Quebec doctors on CAQ tactics: “The government is diminishing access to healthcare services”

Dr. *Smith, a physician and director of a Montreal-based family doctors group (GMF – Groupe de Médecine de Famille) who spoke to me on condition of anonymity, says she first came to Quebec when she attended McGill University. 

“I fell in love with the culture here and decided to stay,” she says. But the CAQ government’s latest bill affecting the province’s medical professionals may just be the last straw for her. And many others. 

“When you start comparing to other provinces,” she says, “if Quebec continues to be more and more restrictive, why not go to where my family is?”

On May 8, Health Minister Christian Dubé tabled a surprise bill aiming to introduce “collective responsibility and accountability for improving access to medical services.” 

How does the CAQ government plan to do that? By ensuring, they say, that 25% of the remuneration package for Quebec family doctors be linked to their performance. This decision has them feeling frustrated, discouraged and, for some, downright livid.

Dr. Véronique Godbout, a practising physician and orthopedic surgeon for the past 17 years, and the president of the Quebec Orthopedic Association, says the government is essentially penalizing them for its own inefficiencies. 

“They tabled a bill that affects our remuneration without even consulting us while we’re in negotiations,” she says. “It’s like imprisoning us in a dysfunctional system where we’re lacking in major resources and where they continue to implement major cuts, but 25% of our remuneration will now depend on whether we achieve the objectives that they set for us.”

Dr. Godbout refers to these actions as “disrespectful and denigrating,” labelling them as “harassment and intimidation.”

This move follows a series of confrontational and authoritarian measures. Bill 83, which aims to stem the exodus of doctors to the private sector and proposes restrictions on doctors, makes it much harder for them to move between public and private sectors, as well as attempting to force Quebec physicians to practise in the public system for at least five years after graduating. The measures have been met with concern by doctors’ federations, patient advocates and policy analysts who worry that punitive measures will only exacerbate the problems they seek to solve. 

The attempt to modify doctors’ remuneration model comes in the middle of negotiations to renew the framework agreement for doctors and has already been rejected by delegates from the Fédération des médecins omnipraticiens du Québec (FMOQ). They say the government’s move is an attempt to hold them responsible for their own continued failings in this file and they worry that if 25% of physicians’ salaries is tied to collective performance indicators that are beyond their control as GMFs, it jeopardizes the financial viability of many clinics. This means access to primary care could be seriously compromised, and medical clinics could be forced to close.

“Doctors pay a percentage of their income to these clinics,” says Dr. Smith. “Salaries haven’t gone up that much, while inflation has. A lot of clinics won’t be able to survive if doctors start leaving. If a clinic closes, it impacts far more than just the patients of the doctors who left.”

She says the current system in place for GMFs is extremely restrictive. 

“There’s already so much bureaucracy and restrictions around our practice here, whereas if you look at any other province, if a family doctor wants to practice, no one is telling them how to. We’re already in a position where a lot of people are doing what they don’t necessarily want to do but they have to. There’s this constant stress because of restrictions already in place.”

Dr. Smith is concerned about burnout. “I worry that it’s yet another thing that’s going to create animosity and frustration with the system,” she says. “It’s going to create a significant exodus.”

For the first 15 years of their practice in Quebec, family doctors must do a minimum of 6 to 12 hours in an activity the government deems to be in need, such as obstetrics, emergency, work in CHSLDs, homecare, etc. “But that takes away time from their clinic,” Dr. Smith, says. “When you start adding performance indicators, many doctors will question how they can manage to see their patients. It may be the last straw for them.”

While she says these doctors may feel guilty about abandoning their patients (and the government may frame it that way), it’s mostly about working conditions and quality of life. 

“There’s this notion,” Dr. Smith says, “that because you’re in healthcare — and I’m sure it also applies to nurses when they’re negotiating their contracts — because you’re taking care of vulnerable populations, you’re expected to do it out of the goodness of your heart, and you can’t negotiate. Because if you do, then you should feel guilty. But in any other field, if someone is offered lower pay with more restrictions, no lunch breaks, we would tell them to go somewhere else.”

La Presse recently revealed that even the government’s own committee of experts didn’t recommend doctors’ pay be tied to performance indicators. It’s not the first time the CAQ government has been accused of failing to listen to its own experts and rushing through decisions that people on the ground denounce as unhelpful and counterproductive.

While Dr. Smith agrees that the current formula doesn’t work and there’s a need for changes, “those changes need to be brainstormed with everyone involved.”

“It feels patronizing and authoritarian,” she says. “To have 25% of your pay dependent on performance and you don’t even have any control over that performance? That’s life-changing for a lot of people.”

She predicts people will leave. 

“I’ve always said that I would move provinces before going private because I think that public healthcare is so important,” she says, “and I’m at the point of thinking, ‘Do I go back to my home province? Other than my patients themselves, what’s keeping me here?’ For me to be reflecting on this is very telling.”

And if doctors leave, she warns, “those who stay are probably going to be in an even worse position. The strain is only going to increase for those who remain.”

Dr. Godbout sees a similar pattern. “On the doctors’ groups I belong to, I see many ready to leave the province and even change professions,” she says. “I see a lot of comments indicating major frustration. People are very angry, they’re insulted and they don’t feel like practising in Quebec anymore. Our groups are national, and I’ve never seen so many messages from Quebec doctors asking what the work conditions are in Alberta, Ontario or B.C. These doctors are being actively recruited and being told that other provinces lack doctors, and that they should move there, that they’ll be better paid, better respected. For example, Ontario just legislated to better protect family medicine.”

Dr. Godbout says that the situation also affects her field in orthopedics. “I have quite a few orthopedic doctors currently in private practice,” she says, “hesitant to re-enter public practice because of these conditions and demands.”

She denounces the lack of collaboration. “All the actions that have recently been undertaken by the government,” she says, “are diminishing access to healthcare services. It’s doing the exact opposite of what they say they want.”

Premier François Legault recently pointed out that, in his opinion, “two-thirds of doctors take care of Quebecers, but there is a third who need to do more.”

Dr. Godbout warns that such statements lack nuance. 

“They say a third of doctors are working part-time, but have they looked to see why?” she says. “Some are progressively returning after being on disability leave, some have health restrictions and can’t do more, and some are older doctors who, instead of retiring, have decided to stay in practice to help out and work part-time. There are so many possible scenarios. Doctors are human, too. It’s not because you have a medical degree that you can’t get sick or become pregnant. The risks of burnout and suicide are very real in our profession because we don’t have the help and resources that we need. This is just not the right approach.”

Dr. Godbout says the government should be looking at why excessive bureaucracy and a lack of staff take up so much of doctors’ time. 

“After my clinic and seeing patients, I spend so much time opening computers and opening applications,” she says. “Clicking on 15 links just so I can print a document for a patient or spending time posing questions that I could have read far more quickly if the answers were already available to me and questions had been asked by a doctor’s assistant or a nurse. If all this work that’s not specific to my expertise was being done by other people, I could potentially see more patients. But none of this is happening because of major service cuts.”

In the meantime, Minister Dubé has stated on social media that he’s working “to ensure that 100% of Quebecers are cared for by the summer of 2026.”

Quebec doctors see it as the political campaigning that it is. 

“We’re discouraged,” Dr. Godbout says. “We don’t know where this is going to go. It’s been 17 years that I’ve been a practising physician and it’s always the same thing. A certain amount of time before an election, the bullying starts. But I don’t think it’s going to work this time around. I think Quebecers know we’re not lazy and we work hard. We take our jobs very seriously.” ■

This article was originally published in the June issue of Cult MTL.

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Read more weekly editorial columns by Toula Drimonis.