The Quebec government has triggered a major confrontation with the medical community by passing sweeping health legislation that fundamentally reshapes physician autonomy, compensation, and accountability. Enacted on November 22, 2025, the law represents the most significant changes to medical practice in the province since the inception of medicare.
A Fundamental Shift in Power
The legislation, officially titled "An act mainly to establish collective responsibility with respect to improvement of access to medical services and to ensure continuity of provision of those services," spans 120 pages of detailed reforms. Critics, including health policy analyst Steven Lewis, describe it as a "seizure of power" that replaces negotiated agreements with government imposition.
Under the new framework, the government now holds unilateral authority to determine physician compensation, effectively ending traditional fee-for-service models in primary care. The new payment structure combines a per-patient flat fee, an hourly wage, and additional payments for specific services.
Patient Assignment and Performance Targets
The law dramatically alters how patients access care. Regional health authorities can now assign unattached patients to primary care practices deemed to be underperforming in their patient load. The government aims to find medical homes for approximately 1.5 million Quebec residents currently without a family doctor within roughly one year.
Financial incentives are directly tied to performance metrics. Up to 10% of physician pay is contingent on meeting targets such as maximum surgical wait times and availability of family doctor appointments. Specialists face particularly stringent requirements, needing to collectively complete close to 100% of scheduled surgeries within a year.
Fierce Backlash and Legal Consequences
The medical community has responded with unprecedented outrage. More than 12,000 people attended a rally in Quebec City to protest the legislation. The Canadian College of Family Physicians has expressed being "appalled" by the government's actions and what it describes as "unremitting attacks on Quebec physicians."
The law includes strict penalties for physician resistance. Doctors risk substantial fines if they refuse to teach students, engage in work-to-rule actions, or threaten to leave the province in protest. Despite the backlash, the legislation leaves little ambiguity about its intent to centralize control over healthcare delivery in government hands.
