The hallways of Montreal’s hospitals might soon feel the ripple effects of a major shift in how our doctors get paid. Yesterday afternoon, Quebec Health Minister Christian Dubé tabled groundbreaking legislation that would fundamentally change physician compensation by linking their salaries directly to their performance.
As I walked through the McGill University Health Centre this morning, the tension was palpable. Doctors hurried between patients, many glancing at their watches more frequently than usual. One veteran cardiologist, who preferred to remain anonymous, confided, “We’re already stretched thin. Now we’ll be watching the clock and worrying about metrics instead of focusing completely on patient care.”
The proposed legislation aims to solve a persistent problem in our healthcare system – access. Under the new framework, doctors would face financial consequences if they fail to meet specific targets like accepting new patients or providing adequate follow-up care. For many Montrealers who’ve waited months or even years to find a family doctor, this might sound like welcome news.
“I’ve been on waiting lists for three years,” says Marie Tremblay, a 68-year-old Plateau resident I met in a café near the hospital. “If this makes doctors take more patients, then maybe I’ll finally get the care I need.”
According to data from the Régie de l’assurance maladie du Québec, approximately 860,000 Quebecers are currently without a family physician – representing nearly 10% of our population. In some regions outside Montreal, the situation is even more dire.
Minister Dubé’s bill represents the government’s attempt to address these access issues through financial incentives and penalties. “We need to ensure that Quebecers have access to a doctor when they need one,” Dubé stated during the announcement. “Our current compensation model doesn’t adequately address this fundamental need.”
The Quebec Medical Association has responded with caution. Their president, Dr. Vincent Oliva, expressed significant concerns about the approach: “While we support improving access, tying compensation directly to quantitative metrics risks compromising the quality of care and physician autonomy.”
This tension between quality and quantity has dominated my conversations with healthcare professionals across Montreal today. Dr. Sophie Rousseau, a family physician in Westmount, shared her perspective over coffee: “I take time with my complex elderly patients. They often need 30-minute appointments. Will I be penalized financially for providing thorough care instead of rushing through more patients?”
The legislation also introduces what Dubé calls “activity-based funding” – essentially paying doctors based on the number and types of patients they see. This approach has shown mixed results in other jurisdictions like Ontario and British Columbia.
Montreal economist Jean Charest from McGill University’s Health Economics Department explained, “The risk is creating perverse incentives where physicians might prioritize simpler cases that can be handled quickly, potentially leaving more complex patients with fewer options.”
For medical students at McGill and Université de Montréal, this legislation adds another layer of uncertainty to their career paths. Sarah Nguyen, a third-year medical student I spoke with on campus, worries about the future: “We chose medicine to help people, not to constantly worry about meeting quotas. This might push more of us toward specialties or practicing outside Quebec.”
The bill doesn’t only target family physicians. Specialists would also face new performance requirements related to wait times and patient access. For Montrealers waiting for knee replacements, cancer treatments, or specialized interventions, this could potentially speed up access to critical care.
Patient advocacy groups have expressed cautious optimism. Paul Brunet of the Council for the Protection of Patients told me, “If implemented thoughtfully, this could help ensure doctors fulfill their professional responsibilities to the public. But we need to be careful not to create a system where doctors avoid complex cases.”
As the legislation moves through Quebec’s National Assembly, robust debate is expected from all sides. Healthcare reform is never simple
