Quebec's Bill 2: Doctors, pharmacists and the health system

Every Quebecer has heard about the adoption, under closure, of Bill 2, which significantly alters the way doctors are paid. Health Minister Christian Dubé claims it's the necessary remedy to heal our healthcare system and ensure Quebecers have access to the health services they need. Doctors have their doubts. . . and they're not alone.This law, passed through a mechanism that is unusual in a democracy, drastically changes the parameters of negotiations between doctors and the government. It went under the radar, but this law also regulates the use of pharmacy placement agencies.It is worth recalling that the possibility for the minister to negotiate with healthcare professionals is provided for in section 19 of the Health Insurance Act. Clearly, this section is being violated here. This principle applies not only to physicians, but to all professionals paid by the Régie de l’assurance maladie du Québec (RAMQ), including community pharmacists.This precedent therefore potentially affects us. It went largely unnoticed, but this law also regulates the use of pharmacy placement agencies. (I'm not debating the merits of regulating this issue, but rather the underlying principle of introducing this change in a law passed under closure.)Overall and without nuance, the minister firmly believes that the new law will provide access to the 1.5 million citizens who do not have a family doctor, reduce surgical wait times, and allow people who go to the emergency room to be seen within 90 minutes. Nothing less.The minister claims that the most profound change for access to primary care will be the concept of collective care, rather than the allocation of a patient-physician partnership. This idea is nonetheless appealing. It has long seemed obvious to me that, with the expansion of the professional roles of paramedical professionals, healthcare practice is more than ever a team sport.This presupposes, however, that these other paramedical professions—nurses, nurse practitioners, physiotherapists, psychologists and, of course, pharmacists—are not only available but also have their place within the remuneration framework and operate within a coherent healthcare system. This is clearly not the case. Not only are the majority of psychologists and physiotherapists not integrated into the public healthcare system, but there is no mechanism in place to network all of these professionals.The minister went so far as to say that nurse practitioners can be “substitutes for physicians,” a statement which, while supporting the role of nurse practitioners in the healthcare system, was nonetheless criticized by their union, the FIQ. There are currently just over 1,800 nurse practitioners in Quebec. Just over a year ago, they were caring for fewer than 500 patients. This gives an idea of the gap in providing care for Quebecers without a family doctor, while the FMOQ (Quebec Federation of General Practitioners) states that there is a shortage of nearly 2,000 family physicians.Quebec’s demographic situation is already telling. The population has grown by one million citizens in 10 years, the average age is constantly increasing, and, as we often forget, a new disease, COVID-19, was still generating over 700 positive cases and hospitalizations in October 2025. This represents a large number of patients occupying hospital beds and consuming increasing amounts of healthcare.In short, the situation is complex, very complex. The minister's solution is simple and simplistic. It seems tinged with magical thinking.The mobilization of doctors against this law is both enlightening and inspiring. While their personal and professional incomes are targeted—which is in itself sufficient reason to mobilize—I believe a significant part of this mobilization stems from the apparent absurdity and lack of cohesion of the government's strategy, including this law. The high level of distress among doctors supports this view.Given this situation, which affects all healthcare professionals in their mission to care for the population, it is surprising that other professions are not more involved in the debate raised by doctors. Although the law directly affects them, the underlying problem and the type of government decisions directly affect us all. The issues are complex, and the solutions are not simple. But the mobilization of all professionals, in an organized, coherent, and functional approach, is part of the solution.Because of its accessibility, pharmacy fears becoming a burden on the healthcare system. It has a role to play, its role, in conjunction with colleagues in other professions. But it cannot do so within a system built on gag laws.I urge us to be vocal, on all platforms, in advocating for positive changes that will improve the healthcare system for us and, above all, for citizens. This isn't just a battle for doctors.Fortunately, this is still possible in Quebec.Marc Parent is a pharmacist in a family medicine clinic after having practiced for several years at the Quebec University Hospital Centre.This article has been translated from its original French and first appeared on our sister site Profession Santé.

Quebec's Bill 2: Doctors, pharmacists and the health system

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