The standoff between Quebec’s medical specialists and the province’s health ministry has intensified this week as both sides dig in over proposed changes to physician compensation. At issue is the Coalition Avenir Québec government’s plan to restructure how doctors are paid—a move officials claim will improve patient access but that physicians warn could undermine Quebec’s already fragile healthcare system.
“We’re facing a critical crossroads in how we compensate our medical professionals,” Health Minister Christian Dubé told reporters at the National Assembly on Wednesday. “The current model isn’t delivering the access Quebecers deserve, and we need a framework that better aligns physician incentives with patient needs.”
The government’s proposal would shift approximately 25% of specialist compensation toward performance-based metrics tied to patient volume and access targets, according to documents obtained through provincial health authority meetings. This represents the most significant overhaul to physician pay structure in nearly a decade.
For Dr. Vincent Oliva, president of the Fédération des médecins spécialistes du Québec (FMSQ), the government’s approach threatens to create more problems than it solves. “You cannot repair a healthcare system by imposing punitive measures on the very professionals holding it together,” he said during a press conference at FMSQ headquarters in Montreal.
The dispute comes amid Quebec’s ongoing struggles with emergency department overcrowding and surgical waitlists that have grown by nearly 30% since the pandemic, according to the province’s health ministry data. More than 150,000 Quebecers are currently waiting for surgeries, with some specialized procedures delayed up to 18 months.
At Lakeshore General Hospital in Montreal’s West Island, emergency physician Dr. Sanjeet Singh witnesses the practical implications daily. “I’m seeing patients who’ve waited hours for care asking why they can’t see specialists faster,” he shared in an interview. “What they don’t realize is many specialists are already working beyond capacity within the constraints of the current system.”
The timing of the government’s push has raised eyebrows among health policy experts. McGill University health economist Erin Strumpf points out that physician compensation agreements traditionally align with election cycles. “The CAQ government likely wants to resolve this issue well before the next provincial election,” she explained. “Healthcare access remains voters’ top concern, and the government needs concrete achievements to showcase.”
Premier François Legault has made healthcare reform central to his government’s mandate since taking office in 2018. His administration previously negotiated substantial pay increases for nurses and expanded the role of pharmacists and nurse practitioners—moves designed to address staffing shortages that continue to plague the province’s hospitals and clinics.
For many family physicians, the dispute highlights deeper structural issues. Dr. Marguerite Duplessis, who runs a family practice in Quebec City’s Limoilou neighbourhood, believes both sides are missing opportunities for meaningful reform. “We’re arguing over compensation models when we should be discussing how to create integrated care teams that make the best use of everyone’s expertise,” she said.
Patient advocates have expressed frustration at being caught in the middle. “Quebecers don’t care about the details of how doctors get paid—they care about getting care when they need it,” said Jean-Pierre Ménard, a lawyer specializing in patient rights. “This dispute risks further delaying necessary treatments while the government and doctors fight over dollars.”
The proposed changes would particularly impact high-volume specialties like radiology, ophthalmology, and general surgery. Under the current fee-for-service system, these specialists earn among the highest incomes in Quebec’s healthcare system, with some billing over $800,000 annually, according to provincial health insurance board reports.
Medical residents, meanwhile, worry about their future working conditions. “We’re training in a system that’s becoming increasingly bureaucratic and less focused on medicine,” said Sophie Tremblay, a third-year internal medicine resident at CHUM in Montreal. “Many of us are considering opportunities in other provinces where the practice environment seems more stable.”
Opposition parties have seized on the dispute as evidence of the CAQ government’s mismanagement. Liberal health critic André Fortin criticized the administration’s approach: “They’re creating unnecessary confrontation instead of collaborative solutions. Healthcare professionals deserve better than to be treated as budget line items.”
As tensions escalate, some community health organizations have proposed alternatives. The Regroupement des centres de santé communautaire du Québec suggests hybrid models that blend fee-for-service with salary components based on community needs. “Rural and underserved urban areas need different incentive structures than downtown Montreal,” notes their policy director, Marie-Claude Goulet.
What happens next will likely shape healthcare delivery across Quebec for years to come. The government has set an ambitious timeline, hoping to implement changes by early 2025. Medical federations have countered with demands for extended negotiations and guarantees against service disruptions during the transition.
For the average Quebecer, the complex dispute boils down to a simple question: Will this help me see a doctor sooner? The answer, like most things in healthcare reform, remains frustratingly uncertain.
