Legault government imposes special law on doctors, FMSQ announces legal challenge

The Legault government is wielding its club to impose a new compensation system on doctors, partly based on the achievement of performance targets. It is also putting an end to their pressure tactics.

The National Assembly is holding a special session on Friday at the request of Premier François Legault to rush through a special law, Bill 2, aimed in particular at “ensuring the continuity of service delivery.”

Doctors or groups of doctors who undertake “concerted actions”, who protest, for example, by reducing their professional activities, will now face heavy penalties.

A doctor could be fined up to $20,000 per day and face disciplinary action. In addition, he or she would have his or her years of practice reduced, which would affect his or her seniority. 

Medical federations, for their part, could have to pay up to $500,000 per day, in addition to having their dues normally paid to them withheld at source. 

Montreal emergency medicine specialist, Dr. Mitchell Shulman is not surprised by this new legislation. “What you see is an attempt by the government not to improve healthcare, but to pick a scapegoat.”

A system for monitoring doctors’ activities would be put in place.

100% of Quebecers supported by 2027, promises the CAQ

After promising a family doctor for every Quebecer, the CAQ government is now promising access to a “healthcare setting,” such as a family medicine group (GMF), for every Quebecer by 2027.

Approximately 1.5 million Quebecers do not have a family doctor, which represents 17 per cent of the population, according to the government. Of this number, 200,000 are considered “vulnerable.”

Bill 2 incorporates several major principles of 106, starting with the collective responsibility of doctors to take care of more patients and the obligation of territorial departments to distribute them.

It introduces a change in remuneration for doctors practicing in the front line: from now on, they would be paid by capitation, by the act and according to an hourly rate.

Currently, the law only allows for payment per service, which does not encourage collaborative work or the management of serious and complex cases, argues the government.

The bill also ties 10 per cent of physicians’ compensation—not the original 25 per cent—to performance targets. There will be national, territorial, and local targets. Physicians aged 65 and over will be exempt.

Doctors have been arguing from the beginning that they lack the resources to achieve the government’s objectives. For example, a third of Quebec’s operating rooms are currently closed.

They also accuse Quebec of wanting “fast-food” medicine, focused on volume. “Quebecers give $9 billion a year to doctors; it’s normal that they demand results,” Legault retorted in the House on Friday.

The government also finds itself extending until 2028 the framework agreement for doctors, which expired two years ago; in other words, the overall remuneration envelope is, for all practical purposes, frozen.

‘Soviet’ regime: FMSQ announces legal challenge

This is the eighth gag order in seven years for the CAQ government, the opposition parties denounced on Friday. According to them, it would have been preferable to continue discussions with the doctors.

Forcing doctors’ hands could lead to their disengagement, which would affect patients, they warned. “The only good agreements are negotiated and signed around the table,” argued Liberal leader Pablo Rodriguez.

“Twenty-two percent of family doctors are over 60. Imagine the premature retirements that will cause,” later said the president of the Fédération des médecins omnipraticiens du Québec (FMOQ), Dr. Marc-André Amyot.

This will be considered a “concerted action,” Health Minister Christian Dubé declared in a press scrum.

Furious, the president of President of the Federation of Medical Specialists of Quebec (FMSQ), Dr. Vincent Oliva, used colourful language to describe the situation.

“We’re entering a Soviet regime,” he exclaimed at a press briefing in Montreal, accompanied by several specialists. “The system is so bad that the only way to keep doctors in it is to put them in prison.”

Psychiatrist and member of the FMSQ board, Dr. Karine Iguarta feels let down by the CAQ government. “It has decided 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…In fact, they’re penalizing us before we even start,” she said at same press briefing, Friday morning, alongside Dr. Vincent Oliva.

Dr. Oliva wants the public to understand the severity of this situation. “This is a very dark day. It’s not only dark for the specialist doctors who are taking a beating, but it’s dark for medicine in general, and for the healthcare system. We are witnessing an authoritarian drift by the government, and I think you need to understand that clearly,” he said.

Dr. Oliva announced a legal challenge on Friday: the FMSQ will take “all measures to have the law invalidated,” he insisted.

–This report by La Presse Canadienne was translated by CityNews, with files from Gareth Madoc-Jones