A subset of Canada just did something most democracies wouldn’t dare: they forced 23,000 doctors into a new contract that includes frozen pay, performance penalties, and the threat of up to $500,000/day fines.
You may have seen the word Québec in the headlines or on medical Reddit.
It’s a province in Canada, home to Montreal, that is facing a major healthcare crisis. The government is taking extreme measures, which some say violate the Canadian Charter of Rights and Freedoms.
In this post, I’ll dissect the Québec healthcare crisis, how this new bill will affect doctors, and what it means for current and future med students.
Is the province out of line and violating doctors’ rights, or is the government revolutionizing its healthcare system before it’s too late?
The State of Healthcare in Québec
So, first off, why did the government decide to crack down?
Québec has one of the highest percentages of provincial residents without family doctors—more than one in five—despite having the largest medical school class size per capita of any province.
The province is estimated to be short by 1,200 to 2,000 family medicine doctors.
And it’s not because there isn’t enough training availability in Québec.
70 family medicine residency spots went unfilled in 2024, compared with only five across the rest of the country. In 2025, 69 family medicine spots went unfilled in Québec and 25 in the rest of Canada. That’s a shocking unfilled rate of over 12% compared to less than 2% unfilled for the rest of the country.
| Year | Québec Unfilled | Rest of Canada Unfilled | Total Canada Unfilled | Québec’s Unfill Rate | Rest of Canada Unfill Rate |
|---|---|---|---|---|---|
| 2025 | 69 | 25 | 94 | 12.5% | 1.8% |
| 2024 | 70 | 5 | 75 | ~12.3% | ~0.4% |
| 2023 | 73 | 27 | 100 | ~13.2% | ~2.4% |
| 2022 | 73 | 26 | 99 | ~13.2% | ~2.3% |
| 2021 | 75 | 14 | 89 | ~14.0% | ~1.3% |
A contributing factor is that Québec medical schools are limited to offering residency placements to French-speaking med students. Québec is the only primarily French-speaking province in Canada.
While Canada is considered bilingual, French is the predominant language in Québec. Any provincial administration, public services, commercial signs, and business operations are in French.
This severely limits the province’s ability to attract future doctors from across the country or even other countries.
These shortages contribute to the 60% burnout rate of Québec physicians.
But despite all of this, Québec has 16% more family physicians per 100,000 people than the rest of Canada. So why are doctors so burned out, and why are people not able to find a family doctor?
Since 1993, Québec has required all family doctors with less than 15 years’ practice to dedicate part of their practice to mandatory special medical activities, such as 24-hour shifts, emergency department work, and elder care. This is generally a minimum of 12 hours a week, and if they don’t comply, they face a 30% cut to all their billings.
This results in Québec family doctors seeing an average of only 685 patients each, compared to 950 in the rest of Canada. Many simply avoid opening family practices altogether, choosing to work only in hospitals or walk-in clinics instead.
But that’s far from the only problem.
780 Québec physicians opted out of Medicare to open private practices last year, compared to fewer than 15 in the rest of the country. Doctors continually leave the public system for better working conditions and a massive income boost in private clinics.
Other provinces have restrictions preventing this from occurring. For example, Ontario added legislation in 2003 banning doctors from charging for services already publicly insured. The health minister at the time said, “It will make two-tier, pay-your-way-to-the-front-of-the-line health care illegal.”
Of course, there’s a huge debate in the US, and around the world, about whether public or private healthcare is better. This isn’t the time for that debate, but what’s clear is that people without the funds for private care are unable to access primary care in Québec. The public sector is in shambles because too many doctors have left for private care. It’s a vicious cycle. The worse the public sector gets, the more doctors want to go private.
The Québec government unveiled a drastic plan to rapidly transform its healthcare system.
The New Legislation
There are two main ways to incentivize people: either with a stick or a carrot. It’s clear the Québec government is going the stick route, only in this case, the stick is dynamite.
After four failed negotiation attempts, the Québec government adopted Bill 2 in a special session on October 25th, just before 4 am.
This is what the bill included, which is in effect until March 31st, 2028.
1 | Performance-based pay was introduced
15% of doctors’ annual salaries are now tied to performance indicators, such as the number of patients seen and the complexity of cases, with collective bonuses for hitting targets. The bill aims to create 16.5 million appointment slots per year and ensure that 98% of surgeries are performed within 1 year of the request.
2 | Doctor salaries are now frozen
In addition to potential financial performance penalties, the bill locks in current compensation for at least 2.5 years. Even when inflation eats into their earnings, Québec doctors are locked in until 2028.
3 | Pressure was added to stay in the public system
All new doctors must practice in the public system for the first 5 years of their career after residency, and they can be fined up to $200,000 per day if they practice outside the public system before the mandatory 5 years are up. Not $200,000 per year, but $200,000 per day, you heard that right.
4 | Permission is now required to leave the Québec public system
Santé Québec, the new provincial health corporation, must approve the request based on criteria like the availability of doctors in that region and whether the doctor’s departure would have negative consequences for patients in that area. Essentially, they could be blocked from changing practice types even after the mandatory 5 years.
5 | Large penalties will be enforced for noncompliance or simply speaking up about the bill
Groups that take “concerted action” to challenge the government face fines of up to $500,000 per day, and individuals face fines of $20,000 per day.
Currently, noncompliance is vague, with the government’s examples of “concerted action” including three doctors leaving the same hospital at the same time or inciting a professional to leave the province to work elsewhere. Basically, your every move will be watched, with the risk of huge fines if you don’t comply or speak out against the new bill.
Why Doctors Are Furious
Doctors are unhappy about these changes, which they had no say in, with many saying they don’t have the resources to meet the targets proposed in the bill.
Doctors claim:
1 | The bill puts more administrative burdens on doctors, burdens that are already leading to physician shortages
Family doctors spend an average of 19.1 hours per week on admin tasks like filling out forms. These rigid targets only create more paperwork.
2 | The bill creates a “Fast-Food Medicine” problem
Performance-based pay creates trade-offs between quality and quantity. Doctors are incentivized to rush through appointments to hit volume targets, rather than prioritizing quality care.
3 | The bill could trigger a mass exodus from public medicine
22% of Québec doctors are over age 60, and this bill will likely demoralize them into early retirement. Additionally, more doctors may choose to leave Québec to work in other provinces.
4 | Already, Québec faces this problem
In 2023, 1,425 medical graduates from Québec migrated to other provinces, such as Ontario and New Brunswick, while only 273 grads from other provinces chose to practice in Québec.
But now doctors will need to be careful not to provoke a “concerted action” accusation, which could trigger an investigation that results in heavy daily fines. Banning doctors from leaving the province entirely would be illegal, but Québec is doing everything it can to scare doctors into staying. Another way this could backfire is if some doctors switch careers and leave medicine entirely.
5 | The bill also introduces “Big Brother” surveillance
The government can investigate suspected “concerted actions.” The surveillance includes centralized data monitoring and a mechanism for aggressive, warrantless investigations into medical offices and records when collective action is suspected.
6 | The bill is authoritarian
Doctors and many in the public argue that the rules, surveillance system, and fines are an attack on fundamental rights, like freedom of association and the right to protest. Merely moving out of the province may trigger investigations. And remember, up to $20,000 if you speak negatively about why you want to move.
Imagine facing $20,000 a day fines just for complaining about your job. And on top of that, if you ever do want to leave for another city, province, or country, it could spark an investigation into your intentions. In America, we’d say this is unconstitutional. In Canada, it violates the Charter of Rights and Freedoms.
This is all leading to what may become a long and drawn-out court battle, as family medicine federations have already begun legal proceedings to challenge the bill.
But the Québec Premier Legault has threatened to invoke the notwithstanding clause to shield the bill from constitutional challenges—basically saying ‘we know this might violate the Charter, but we’re doing it anyway.’
Superior Court proceedings, appeals, and possibly the Supreme Court could take months. In the meantime, the bill remains in effect through March 2028, as doctors and med students make tough career decisions.
Is There a Better Way?
Did the government have any other options?
Just next door in Nova Scotia, the government chose the carrot rather than the stick. They worked with doctors to create a new compensation system in the province. In 2023, they negotiated a payment model based on hours worked, panel size, and services delivered, resulting in a 20% increase in compensation for family doctors. They added retirement benefits and financial incentives, rather than reduced pay, fines, and control.
Since April 2024, the small province has recruited 205 new physicians—a 90% increase in family medicine compared to the previous year. The waiting list dropped from over 160,000 to less than 116,500 in months. Nova Scotia doctors chose to participate because the terms addressed their concerns, incentivizing current doctors to stay and new doctors to join.
While right now it’s the doctors in Québec who are outraged, if this plan fails to produce the intended results, the real victims will be the patients.
