By William Crooks

Local Journalism Initiative

Quebec Health Minister Christian Dubé took a firm stance Tuesday on the province’s proposed Bill 106, which aims to overhaul how doctors are paid, insisting that the legislation is essential to improving patient access and the quality of care. Speaking at a press conference in Montréal, Dubé acknowledged tensions with physicians’ federations but said the principles at stake are non-negotiable.

“The bill is there to stay,” he told reporters. “We will be firm on the principles … because that is what the population wants us to do, to make changes.”

Background and context

Bill 106, tabled in April, would tie part of doctors’ pay to performance targets such as reduced wait times and better patient outcomes. Negotiations with the Fédération des médecins omnipraticiens du Québec (FMOQ) and the Fédération des médecins spécialistes du Québec (FMSQ) have been stalled since spring. Both federations have resisted presenting counter-proposals as long as the bill remains on the table.

Dubé said Quebecers have made it clear they want timely access to doctors and health professionals. “Seventy-five per cent of Quebecers agree to evaluate the performance and the quality of care given by doctors,” he noted, citing a recent poll.

The government spends nearly $9 billion annually on physician remuneration, he said, with about $3 billion going to family doctors and $5 billion to specialists. Despite that, 1.5 million Quebecers lack reliable access to a family doctor, including 200,000 vulnerable patients with chronic conditions.

Proposed changes for family doctors

Dubé outlined three major components of a simplified pay structure for general practitioners:

• Simplification of billing: Reducing the current 5,000 fee codes to about 10.
• Capitation model: Linking part of payment to a formal commitment to see a set number of patients.
• Hourly rate option: Allowing additional pay for complex cases.

The province also wants more evening and weekend appointments, raising availability from the current 10 per cent of slots to 15–20 per cent. Dubé illustrated the need with an example: “Julie is 47 years old. She has diabetes. On a Friday night, she suffers from leg pain. Today, she has to wait until Monday or go to the emergency. With what we are proposing, her GMF [family medicine group] is committed to being open Friday night.”

Another proposed change would redirect the 30 per cent bonus family doctors now receive for working in GMFs directly to the clinics instead. Dubé argued this would help hire more nurses, psychologists and other professionals rather than being taken as extra income by doctors.

Proposed changes for specialists

Specialists would keep their $5-billion annual envelope, but part of it would be conditional on targets such as:

• Ensuring 99 per cent of surgeries are performed within a year.
• Reducing delays for specialist consultations, some of which now exceed two years.
• Guaranteeing more availability in emergency departments.

Dubé also called for correcting pay disparities among specialties, particularly those with more women, such as obstetrics, and for modernizing operating room practices, like allowing one anaesthetist to oversee two theatres simultaneously.

Digital health file controversy

Tensions with specialists have extended to Quebec’s digital health file project, which Dubé said is critical to improving efficiency. He accused the FMSQ of applying pressure by not participating in its rollout. “To sabotage the implementation of the digital health record is to make a mistake,” he said.

Reporters pressed him on whether costs for digital projects such as the CIFAR health platform are ballooning. Dubé rejected that suggestion, pledging transparency and promising a dedicated briefing. “If we ask for more help, we’re going to be able to explain why,” he said.

Reporters’ questions: firm stance

Journalists repeatedly asked whether Dubé would impose Bill 106 if negotiations remain deadlocked. “My conditions to remove the bill? For me, it’s an unresolved end,” he said. While he left the door open to amendments, he was clear the bill’s core principles will not change.

When asked about accusations the plan would create “fast food medicine,” Dubé pushed back. “It’s exactly the opposite of what we’re asking. If a patient has a more complex problem, remuneration could include an hourly component to account for that. What I want is not more volume but better care,” he said.

He also fielded questions about whether the province might end doctors’ ability to incorporate, a tax-saving measure. He said Quebec would not act unilaterally while incorporation is permitted elsewhere in Canada, but emphasized that such privileges cost taxpayers “hundreds of millions a year” and must be matched by results.

Asked if the measures risk driving doctors out of Quebec, Dubé admitted concern but said he believes most physicians want a reasonable compromise. He pointed to lowered expectations on some targets as proof of good faith.

Linking managers’ pay to results

In a notable shift, Dubé said he also wants to link the remuneration of senior health-care managers at Santé Québec to performance targets, mirroring the approach proposed for doctors. “We have managers … I would like there to be a marriage of the targets asked to the doctors with a part of the targets that are asked to Health Quebec,” he explained.

Dubé’s bottom line: patients first

Throughout the press conference, Dubé stressed that the reforms are aimed at improving care for patients rather than punishing doctors. “I’m not blaming anybody,” he said. “We don’t want them to work harder, we want them to work differently.”

He concluded by urging the federations to return to the table before Parliament resumes. “We still have time to come back and make counter-proposals … But we will be firm on the principles,” he said.