Quebec's Family Doctor Pay Reform: How the New Blended Model Affects Patient Care
After months of contentious negotiations, Quebec has reached a landmark agreement with family physicians that fundamentally changes how doctors are compensated. The deal, heralded by outgoing Premier François Legault as the largest pay reform in over fifty years, shifts from a traditional fee-for-service model to a blended payment scheme centered around patient enrollment.
The Shift from Service-Based to Patient-Centered Compensation
Under the current system, Quebec's family physicians earn the majority of their income by billing the health system for specific services provided to patients. This approach, according to health experts, creates perverse incentives where doctors might ask patients to book multiple appointments for separate health concerns or prioritize services that generate higher fees.
The new model introduces a three-part compensation structure:
- 30% tied to traditional service fees
- 20% based on an hourly rate
- 50% allocated to "capitation" – per-patient fees doctors receive for each person enrolled in their practice
"With capitation, to make money, the doctor needs to see more people," explained Régis Blais, a professor at Université de Montréal's school of public health. This fundamental shift aims to address Quebec's chronic shortage of family doctors by incentivizing physicians to take on more patients.
Patient Impact: Access, Quality, and Potential Trade-offs
The agreement's primary goal is ambitious: connect 500,000 more Quebecers with a family doctor by the end of June 2026. The Federation of General Practitioners of Quebec (FMOQ) is currently working with the province to finalize the agreement's details, but the patient-focused approach represents a significant departure from previous compensation methods.
According to Erin Strumpf, a health economics professor at McGill University, capitation creates "an incentive to keep patients healthier so that they don't need to come and see you." Under this system, doctors receive a fixed amount per patient annually and must manage that budget to cover all necessary care.
"You make money by enrolling patients and not seeing them," Strumpf noted, highlighting how the financial incentives differ dramatically from the current model where "you provide more care, you make more money."
International Precedents and Implementation Challenges
Both experts emphasized that blended payment models incorporating capitation are becoming the international consensus. Denmark serves as a successful example where patients can change doctors annually, creating natural accountability as physicians must satisfy patients to retain them in their practice.
Closer to home, Ontario already utilizes capitation for some physicians while maintaining fee-for-service for others. The Quebec model attempts to balance these approaches through its blended structure, which Strumpf describes as necessary to create "guardrails" that temper the extremes of either pure fee-for-service or pure capitation systems.
A Contentious Path to Agreement
The road to this agreement was marked by significant conflict. Former health minister Christian Dubé initially proposed withholding portions of doctors' pay if they didn't meet patient enrollment targets. When physicians rejected this approach, the government passed Bill 2 to impose Dubé's model, prompting some doctors to threaten clinic closures.
The December agreement, negotiated by Treasury Board President France-Élaine Duranceau after Dubé was sidelined, amends Bill 2 to replace pay clawbacks with a system of incentives at a cost of $434 million. Blais suggested this additional spending "might not have been necessary" had the province taken a more collaborative approach from the beginning.
As Quebec implements this significant healthcare reform, specialists remain without a similar agreement, and the true impact on patient care quality, physician satisfaction, and healthcare accessibility will unfold in the coming years.
