Quebec’s health reforms are controversial—and exactly the shake-up Canadian health-care needs

As governments look for ways to improve health-care access, doctors’ prominent role in the system makes them an obvious focal point for reforms to the way they work—possibly working more off-hours or seeing more patients with complex medical conditions that take more time. No province outside of Alberta has taken up the task as vigorously as Quebec. Last month, its National Assembly passed Bill 2, legislation that makes radical changes to the way doctors are paid, where they can practice, and how they manage their patient loads. It gives the government the ability to regulate targets for the number of patients each doctor manages and bases a part of doctors’ pay on performance measures. It also upends the fee-for-service model, allowing the government to pay doctors a fixed amount per patient depending on their health and vulnerability. Moreover, it gives the government the power to impose severe penalties on groups of doctors taking concerted action to protest the changes—a significant measure given doctors’ widespread and vehement opposition to the legislation. While it is anticipated that the legislation and changes in how the province manages its doctors’ practices and method of pay will be in court very soon, the magnitude of the legislated reform cannot be understated in Canada, where physicians have been paid the same way for decades. In sharp contrast, British Columbia has opted for a carrot-like approach. Responding to recent job actions by obstetrician/gynecologists, a region of B.C. is advertising for temporary obstetrician/gynecologists with super-sized payments. The rate is currently advertised at $7,117 per 24-hour period—a significant sum of public money, given that in 2025 the median annual salary for obstetrician/gynecologists was $441,788 in B.C. The advertisement also offers extra money for working after-hours and paid accommodation. While B.C.’s approach is bound to attract applicants—possibly even unhappy Quebec obstetricians/gynecologists—it does little to change physician practices. Instead of addressing any of the underlying problems in health-care delivery, like access, cost, quality, and equity, the only certain outcome is that B.C. residents will pay more for the same services. The Quebec government and doctors’ unions are at loggerheads over the legislation, and it is hard to predict whether the changes will stick. Other provinces will find themselves in the same boat of having to take drastic action to spur doctors to work differently. While it is too early to know whether Quebec’s heavy-handed approach will improve patient access and outcomes—or fix issues around costliness, quality, and equity—it is clear that provinces need to go beyond half measures to deliver the reforms their health-care systems need. It is time for governments to think big and be bold about making sweeping health-care reforms. Canadians have waited long enough.