Amendments to Bill 83: Dubé's weak strategy to counter Quebec doctors' exodus to the private sector

MONTREAL, April 22, 2025 /CNW/ - Bill 83, which promotes the practice of medicine within the public health and social services network, will be adopted this week by the Quebec National Assembly. Despite the amendments made during the detailed study of Bill 83, the Point St. Charles Community Clinic reiterates that these measures are clearly insufficient to counter the exodus of doctors to the private sector.

In this new version of the bill, Santé Québec will assess the relevance of a doctor's request to disaffiliate from the public system on the basis of the following criteria:

• The number of doctors who are already non-participants in the region where the doctor intends to practise and whether this number is too high for services to continue to be provided under uniform conditions
• The repercussions of authorisation on the quality or accessibility of services in such a region
• The doctor's ability to contribute to improving the quality and accessibility of services in the region
• If the doctor plans to change region after obtaining authorisation, the assessment must also take account of his or her current region

At present, the criteria established by Minister Dubé leave us perplexed, since they raise more questions than they answer.

"Given the current shortage of doctors, exactly how many doctors in a given region can be non- participants without jeopardising the services they provide?," asks William Archambault, a member of the Community Clinic's Health Action Committee. "Also, the repercussions of authorisations to leave the public system on the quality or accessibility of services must be clearly defined. The amendments proposed by Christian Dubé leave too much room for interpretation. They give Santé Québec a discretionary power that has no defined limits and, above all, is not based on any conclusive data. What's more, Bill 83 does absolutely nothing to encourage the 800 doctors who made the leap to the private sector to return to the public system, or to ensure that future doctors do not move to the private sector after their statutory five years."

To this end, the Community Clinic is proposing two concrete measures to limit, and ideally reduce - or even eliminate - the practice of medicine in private clinics.

Firstly, the status of 'non-participating' doctor should be abolished. As in the vast majority of other Canadian provinces, only 'disengaged' status should be permitted for doctors who do not wish to practise within the public system. It should be noted that a disengaged doctor must apply the fee schedule of the Régie de l'assurance-maladie du Québec for a consultation, as well as for any surgery or operation performed in a private specialist medical clinic. This small change would have the enormous advantage of eliminating the financial attraction of the private sector for our doctors.

Secondly, it is imperative that action be taken to curb the back-and-forth movement of many doctors who merrily switch from the public system to the private sector several times a year. This state-sponsored scheme allows specialist doctors to offer patients on their waiting lists the surgery they have been hoping for for months, at a staggering cost in specialist private clinics. This practice is a concrete example of two-tier medicine, where wealthier people get faster care while those who can't afford to pay sit on interminable waiting lists.

As a deterrent, the Community Clinic proposes to increase the time limit for disaffiliating from the RAMQ from 30 days to eight months. What's more, this would only be possible twice in any five-year period.

"If Minister Dubé really wants to curb the privatisation of healthcare in Quebec, he needs to implement our two recommendations as soon as possible," explains Marie-Chantal Vincent, a member of the Clinic's Health Action Committee. "It's imperative that we reverse the trend in Quebec, where health care delivery is increasingly based on a business model."

Quebec is by far the province with the highest number of doctors working in the private sector. In the last census published in the Gazette officielle du Québec, more than 800 doctors left the public system, compared with just a few dozen in the rest of Canada.

About the Point St. Charles Community Clinic

The Point St. Charles Community Clinic is a health organization run by the residents of Point St. Charles. It provides preventive and curative services, while bringing citizens to- gether to discuss health issues and improve health conditions in the short and long term. The Health Action Committee, an offshoot of the Community Clinic, calls for a universal public health system accessible to all.

SOURCE Clinique communautaire de Pointe-Saint-Charles

Information: Stéphane Defoy, Community Organizer, Point St. Charles Community Clinic, Phone: [phone], Email: [email protected]; Céline Bianchi, Communications Officer, Point St. Charles Community Clinic Phone: [phone], poste 7239, Email: [email protected]