Outaouais doctors and healthcare advocates are concerned a provincial bill tabled in May, if adopted as law, will decrease the already low number of available family doctors in this region.
Bill 106 states its purpose is to improve access to medical services for all Quebec residents, and attempts to do so by using financial incentives and social pressure to encourage doctors to take on heavier workloads.
Under this law, about 25 per cent of a doctor’s pay would be dependent on their performance – including the number of patients they see – in an effort to get them to increase case loads. Additionally, the bill links compensation to some form of collective performance of family doctors and specialists, but how exactly the province defines “collective” is not entirely clear.
Some local doctors are joining those across the province in warning the bill will likely not work to its intended effect, and may lead to some doctors leaving the province or practice altogether, especially in the Outaouais, which because of its proximity to Ontario, is particularly vulnerable to pressures like these.
“What they’re trying to do is to squeeze more out of people who are already overstretched,” said Dr. Thomas O’Neill, a family physician at the Lotus Clinic in Shawville who has spent many decades working at the Pontiac Hospital.
“You’re already significantly short with doctors. You’re now going to push them to do more and see patients they don’t even know, which will take longer. You’re going to ask them to work longer,” O’Neill said.
Twenty-two per cent of family doctors in Quebec are over the age of 60. Many in this cohort may be working a reduced schedule, two or three days a week, because they are working towards retirement while still continuing to offer care to patients.
O’Neill believes Bill 106 will push many of these doctors in the Pontiac to leave the practice entirely.
He said the pressure to take on more patients, combined with the possibility that pay will be connected to some form of collective responsibility to meet targets, will ultimately incentivise doctors with a reduced schedule to simply retire so as to not cause a burden on their colleagues.
“What it’s basically doing is it’s linking doctors’ pay with provincial objectives – not with their individual objectives, but objectives that are completely out of their hands,” he said, explaining his interpretation of the bill.
“For example, doctors in the Pontiac will have their pay reduced if doctors in Trois-Rivières, Quebec City, or Gaspé Bay don’t meet a certain set of government objectives, but they’ve got no control over that.”
Dr. Guillaume Charbonneau, president of l’Association des médecins omnipraticiens de l’ouest du Québec, the association that represents doctors at the provincial level, said while retirement is an issue across the province, the Pontiac has an additional hurdle when it comes to retention and recruitment.
“We share a border with another province that doesn’t decide to fight with their doctors, but to work with their doctors,” he said. “We are in a situation where the competition makes it very attractive to go to the other place. [ . . . ] The feeling is that the environment here is not favourable. We would like our partner, the government, to help us recruit doctors, not make them afraid to come here.”
He added that paying doctors based on a volume based approach risks compromising the quality of care patients receive, which in turn, he believes will put added stress on the healthcare system.
A negotiating tactic, says Fortin
This bill was introduced amidst ongoing negotiations of the framework agreement between the Quebec government and the Fédération des médecins omnipraticiens du Québec (FMOQ), representing family doctors, as well as the Fédération des médecins spécialistes du Québec (FMSQ), who represent doctor specialists.
“It’s basically a signal from the government that they want to pick a fight with healthcare professionals,” said Pontiac MNA André Fortin, who served as health critic for the official opposition from 2022 until 2025. He said he believes the bill is a part of greater negotiation tactics.
“This bill is basically taking the government’s own responsibility of providing conditions in which doctors can do their work properly and effectively, and putting that onus on the shoulders of doctors,” Fortin said.
THE EQUITY reached out to the Ministry of Health to better understand its intentions with this bill, but did not hear back before publication deadline.
O’Neill said Bill 106 is an administrator’s solution to the doctor shortage that goes back decades.
Around 25 years ago, the government cut back on medical school enrolment, and now, combined with the aging population’s increased demand for care, there are not enough doctors for each resident of Quebec to have appropriate access to a family doctor, he explained.
“And now you find that people don’t have the ability to get a doctor, and you’re going to fix it by compelling [doctors] to see more patients? You’ve got a problem there. You’ve got a problem with planning,” he said.
“What they should be doing, and should have done, is increase the number of doctors. The problem now is it’s going to take time for that to happen.”
Fortin noted Quebec has increased admissions into medical programs across the province in recent years, but when simultaneously putting forward bills, such as 106, it risks driving people away from the profession.
Charbonneau echoed this point.
“[The bill] caused a lot of anxiety and it also sends a bad message to family doctors who already work very hard to provide care in a system where they don’t necessarily have the tools to provide the service,” he said.
“So the feeling is that this bill puts all the responsibility of access on the shoulders of family doctors without giving them the tools to succeed.”
