Via CBC

Mika Sauvageau

Copy Editor

Since the adoption of Bill 2 on October 25th, which affects doctors’ pay and working conditions, social media has been abuzz with criticism, condemning the legislation as unclear and detached from the profession’s realities. While its full implications remain quite convoluted, the legislation introduces performance targets for physicians that directly affect their compensation — raising concerns over doctors’ professional freedom and autonomy. Are they now salespeople instead of doctors?

For the past two years, the Fédération des médecins spécialistes du Québec (FMSQ) and the Fédération des médecins omnipraticiens du Québec (FMOQ) have been negotiating with the Coalition Avenir Québec (CAQ) government. Health Minister Christian Dubé has tabled four proposals, all of which have been rejected by the various federations.

In response, on October 24th, Premier François Legault convened the National Assembly in the salon Rouge and invoked closure — a parliamentary procedure that limits debate and forces a final vote. The law passed hours later by 63 votes to 27; all opposition members voted against.

This is not Legault’s first involvement in physician contract negotiations. In 2003, as Health Minister under the Parti Québécois, he proposed similar reforms that were at the time overruled by then-Premier Bernard Landry, which contributed to Mr. Legault’s departure as Health Minister. Bill 2, which builds on Bill 106 introduced in May 2025, represents his return to the issue with renewed determination. 

The new legislation shifts Quebec’s physician payment model from a fee-for-service system to a performance-based structure grounded in capitation.

Previously, doctors were paid per service provided. Under the new system, however, they receive a fixed payment per patient, adjusted for the patient’s health status and vulnerability. Additionally, fifteen percent of physicians’ pay is now tied to performance indicators that are withheld until the end of the fiscal year and released based on collective target achievement.

According to the new legislation, every Quebecer must have a family doctor by 2027, which means assigning 1.5 million residents to existing physicians. What’s more, general practitioners must provide at least 16.5 million appointment slots annually, and 75% of emergency-room patients must be seen within 90 minutes of triage. According to the Ministère de l’Économie et de l’Innovation (MEI), wait times in ERs are currently around 5.22 hours for non-priority cases, and it is estimated that Quebec is still 2,000 doctors short of being able to feasibly treat all of Quebecers.

Moreover, non-clinical contributions — such as teaching, mentoring, research, and system leadership — are largely excluded from the performance metrics. This demonstrates a lack of recognition for broader professional work.

According to Michael Kalen, the coordinator of the Département territorial de médecine familiale de Montréal (DTMF), the performance-based model sets unrealistic targets, resulting in reduced pay, fewer vacation days, and grueling schedules that fail to account for individual circumstances. Over 55% of Quebec’s doctors are women, many of whom work part-time to act as primary caregivers. This bill forces them into an impossible choice between their family and their career.

One of the most controversial provisions prohibits doctors from engaging in any “concerted action” that could negatively affect the quality or the access to services. This includes the recent protests organized by doctors across the province in response to the adoption of Bill 2. According to the legislation, 40% of their average weekly remuneration will be deducted for each day of “non-compliance.” This penalty also applies to those who fail to report the “concerted actions” of other practicing healthcare providers.

Maxence Pelletier-Lebrun, president of the Quebec Medical Students’ Federation (FMEQ), warns that around 1,000 medical students may not graduate in June due to class cancellations caused by the labor dispute, affecting future patient care.

Bill 2 shifts responsibility from policymakers to frontline physicians. Instead of addressing structural problems, such as insufficient administrative support and poor management, the government has imposed quotas and sanctions.

Health policy expert Olivier Jacques notes, ‘Forcing people to implement change is not necessarily the best way to implement change.’ “

Many physicians caution that the top-down approach may drive them out of the public system—or even the province entirely.

Since the bill’s passing, 25 family doctors have formally notified their federation, the FMOQ, of their intention to leave Quebec’s public healthcare system, and the College of Physicians and Surgeons of Ontario (CPSO) confirmed to CTV News that it has received 148 license applications from doctors living in Quebec. 

To date, the government’s assent has not been uploaded to the National Assembly’s website, and the FMSQ has requested an urgent hearing in the Quebec Superior Court to challenge specific provisions of Bill 2, particularly those prohibiting concerted actions opposing the law, arguing that they violate individual liberties.

While the CAQ believes that the bill will not harm the quality of care, doctors warn that there could be long-term negative effects, particularly on women in medicine.