McGill Journal of Law and Health

Munazzah Jaffer & Hoang Xuan Kathy Vo

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Introduction

In May 2025, Quebec’s Minister of Health, Christian Dubé, introduced Bill 106, An Act mainly to establish the collective responsibility and the accountability of physicians with respect to improvement of access to medical services.^[1] As Dubé describes, Bill 106 intends to improve access to medical services by ensuring all insured persons receive primary care treatment and by encouraging physicians to meet target objectives.^[2] Although Bill 106 may seem prima facie beneficial to Quebecers, it would impose significant burdens on physicians and patients. In this discussion, Section I outlines the main objectives and legislative proposals of Bill 106. Section II highlights responses and actions opposing the Bill. Section III discusses Bill 106’s possible consequences on patients and practitioners.

Section I: Bill 106 – What Is It?

Bill 106 introduces several legislative amendments, most notably the enactment of a new remuneration scheme for practitioners. Firstly, Bill 106 seeks to place the onus to alleviate inaccessibility to healthcare services on the territorial departments of family medicine and their respective doctors.^[3] Departments would have to ensure “the affiliation with a practice environment of all the eligible persons of its territory”,^[4] and family doctors in such practice environments would share “collective responsibility for taking in charge of the persons affiliated with that environment”.^[5] Secondly, the Bill would grant the Health Minister powers to establish and manage remuneration methods of health professionals.^[6] Part of these powers would allow the Health Minister to dictate the terms and obligations of health professionals treating an insured person.^[7] Thirdly, Bill 106 would transform the remuneration mechanism for physicians.^[8] General physicians’ salaries would shift from the primarily fee-for-service framework to a blended composition of “capitation remuneration, hourly rate remuneration, and additional remuneration for certain acts”.^[9] Most controversially, Bill 106 proposes to add a ‘collective supplement’ to all physicians’ remuneration, where general and specialist providers’ salaries will depend on whether they meet government-established local, territorial, and/or national performance targets.^[10] Although Minister Dubé’s proposals were met with raucous applause from members of his own party during their introduction in Quebec’s National Assembly, Quebec doctors and medical associations have voiced concerns and disapproval of Bill 106.

Section II: Opposing Bill 106 – Strikes & Protest

Since its introduction, medical associations and doctors have opposed Bill 106. On September 15^th, 2025, the Fédération des médecins spécialistes du Québec (FMSQ) initiated a strike; specialists have halted all teaching duties towards undergraduate medical students to pressure the government. On September 23^rd, 2025, general practitioners represented by the Fédération des médecins omnipraticiens du Québec (FMOQ) voted to join the strike on October 1^st. Consequently, thousands of Quebec medical students and future physicians are currently missing crucial training opportunities for an indefinite amount of time. The Vice-President of the Fédération Médicale Étudiante du Québec, Félicia Harvey, has publicly commented on the distress that this decision has caused for medical students. Notably, she explained that final-year students expecting to apply for residency programs are now deprived of essential experiencesto hone their clinical skills and build their residency application. As of September 12^th, 2025, all four Quebec medical faculties are developing contingency plans to accommodate students during the strike and are collaborating with the Canadian Residency Match Service to inform program directors of the ongoing disruption in the province. However, the longer the strike continues, the greater the risk that medical students will be unable to graduate in time to begin residency in July 2026. Consequently, medical students have also voiced their opposition to Bill 106, protesting in front of McGill University on September 23^rd, 2025.

Section III: Arguments Against Bill 106

Health experts argue that Bill 106 unfairly blames doctors for systemic issues in healthcare and that performance-based remuneration will harm both physicians and patients.

Systemic Failures – According to healthcare professionals, Bill 106 wrongfully blames physicians for the lack of access to medical services. The FMOQ, the FMSQ, and the Canadian Medical Association (CMA) argue that Bill 106 fails to address the underlying systemic issues resulting in the inaccessibility of healthcare, including the shortages of medical personnel (e.g., doctors, nurses, technicians, etc.), aging population, underfunding, and the scarcity of supportresources. These claims are not baseless.

For years, inaccessibility of medical services continues to be a prominent issue in Quebec’s healthcare system. In 2024, Québec’s Institut national d’excellence en santé et en services sociaux reported that 2.1 million persons were not registered with a primary care physician from 2022 to 2023. This statistic aligns with a 2023 report from a pan-Canadian organization, OurCare, which found that over 2 million Quebecers do not have an “assigned family doctor or nurse practitioner”. The Coalition Avenir Québec government has historically, and through Bill 106, attributed such inaccessibility of healthcare to physicians.^[11] In 2021, Premier François Legault accused family doctors of not working hard enough to take in patients under their charge, threatening to penalize these providers. However, blaming individual professionals overlooks the underlying systemic shortcomings responsible for the lack of access to care. The reality is that there are not enough primary care doctors in Quebec to address population needs, limiting access to care. The shortage of family physicians stems from various factors, such as unfilled residencies, unattractive working conditions (e.g., demanding workloads, practice restrictions (PREM), etc.), and migration from the public to private sector. Beyond physicians, Quebec also faces shortages of nurses and technicians (e.g., perfusionists, respiratory therapists, etc.) for similar reasons, particularly the province’s undesirable working conditions.^[12] Instead of improving working conditions to address shortages in healthcare, Health Minister Dubé seeks to place greater burden on physicians by imposing performance-based remuneration.

Performance-Based Remuneration – Health Minister Dubé’s proposal for a blended remuneration, including performance-based remuneration, has the potential to jeopardize the quality of patient care. This remuneration method initially tied up to 25% (now negotiated down to 15%) of a physician’s salary to government-imposed performance targets. Bill 106 outlines that such targets may be on a national, territorial or local scale.^[13] While these targets are vague, the Legault government has specified some of their expectations after receiving pressure and criticism from medical associations. One of the government’s expectations is for 99% of surgeries to be performed within one year of being on the waitlist. Alternatively, for oncological cases, surgery must take place within “56 days of the request”. However, operating room availabilities in Quebec are limited and dependent on the presence of other allied healthcare professionals such as the nursing staff. At the moment, the government’s performance targets concerning surgeries do not account for the need to increase the resources needed to complete those surgeries. Another example would be for physicians to offer more evening and weekend availability. However, offering more availability without complementing it with administrative and nursing staff is not achievable, and would lead to shorter appointments that are harder to obtain.

For family physicians, Bill 106 would implicate that they would receive a collective amount based on their “prise en charge” and the level of “patient vulnerability” (i.e., chronic health issues, socioeconomic status) in order to encourage current physicians to take on more patients in order to ensure that every Quebecer has a family physician before Summer 2026. This “volume-based approach”, as FMOQ describes it, would shorten appointments, worsen burnout and reduce retention of family physicians in the Quebec healthcare system.^[14]

Overall, FMSQ and FMOQ both aim to improve access to care, but this performance-based remuneration overestimates their ability to meet government-established targets without simultaneously obtaining funding for other aspects of the healthcare system.

Conclusion

Ultimately, Bill 106 highlights the longstanding issue of accessible healthcare services in Quebec. Although this bill aims to provide the Quebec population to receive timely care, medical associations, providers, and students oppose the government’s unachievable and punitive targets. Tension between government and healthcare providers has escalated, disrupting medical students’ education and training. Opposition stems from Bill 106’s failures to address underlying causes of healthcare inaccessibility and the CAQ government’s unrealistic performance targets. As systemic issues persist in plaguing Quebec’s healthcare, the population will continue to experience lack of access to care.

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^[1] See Bill 106, An Act mainly to establish the collective responsibility and the accountability of physicians with respect to improvement of access to medical services, 1 sess, 43rd leg, Quebec, 2025 [Bill 106]. 

^[2] See also ibid at 1–4 (“Explanatory Notes”).

^[3] See ibid at 1 (“Explanatory Notes”).

^[4] See ibid, ss 2–3 (Amending the Act respecting the governance of the health and social services system, CQLR c G-1.021).

^[5] See ibid at 1 (“Explanatory Notes”).

^[6] See ibid, ss 7–8 (Amending the Health Insurance Act, CQLR c A-29)

^[7] See ibid, s 8 (Amending the Health Insurance Act, CQLR c A-29 by granting the Minister powers over health professional’s renumeration.) 

^[8] See ibid at 1–2 (“Explanatory Notes”).

^[9] See ibid, s 17 (Proposing the enactment of the Regulation Respecting the Blended Renumeration Method Applicable to General Practitioners).

^[10] See ibid, s 22 (Amending the Act to promote access to family medicine and specialized medicine services, CQLR c A-2.2)

^[11] In Legault’s early 2018 campaign, he promised primary care access to the population. See Coalition Avenir Québec, “Santé : Un accès à un médecin ou à une super infirmière en moins de 36 heures” (2 September 2018), online: <coalitionavenirquebec.org/fr/blog/2018/09/02/sante-un-acces-a-un-medecin-ou-a-une-super-infirmiere-en-moins-de-36-heures/>.

However, he has since abandoned this promise, with Health Minister Dubé characterizing it as “not possible”. See Hugo Pilon-Larose, “La CAQ ne promet plus un médecin de famille à tous les Québécois” (3 September 2022), online: <lapresse.ca/elections-quebecoises/2022-09-02/sante/la-caq-ne-promet-plus-un-medecin-de-famille-a-tous-les-quebecois.php> (translated by author).

^[12] Although Quebec tried to address shortages through program recruiting foreign nurses, these workers experienced poor training and social conditions, see Maura Forrest, “Foreign Nurses Recruitment Program in Quebec Plagued by Major Flaws, Internal Report Reveals” CBC News(25 March 2025), online: <cbc.ca/news/canada/montreal/foreign-nurses-quebec-report-1.7492479>.

^[13] See Bill 106, supra note 1, s 22.

^[14] For discussions of burnout and patient care, see generally National Academies of Science, Engineering and Medicine, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, (Washington, DC: National Academies Press, 2019), ch 4 at 81ff, DOI: <10.17226/25521>; Alexander Hodkinson et al, “Associations of Physician Burnout with Career Engagement and Quality of Patient Care: Systematic Review and Meta-Analysis” (2022) 378 BMJ, DOI: <10.1136/bmj-2022-070442>.