The stability of Quebec's primary healthcare network is hanging by a thread after crucial negotiations between the provincial government and the federation representing family doctors collapsed once again. The breakdown, which occurred on Thursday, December 4, 2025, centers on the controversial new physician remuneration model imposed by Bill 2. With the National Assembly set to adjourn on December 12, multiple clinics are now warning they will be forced to close their doors permanently if the law is not substantially altered or withdrawn before it takes effect on January 1.
A Wave of Impending Closures
This week, more family medicine groups (known as GMFs) announced they are shutting down, citing insufficient funding to operate under the proposed law. Others have issued a stark ultimatum, stating they will reach a point of no return on December 12, 2025. Dr. Michael Kalin, owner of Santé Kildare in Côte St. Luc, described the situation as a dire countdown. "The clock is ticking. There is literally a countdown and I think we have seven days left," he said. "This is not a threat... The government is playing Russian roulette with our primary-care network and come Dec. 12, clinics will close."
The crisis is not isolated. A group of over 20 doctors from more than a dozen clinics in west-end Montreal wrote a second letter to their local health authority, the CIUSSS du Centre-Ouest-de-l’île-de-Montréal, stating their practices are financially unviable under Bill 2. They collectively care for 310,430 patients in a territory of about 400,000. Their closure would deregister those patients and result in the loss of approximately 120 jobs for nurses, social workers, and other professionals.
The Financial Impossibility of Bill 2
At the heart of the dispute is the new funding formula. Bill 2 shifts doctor pay to a system based on capitation (patient caseloads), patient vulnerability, and collective performance indicators. Physicians argue this will drastically cut their income, which in turn funds clinic operations. Clinics typically depend on physician contributions for 60 to 75 per cent of their operating budgets.
A major point of contention is the classification of patients. Under the law, 57% of a clinic's rostered population could be designated as "green" or healthy, for which the clinic receives only $9.16 per patient annually. In contrast, a "red" or vulnerable adult designation brings $160 per year. This disparity is particularly devastating for pediatric clinics. Dr. David Rothstein of Clinique Médicale Step in Côte St-Luc, which cares for 21,000 patients, 95% of whom are children, explained that over 70% of their operating funds come from doctor contributions, which are projected to fall by more than 50%.
"What they’ve said is that a newborn baby that has to be seen at two weeks old, one month old, two months old... that isn’t vulnerable enough," Rothstein said, highlighting the burden of pediatric care the model fails to acknowledge.
Exodus of Doctors and a Chain Reaction
The uncertainty is already triggering an exodus. Dr. Ariane Murray, head of the Département territorial de médecine familiale de Montréal, reported that many doctors have "Plan B" ready, with applications for permits in Ontario and British Columbia. "It’s certain that if we reach Jan. 1 and there’s no agreement... people are going to put their plans in motion. They’re going to quit and they’re going to leave," she warned, describing the potential for a "chain reaction." At Dr. Rothstein's clinic, two doctors have already announced departures and three have applied to work in Ontario.
The ripple effects are province-wide. Le Journal de Montréal published a list of 40 clinics announcing closures or at risk, including the Centre Médical Pour Enfants LaSalle and Hudson Médicentre. Larger clinics like the Polyclinique Médicale Pierre-Le Gardeur in Terrebonne—with 25 doctors, 32,000 patients, and 100,000 appointments annually—have posted public pleas, stating they will have "no other choice but to close" if Bill 2 is applied unchanged.
Despite Health Minister Christian Dubé hinting at possible "adjustments" earlier in the week, the Fédération des médecins omnipraticiens du Québec told members the government "went back on its word." Treasury Board President France-Élaine Duranceau expressed disappointment, blaming the doctors for the impasse.
Adding to the government's challenges, medical directors of family medicine departments across Quebec have stated they will refuse to implement key parts of Bill 2, including assigning 1.5 million orphan patients to overwhelmed clinics. They join the growing chorus calling for the law to be suspended and significantly modified before Quebec's primary care system faces what Dr. Kalin described as a "meltdown of a nuclear reactor."
