Legault took aim at Quebec physicians

The Legault government in its final failed attempt to control health care — and get elected — took aim at Quebec physicians. Bill 83, passed on April 24, 2025, requires new physicians to work in the public system for their first 5 years and includes clauses that penalize them for failing to meet that obligation.¹ Bill 2, passed on October 25, 2025, makes individual physicians responsible for improving access to care, with an overhaul to compensation models and patient volume requirements.² These Acts go far beyond an attempt to bolster public health care and address access; they are an unprecedented assertion of state control over physician practice, threatening to reshape the structure of medical careers. The fallout has left the province’s leadership structure in tatters with the resignations of Health Minister Christian Dubé and other cabinet ministers as well as that of Premier François Legault himself.³

The significance of Bill 2 for surgeons is its constraints on practice, resource allocation, and patient interaction. For surgeons across Canada, this law serves as a stark warning, a potential blueprint for the erosion of professional autonomy. The Canadian Civil Liberties Association has been a vocal critic of Bill 2, calling October 25 “a dark day for fundamental freedoms in Quebec” (and Canada).⁴ The fact that the bill has been paused and is currently in a drawn out negotiation process does not make its passing any less pertinent — it has repercussions for all members of society and raises several specific constitutional and civil rights concerns. It can be argued that unilaterally ending conversation before passing the bill and prohibiting pressure tactics undermined physicians’ right to collective bargaining and association. The Act attacks freedom of association, freedom of expression, and mobility rights.⁴ It violates, amongst others, Section 6 of the Canadian Charter of Rights and Freedoms by prohibiting action that includes resignation or relocation to another province.

At its core, Bill 2 also introduced a coercive metric for payment structure. Physician compensation was to be contingent on meeting collective performance targets. For surgeons, this translated to an almost unreal expectation. The bill allows the government to arbitrarily designate goals for surgical caseload or new patient visits. Unfortunately, the resources needed to achieve these metrics are not promised in the bill.² Worse still, because the government would decide the collective responsible for meeting the metrics (i.e., how to group people in terms of responsibility), it was obvious to even a casual observer that the targets could never realistically be met. While the goal of reducing wait times is universally shared by all parties, the imposition of penalties on individual surgeons for systemic failures such as lack of operating room time, nursing shortages, or unavailable postoperative beds is profoundly unjust. Surgeons, despite their dedication, do not control these critical factors on which their livelihood and patient care depends.

Even more alarming is the absolute prohibition under Bill 2 of concerted actions. This clause bans collective attempts to slow down any medical activity, with individual physicians and medical organizations of physician groups facing daily fines of up to $20 000 and $500 000, respectively. This attempt to muzzle the profession strips physicians of their fundamental right to advocate for their patients and for better working conditions. Discussing alternative career paths, vacation plans, or even expressing discontent in a collective manner could be deemed illegal under Bill 2, turning professional discourse into a perilous activity. Furthermore, Bill 83 compounds the issue by locking new physicians into public practice for 5 years and requiring authorization from the new Santé Québec agency to leave the public system, basically transforming a professional licence or medical education in the province into a state service mandate. Surprisingly, there was no immediate meaningful dissent from the province’s medical students when the bill was tabled. Bill 2 also penalizes actions that hinder medical education, complete with a formal gag order. What message does this send to aspiring residents? The number of unfilled family medicine residency positions in Quebec last year are a troubling precursor to this heavy penalty for pressure tactics on the part of residents.

The long-term implications for training and talent retention were imminently apparent. Several physicians started the process of licensure elsewhere. Humorously, Ontario Premier Doug Ford offered the telephone number 1-800-DOUG-FORD and promised if he was contacted, he would find health care workers jobs in Ontario.⁵ By mid-November, nearly 300 doctors had applied to get a license in Ontario; the College of Physicians and Surgeons of New Brunswick had also received many applications.⁶

We risk a generational exodus where the brightest minds and most capable physicians are unwilling to practise under such constraints or in a province that had no trouble passing the bill. Once the actions show instability in the system, physicians will not hesitate to look for more stable ground. They will seek opportunities elsewhere, leaving Quebec’s health care system — and its patients — in a perilous state.