Quebec’s Bill 83 Risks Worsening the Healthcare Crisis

To: Healthcare observers
From: Tingting Zhang
Date: February 21, 2025
Re: Quebec’s Bill 83 Risks Worsening the Healthcare Crisis

In response to the growing exodus of doctors from Quebec’s public healthcare system, the government has introduced Bill 83, which requires new physicians to work in public institutions for their first five years or face daily fines ranging from $20,000 to $200,000. While this aims to address the crisis, it risks exacerbating the very problems it seeks to solve.

Quebec’s healthcare challenges are multifaceted. The 2005 Chaoulli v. Quebec ruling and subsequent legal changes on double billing have contributed to an increase in physicians opting out of the public system. The pandemic further exacerbated this trend, with a 70 percent surge in doctors working exclusively in the private sector since 2020. By last July, 780 of them had withdrawn from the public insurance system; two-thirds were general practitioners.

Several factors are at play. Burdensome bureaucracy, restrictive working conditions and excessive administrative workloads make public practice less appealing. Policies like the local staffing plans (PREM) and mandatory shifts in short-staffed hospitals and other public facilities (AMP) unintentionally limit family physicians’ availability to provide comprehensive care.

The stakes are high. Quebec faces Canada’s worst primary care access, with more than 21 percent of people without a regular healthcare provider. Nearly three-quarters struggle to access same or next-day care as well as after-hours care. Those without family doctors often pay out-of-pocket fees, creating a two-tier system that particularly burdens low-income populations.

The province’s aging physician workforce compounds the crisis. With an average age of 51, more family doctors are retiring each year than entering the field. Quebec needs an estimated 2,658 family doctors to meet current demands, but recruitment is falling short. Since 2020, the number of unfilled residency spots in family medicine has doubled in Quebec, and last year, the province accounted for more than 90 percent of Canada’s vacant positions. Notably, all these unfilled residency spots are in French-speaking regions, highlighting the critical role of language. Quebec’s licensing and accreditation process further hinders physician mobility from other provinces and abroad.

While Bill 83’s punitive measures may temporarily retain some physicians, they risk making medical education and residency training in Quebec less attractive. In 2023, 1,425 medical graduates from Quebec migrated to other provinces, such as Ontario and New Brunswick, while only 273 medical graduates from other provinces chose to practice in Quebec. More than a third of graduates from McGill University – the only English-speaking medical school in Quebec – left to practice in Ontario, further straining a fragile primary care system. Forcing physicians to stay through legislative mandates is more likely to drive medical students to seek opportunities elsewhere.

Furthermore, there is limited evidence to support the effectiveness of regulatory mechanisms in retaining physicians within the public sector. For example, the UK considered a similar ban on private practice but instead opted for pay adjustments and improved working conditions, including a 20-percent increase in starting salaries.

Evidence suggests that financial incentives and professional development opportunities are key factors influencing physicians’ choice of workplace. However, Quebec continues to operate under an outdated fee-for-service compensation model for family physicians, which still accounts for 73 percent of physician payments. This model discourages the delegation of tasks to other healthcare professionals, further exacerbates inefficiencies, and hinders the development of collaborative care models.

Adopting alternative payment models, similar to those implemented in British Columbia, could better support family medicine, attract medical students, and encourage patient-centred care. Since February 2023, BC’s new model has successfully attracted more than 800 longitudinal family doctors practicing in the province.

Reducing administrative burdens is another crucial reform. Quebec’s family doctors currently spend 25 percent of their working hours on paperwork – time that could be better spent on patient care. Nova Scotia’s success in reducing administrative tasks and Australia’s use of electronic claims processing systems offer valuable lessons for Quebec and other provinces to streamline processes and improve efficiency.

Quebec could also increase its intake of internationally trained doctors, who make up just 7.7 percent of the province’s physician workforce – the lowest proportion in Canada. Streamlining credential recognition and expediting licensing for international medical graduates, particularly through existing agreements with countries like France, could expand the province’s physician pool.

Given its unique context, Quebec could also explore integrating private-sector support through well-designed regulations that encourage positive outcomes from dual practice. An efficient private sector could complement the public system, providing immediate relief as broader reforms take effect. Expanded patient choice and competition from healthcare providers outside medicare could also incentivize policymakers and administrators to manage the public system more efficiently.

Ultimately, punitive measures will not solve Quebec’s healthcare challenges. Medical students may choose to study elsewhere, avoiding a system that feels restrictive and unwelcoming. The most talented professionals will seek opportunities in provinces – and potentially countries – that offer more supportive and rewarding working environments. Those who remain in Quebec will also be more inclined to opt out of the public system after facing five years of restrictions.

Tinging Zhang is a junior policy analyst at the C.D. Howe Institute.

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The views expressed here are those of the author. The C.D. Howe Institute does not take corporate positions on policy matters.