Quebec doctors say new bill will drive them away, threaten patient access

Doctors at a medical clinic in Kingsey Falls, a town in central Quebec, say they are contemplating closing their clinic and pivoting out of family practice — or Quebec altogether — if a bill allowing the province to regulate how physicians are paid is adopted as it is written.

Bill 106, tabled earlier this month, would link up to 25 per cent of physicians' pay to their performance in an effort to get them to take on more patients.

But in a statement posted to their social media, doctors at the Kingsey Falls medical clinic said the new rules would impose unattainable performance targets on them and reduce their ability to deliver quality care to patients. 

"We can't take on more patients if we don't have more resources or a system that's more efficient and productive to be able to take good care of them," said Dr. Isabelle Lemieux, who works at the clinic.

As legislative hearings on the bill run their course, the clinic and others in the province are warning their patients that they risk losing their family doctor — despite Article 4 of the bill suggesting otherwise — and are asking them to write to their local MNA. The clinic has since deleted its statement and letter templates from its Facebook page.

Quebec's College of Physicians (CMQ) has condemned these types of communications after being confronted about them by Health Minister Christian Dubé during Tuesday's hearing.

"They transmit false information," wrote the college's president Mauril Gaudreault in a statement to Facebook.

In the halls of the National Assembly Thursday morning, Dubé said the college did the right thing by adding that "what is important are the interests of the patients."

But the debate rages on as doctors continue to voice their concerns, some echoed by the CMQ, about the bill's impact.

Gaudreault argues the bill and its title — An Act mainly to establish the collective responsibility and the accountability of physicians with respect to improvement of access to medical services — make explicit the government's attempt to place the burden of a well-functioning health-care system squarely on the shoulders of doctors.

The bill proposes a mixed model of remuneration for family doctors: capitation payments (an annual flat rate per patient based on their level of vulnerability), an hourly rate for time spent with patients and a fee-for-service.

Part of their pay would also be tied to their collective performance based on targets set at the provincial and local levels.

Those targets aren't specified in the bill but could look like reducing waiting times and absenteeism rates as well as increasing quality of care, said Dubé at Tuesday's hearing, adding the targets would need to be discussed.

The president of the Fédération des médecins omnipraticiens du Québec (FMOQ), which represents family doctors, called the bill "catastrophic," warning that it will negatively affect accessibility to doctors.