Quebec Health Minister tables amendments to keep doctors in public sector

Quebec Health Minister Christian Dubé wants to strengthen Bill 83, which aims to curb the exodus of doctors to the private sector.

On Tuesday, Dubé tabled a raft of amendments that would make it more complicated for doctors temporarily leaving the public system to go into private practice.

The amendments propose that all doctors should obtain authorization from Santé Québec to disaffiliate from the public system.

Right now, all they have to do is inform the Régie de l’assurance maladie du Québec (RAMQ) within certain time limits.

Santé Québec would have the task of assessing the relevance of requests from doctors wishing to work in the private network, said Dubé.

“There are about 150 doctors, particularly specialists, who go back and forth,” the minister said Tuesday, the first day of detailed study of Bill 83.

“You’re going to tell me that 150 doctors isn’t a lot, but 150 doctors who don’t perform surgery on the public for 60 days can make a huge difference to our waiting list,” he added.

He wants Santé Québec to assess the relevance of each request according to the following criteria:

• there must be a sufficient number of doctors practising in public establishments in the doctor’s region;
• his or her departure must not have a negative impact on patients in the region;
• there must be evidence that the public network is unable to provide this doctor with the facilities in his or her region.

“Quebecers invest massively in the healthcare system, spending over $60 billion a year. I think they are entitled to have access to a doctor,” said Dubé.

In its initial form, Bill 83 would have required all new doctors to start practicing and remain a participating doctor in Quebec’s public network for at least five years before being allowed to practice in the private sector.

Failure to do so would result in a fine of up to $100,000 per day per act. During public consultations in February, associations of young doctors considered the idea to be “discriminatory.”

On Tuesday, Dubé said he wanted to cast a wider net with his bill out of a concern for “fairness” towards young doctors.

According to the figures he presented, of the 22,011 doctors in Quebec, more than 820 are currently working in the private network, representing an increase of more than 80 per cent compared with the same date in 2020.

In the last three months, nearly 60 more doctors have disaffiliated from the public network, in addition to the 150 doctors, including 145 specialists, who have alternated between the private and public networks in the last year.

Liberal health critic André Fortin accused the government of implementing “half-measures.”

“We are quite convinced that this is not the horse’s medicine we need,” he said.

The same reaction was voiced by Québec Solidaire (QS), which said the government lacks “political courage.”

“If we really wanted to put an end to the exodus of doctors to the private sector, there are two ways to do it: ban outright the move to the private sector, (...) or (...) cap the fees charged by the private sector,” said QS MNA Vincent Marissal.

“The very socialist Alberta is doing that. No less socialist Ontario is doing that. The comparison is not to our advantage here,” he added with a touch of irony.

Marissal also questioned whether Santé Québec would really want to prevent doctors from going into private practice, given that the agency has to clear waiting lists.

“I’m stuck with the obligation to ensure that there is public coverage, (...) and on top of that, I’m going to have to move doctors to the private sector because my waiting lists exceed the deadlines and I have to deliver results,” he said.

“I put myself in their shoes, it’s like squaring a circle.”

“The minister’s stated aim is to increase the private sector’s role in our network. The government can try to disguise itself as a lamb, but the wolf has definitely entered the henhouse,” reacted CSN President Caroline Senneville in a news release.

“Are the solutions proposed in the bill the right ones? We don’t think so,” said PQ MNA Pascal Paradis.

This report by The Canadian Press was first published in French April 1, 2025.