A prominent Quebec psychiatrist is sounding the alarm, warning that the province's proposed Bill 2 threatens to fundamentally distort the ethical foundations of medical practice by imposing rigid performance targets on physicians.
The Core Conflict: Conscience vs. Quotas
In a detailed critique, Dr. Julian Xue, a McGill faculty psychiatrist, argues that the legislation misunderstands what already motivates healthcare professionals. He points out that doctors in Quebec are already paid on a fee-for-service basis, a system akin to "a commissions-only sales job with no base salary." In such a model, the primary restraint against rushing patients or cutting corners is not financial penalty, but the practitioner's own conscience and ethical training.
"When doctors explain a diagnosis, listen to a frightened family, or take time to understand a complex story, they are paid less for it," Xue writes. "The system already rewards most those who hear their conscience least." Adding a further 10 to 15 percent income penalty for missing government-set performance metrics, he contends, will only intensify this perverse incentive, eroding the patient-doctor relationship.
Fueling Burnout and Moral Injury
Dr. Xue links the pressure of such quotas directly to the epidemic of burnout among healthcare workers, specifically through the lens of "moral injury." This occurs when professionals are forced to act against their core ethical values. The tradition of medicine, he notes, demands a physician's full attention, empathy, and skill for the person in front of them.
"When we cannot — when the back of our mind is filled with 'I’m falling behind on my quota' or 'listening isn’t what I’m paid to do' — we degrade," he states. "Irritation replaces empathy. Cynicism replaces care." He asserts that the government's responsibility is to build a system that leverages, rather than undermines, the moral backbone of its medical professionals.
Broader System Dysfunction and Contradictions
The psychiatrist places Bill 2 within a broader context of systemic issues. He notes that Quebec already micromanages its health professionals and suggests a link between this approach and the network's well-documented dysfunction. Despite having more doctors per capita than most provinces, Quebec's system serves its population worse—a failure Xue attributes to political management, not clinicians.
He also highlights other concerning clauses in the bill that seem counterproductive to improving access, such as slashing telemedicine rates by half or more, which would disproportionately affect rural communities.
Dr. Xue reveals that many physicians have already absorbed significant billing cuts exceeding 30 percent in the past year, making the proposed performance penalties an additional financial and ethical burden. His conclusion is stark: A generation of Quebec doctors is being asked to override their conscience to meet government targets. He warns patients that if their physician seems impatient or indifferent in a moment of need, Bill 2 may be a primary reason.
Dr. Julian Xue is a McGill faculty psychiatrist and co-owner of the Libera teaching clinic. His opinion was published on December 2, 2025.
