doctors are compensated. While the government aims to improve access to care for all residents, the pushback from medical professionals highlights the complexities and challenges inherent in enacting such sweeping reforms. The outcome of this legislative effort will have lasting implications for both health care providers and patients in the province.
