Negotiations between the Quebec government and the province’s family doctors are showing tentative progress as both sides seek to resolve a dispute over sweeping changes to physician compensation. The talks, led by representatives from the Treasury Board and the Fédération des médecins omnipraticiens du Québec (FMOQ), center on the controversial Law 2, which proposes a significant shift away from conventional fee-for-service payments. With physicians voicing concerns over potential income reductions and the feasibility of new performance targets, the outcome of these discussions will be critical for the future of healthcare access across quebec.
Negotiations between the Quebec government and family doctors are showing cautious optimism, as both sides explore potential compromises to address ongoing labor disputes.
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Discussions are underway to determine what concessions Quebec is prepared to make, and what terms would ultimately be acceptable to the Fédération des médecins omnipraticiens du Québec (FMOQ), the province’s association of family physicians. These talks, which began Thursday and continued through the weekend, are focused on finding solutions rather than formal negotiations at this stage, but sources indicate a positive, albeit cautious, outlook.
The meetings involve representatives from the team led by France-Élaine Duranceau, the Minister responsible for the Treasury Board, and Dr. Marc-André Amyot, President of the FMOQ. The dispute centers on a significant overhaul of physician compensation, a move that has prompted resistance from the FMOQ.
Currently, the FMOQ is demanding the withdrawal of Law 2 as a prerequisite for resuming negotiations. Key concerns regarding the law include the 10-15% of remuneration tied to performance targets, the feasibility of achieving those targets, and the oversight mechanisms for physicians.
Quebec, however, insists that any negotiations take place within the framework of Law 2. This impasse highlights the core challenge in reaching an agreement: finding common ground on the structure of the new compensation model.
Both the FMOQ and the government agree on the need to reform the fee-for-service model, shifting towards a greater emphasis on capitation – payment based on the number of patients a physician manages.
However, disagreement remains on the specifics, particularly the criteria for determining patient complexity, a fundamental element in capitation-based remuneration. Other sticking points include the speed of implementation and whether the changes will apply to senior physicians.
The proposed changes represent a significant shift, reducing the proportion of fee-for-service payments for family physicians from 70% currently to just 25%. Law 2 would reduce the number of tariff codes from 275 to 9.
The remaining compensation would come from patient management (42%), hours worked (20%), and a collective supplement (13%). This restructuring aims to incentivize preventative care and long-term patient relationships, but physicians have expressed concerns about potential income reductions.
According to sources familiar with the discussions, both sides are seeking to identify areas of compromise, recognizing that the status quo is not a viable option.
Will the FMOQ agree to work within the framework of Law 2 if Quebec offers concessions on implementation timelines, target levels, or the 10-15% “penalty” supplement? And will Quebec be willing to relinquish some of its oversight authority, particularly its power to unilaterally set targets without union agreement?
Could a phased implementation of Law 2, guided by agreements between the two sides, be a workable solution? The financial implications of the new system, including remuneration levels, also remain a key point of contention.
“If there’s good news, it’s that the communication channel is open. I’m much more optimistic with the arrival of Ms. Duranceau than I was three weeks ago,” said a spokesperson for the FMOQ, Stéphane Gosselin.
Catherine Barbeau, Director of Communications for Christian Dubé, confirms the resumption of discussions but declined to comment further, citing the sensitive nature of the situation. The outcome of these negotiations will have significant implications for healthcare access and delivery in Quebec.
A phased implementation of Law 2, developed collaboratively, could address potential shortcomings inherent in such a broad reform. Several physicians have voiced these concerns in recent days, following a previous report on the matter. Read “Certain doctors could lose $145,000”
One physician from the Outaouais region raised concerns about the government’s proposed system of using color-coded “pastilles” to determine patient complexity, citing data limitations. “In recent years, the entry of a diagnosis during billing was not mandatory, and therefore this database is very incomplete. Very often, the diagnosis is not there,” the physician stated.
These past few years, the entry of a diagnosis during billing wasn’t mandatory, and therefore this database is very incomplete. Very often, the diagnosis isn’t there.
Testimony from a physician in the Outaouais region
Physicians in the Outaouais and Montérégie regions also expressed concerns that the Ministry is misreporting the number of physicians per clinic, potentially affecting calculations for the collective supplement. “The Ministry considers that there are 62 doctors at our GMF. There are a lot of ghost doctors, because we are currently 35… There’s no way to correct the numbers,” one physician noted.
Several physicians who treat pregnant women and children fear the impact of Law 2 on their remuneration. “One of the problems is the color-coded pastilles for patient complexity. Children are green, even though they sometimes consult 5-10 times a year. Pregnancies have a green code, even though we see them more than 10 times during the pregnancy,” wrote Mathilde Bourdua, a physician responsible for the Sainte-Julie clinic, a suburb of Montreal.
Like many others, she shared the distress felt by physicians, who believe their compensation will significantly decrease. “The doctors at my clinic all consider themselves losers. To the point that 6 of them have submitted their resignations to me. And I fear that 2 more will be added in the short term. Not to mention the resident who was supposed to start in December and has withdrawn to go to Ontario,” she added.
Some physicians have questioned the representativeness of the six case studies used by the Minister of Health to illustrate the effects of Law 2, which showed both winners and losers. Consult the webinars from the Ministry of Health
These examples – the only ones available – focused on physicians with 1700, 2200, or even 3450 patients, representing a very large volume. A single full-time example involved 1000 patients. The average for family physicians working in clinics or GMFs is estimated to be around 1300 patients, according to sources.
However, many younger physicians are choosing to manage fewer than 1000 patients, according to some emails, in order to balance work and family life.
Furthermore, some physicians’ statements indicate a lack of information. Some continue to believe that the overall compensation envelope will decrease over five years under Law 2, falling from $3 billion to $2.3 billion for family physicians. In reality, the envelope will slightly increase to $3.4 billion, including cabinet fees and the 15% supplement, as the Ministry explained in a webinar.
Other family physicians have made projections of their income omitting key elements, such as the guaranteed 5% supplement applied to their entire remuneration (or 15% if all targets are met). Despite this omission, a significant decrease in their remuneration remains under Law 2, according to their calculations.
In short, there is considerable tension and misunderstanding within the medical community.
Regardless, neither the government nor the physicians can afford to remain entrenched in their positions. It is hoped that both sides will compromise and transform the discussions into genuine negotiations to reach an agreement before the holidays.
2. It should be noted that one of the physicians had planned to retire before Law 2. Nevertheless, of the 19 physicians, the clinic will lose 5 due to Law 2, she said. More than 5000 patients could become orphaned.
