Quebec plans to force new doctors to stay in the province and work in public system

The Quebec government is planning to force new doctors trained in the province to work in Quebec’s public health-care system for the first few years of their practice, in a bid to slow the loss of physicians to the private sector and to other provinces.

Health Minister Christian Dubé says he will table a bill by the end of the legislative session, to be debated next spring, that would require family doctors and specialists to start their careers in Quebec’s public network.

“While too many Quebecers are still waiting to be treated, too many doctors decide, from the start of their career, to leave the Quebec public network,” he said in a statement Sunday evening. “We will take steps to ensure that the population has access to the care for which they pay.”

Dubé told a Montreal radio station on Monday morning that those who want to leave Quebec or work in the private system will face “consequences,” though he offered no details. It’s also unclear how long new doctors would be required to practise in Quebec’s public network.

Montreal doctor Michael Kalin called Dubé’s proposal an important “piece of the puzzle.”

“We have to stop the mass exodus to the private sector,” he told CityNews.

“I think that there’s a social contract and that educating physicians is costly and time-consuming. And I think young doctors have an obligation or responsibility to give back.”

The Quebec government estimates it costs between $435,000 and $790,000 to train a doctor, including during their residency.

A medical student at the Université de Montréal, who asked to remain anonymous for fear of hindering his residency applications, says the proposition is more of a political statement, and that most of his peers end up in the public system to start off anyway.

“In Quebec, we do have a great medical education and our costs do stay low,” he said. “So it is important to stay in the system and give back to the province, which gave us so much.”

It says that 775 of Quebec’s 22,479 practicing physicians are working exclusively in the private sector – just over three per cent. Though it’s a 70 per cent increase since 2020. That trend is especially notable among new doctors, according to the province.

‘Valid reasons for leaving’

The Université de Montréal med student believes it may not be due to salary increases, but about quality of life.

“A big reality that a lot of people don’t know of is that many doctors who graduate, at least in family medicine, are forced either to work in areas that they otherwise wouldn’t work in or practise what we call PREMs, which basically force you to go into fields of interest which actually don’t stimulate you and are not your choice,” he said. “And I think that just leads to overall dissatisfaction at work and maybe patient care that isn’t ideal.

“If we all work together to find solutions to keep even that per cent of physicians in the public sector, and I think that’s the ideal solution instead of penalizing the ones who leave, who might have valid reasons for leaving.”

Dr. Kalin believes it’s the responsibility of the government to ensure there are opportunities and jobs.

“So you can’t say to a young doctor, we insist that you work here, but we’re not going to give you a licence. It has to work both ways.”

In a statement to CityNews, Dube’s office says too many doctors decide, at the beginning of their careers, to leave the Quebec public network

“We will take the means to give the population access to the care they pay for. Our government has the courage to take all necessary steps to strengthen doctors’ commitment to the population and our public network. This measure is part of a few other ways to strengthen our public network and attract our professionals to work there from the beginning of their careers.”

Data from the Canadian Institute for Health Information show that just 60 per cent of family doctors who had recently graduated in Quebec were still practising in the province in 2022, while nearly 20 per cent had moved to Ontario. The number was higher for specialists, with 77 per cent of recent graduates still practising in Quebec.

In Ontario, 85 per cent of recently graduated family doctors and 80 per cent of specialists were still in the province in 2022. In Nova Scotia, however, just 42 per cent of family doctors and 38 per cent of specialists remained in the province.

Quebec’s college of physicians said it supports the government’s plan. “For us, this is a question of social responsibility,” it said in a statement. “But we will want to see the terms of this bill.”

On Monday, the college released a set of guiding principles for the role of the private sector in health care, which included a call for the expansion of the private health system to be “suspended immediately.”