Quebec introduces legislation to amend Bill 2, which imposed performance targets on doctors

The Coalition Avenir Québec (CAQ) government tabled another bill on Wednesday to amend its own Bill 2.

Bill 2, which changed how doctors are paid, imposed performance targets, and threatened them with sanctions, was passed on Oct. 25, 2025.

It sparked outrage among doctors and patients and led to the resignation of three CAQ members, including two heavyweights in the government: Lionel Carmant and Christian Dubé.

Dubé resigned from the CAQ in December after Premier François Legault yielded to pressure from family doctors and dropped significant sections of Bill 2.

An initial bill, repealing 78 articles and postponing the implementation date of Bill 2 to Feb. 28, was then passed.

“I think that we’re all traumatized by Bill 2 and nobody wants to go through that again. Certainly not the population and not the doctors,” Montreal family doctor Michael Kalin told CityNews.

On Wednesday, Health Minister Sonia Bélanger went further by tabling Bill 19, which makes several other concessions to reflect the agreement reached with general practitioners.

“We were told we were too tough. Now we’re being told we’re too soft. I think we’re in the middle, and we’re in the right place, and this will make a difference for Quebecers,” she stated at a press conference.

“We are doing this for patients. Every action has one goal, better access to care.”

Bill 19 confirms that the most restrictive elements of Bill 2 have been dropped.

Instead, the voluntary enrollment of 500,000 new patients (including 180,000 vulnerable individuals) by June 2026 will be accompanied by a $75 million incentive — a 2.5 per cent bonus for doctors if the target is met.

“We could have taken a coercive approach. We saw how that worked: nobody was on board. So, we chose to do things collaboratively,” said Treasury Board President France-Élaine Duranceau at a press scrum.

But doctors are already warning the goal may be difficult to reach and some patients shared those concerns.

“It’s not achievable, but it’s a good goal,” Kalin said. “And right now, she said that 78,000 patients have been registered, which is fantastic. That’s quite short of 500,000 and we only have five months left.”

“I think it’s putting a lot of stress on doctors’ shoulders,” said Montrealer Vanessa Cabral. “I feel like they’re already overworked. I don’t know if it’s an attainable goal.”

“I think it sounds very ambitious,” added Ellen Tissenbaum, whose daughter is still looking for a family doctor. “I hope it could be done. But I’m really very nervous. Because I think we set goals, but are they realistic?”

The government is increasing the compensation envelope for family physicians by 14.5 per cent, or $435 million. It marks a major shift from the original reform, where compensation was tied to performance targets and financial penalties.

“What’s more important than a 14.5 per cent pay discussion is really getting rid of the prems, which are the licenses, getting rid of the AMPs, all these extra legislation, and let’s open up the doors so family doctors can practise in Quebec,” Kalin said.

The legislation introduced Wednesday reintroduces the concept of capitation-based compensation for family physicians working in primary care. However, many physicians will be able to choose not to participate.

Capitation is the opposite of fee-for-service. Rather than being paid for each service rendered, physicians receive a fixed annual amount for each patient on their list.

It notably promotes interprofessional collaboration, according to the bill. Physicians at the beginning of their practice or nearing retirement will, however, be able to opt out, explained Bélanger.

“This method of remuneration notably ensures better care and encourages better access,” she said.

“Capitation is the idea that instead of being paid for each act, each visit, you’re paid to cover a practice,” Kalin explained. “And this has been successfully done in other provinces. So I think this is the model that we have to go towards.

“It really encourages the collaboration of an entire team. So if somebody is sick, it’s not that the doctor has to see that person, but maybe the nurse can, or maybe it can be a nurse practitioner or a social worker.”

Several details, including these “exclusions,” remain to be negotiated with the Quebec Federation of General Practitioners (FMOQ).

In parallel, the government is still negotiating with the Quebec Federation of Medical Specialists (FMSQ). The outcome of these negotiations will have to be incorporated into the legislation in one way or another, the minister of health indicated.

It is therefore possible that a third bill will be required to amend Bill 2 once again.