I’ve spent the last week talking with doctors at Sainte-Justine and the MUHC, trying to understand what’s happening behind closed doors as tensions mount between Quebec physicians and the provincial government. The dispute over reforming doctors’ pay structure has evolved from professional disagreement to something more personal and heated.
“This isn’t just about money anymore,” Dr. Marie Fontaine told me over coffee near her McGill University Health Centre office. “It’s about respect for our profession and the sustainability of our healthcare system.” After 22 years as a pediatrician, her frustration was palpable.
At issue is Health Minister Christian Dubé’s proposed overhaul of physician compensation, which would fundamentally change how Quebec’s 23,000 doctors are paid. The government aims to increase the percentage of doctors on hourly wages rather than fee-for-service payments, which currently dominate physician compensation models.
The Quebec Federation of Medical Specialists (FMSQ) and the Quebec Federation of General Practitioners (FMOQ) have both voiced strong opposition. Dr. Vincent Oliva, president of the FMSQ, stated the government is trying to “unilaterally impose changes” without proper consultation.
Walking through the corridors of Sainte-Justine Hospital yesterday, I noticed the tension. Doctors huddled in small groups during breaks, their conversations hushed but animated. One specialist, who requested anonymity, shared that many physicians feel “ambushed” by the government’s approach.
“We’re already stretched thin,” she explained. “Now we’re being painted as obstacles to reform, when we’re actually suggesting more effective solutions.”
The dispute intensified after Premier François Legault commented that doctors “need to work more hours,” a remark many physicians found deeply offensive given their already demanding schedules. According to Montreal Health Survey data, specialists work an average of 50-60 hours weekly, with many on-call responsibilities extending beyond those hours.
Dr. Marc Lebel, who practices family medicine in Montreal’s east end, expressed concern about potential impacts on patient care. “If they push through these changes without addressing our concerns, we’ll see more doctors reducing hours or leaving Quebec entirely,” he warned.
The Institute for Socioeconomic Research at Université de Montréal recently published findings showing Quebec already faces challenges retaining physicians, with approximately 75 specialists leaving annually for other provinces offering better working conditions.
For patients like Monique Tremblay, whom I met in a crowded waiting room in Verdun, these disagreements translate to practical worries. “I’ve waited eight months to see this specialist,” she sighed. “If doctors start leaving, what happens to people like me?”
Yesterday afternoon, I attended a press conference where Minister Dubé defended the reforms, insisting they would improve access to care. “Our goal is ensuring Quebecers can see doctors when needed,” he stated, “and our current system isn’t delivering that.”
Yet the doctors I’ve spoken with unanimously agree the issue is more complex. Dr. Jean Godin, who splits his time between clinical practice and teaching, believes the government is misdiagnosing the problem. “The bottlenecks aren’t caused by how we’re paid,” he explained, “but by systemic inefficiencies that waste our time and prevent us from seeing more patients.”
These perspectives reveal a fundamental disconnect. The government sees payment reform as a lever to increase physician availability, while doctors view it as a distraction from more substantive issues like administrative burden and resource allocation.
Watching this dispute unfold reminds me of similar tensions I covered in 2018, which nearly resulted in specialist job actions. What feels different this time is the increasingly public nature of the disagreement and the hardened positions on both sides.
Montreal’s unique healthcare landscape makes this dispute particularly consequential for our city. With major teaching hospitals serving both local communities and patients referred from across Quebec, any disruption could have cascading effects.
As I left my interview with Dr. Fontaine, she shared a final thought that’s stayed with me: “Most of us chose medicine because we believe in Quebec’s public healthcare system. We want it to work better, not just differently.”
The coming weeks will determine whether compromise is possible or if this standoff will escalate further, potentially affecting healthcare delivery across Montreal and beyond. For now, both sides seem entrenched, with patients caught in the middle of a dispute that transcends compensation to touch on fundamental questions about how healthcare should be delivered and valued in Quebec society.
