Family doctors fear a major crisis in pediatric care due to the controversial Bill 2, which will link doctors’ remuneration to performance indicators. The patient vulnerability codes established by the government disadvantage babies and children, as they are mostly classified as “green,” meaning non-vulnerable.
David Rothstein and Alicia Lessard are family doctors and medical directors at the Step Medical Clinic in Montreal, which cares for more than 21,000 families and sees nearly 300 children every day. They are concerned about children and want to give them a “voice.”
It should be noted that the Quebec health insurance board (RAMQ) will be responsible for setting patient vulnerability levels, which are as follows:
– healthy (green), which includes patients with no illness or minor acute illness, as well as healthy newborns
– minor chronic illness (yellow)
– moderate condition (orange), which includes certain cancers or mental health disorders
– major condition (red), including people with major cancer, major mental health disorders, and major conditions in newborns.
Babies and children are generally labeled as “healthy.”
“It completely deprioritizes them,” says Lessard. “It’s as if we’re saying that they are the ones who need medical services the least. So deprioritizing them means that they are not likely to have priority access. That’s what worries us the most.”
In applying its law, the government stipulates that as of July 1, 2026, “a territorial family medicine department is required to give priority to the distribution of people whose level of vulnerability is ‘major illness.’” Then, gradually, until Dec. 31, 2026, the allocation of patients will continue with the categories “moderate condition” and “minor chronic condition.”
This is a problem, according to Craig McCullogh, who also works at Step Medical Clinic. “With this law, in the next year, they will assign most vulnerable patients to clinics. They will start with red patients, then move on to orange, then yellow patients, and it will probably be 2027 before green patients are affiliated with a clinic. So, for the next year, if they do it this way, no child will have a family doctor,” he warns.
The Step clinic, which opened in 2024, has established “corridors with major hospitals in the region” to care for newborns without a family doctor. In practical terms, mothers who have just given birth are asked if they and their babies will be able to be seen by a doctor. “If they don’t have one, we automatically take them here,” summarizes Lessard.
“But now, that won’t really be possible anymore because we’ll have several time slots that will have to be removed for green patients, in order to see other types of patients,” she explains.
Performance targets are difficult to apply to children, since a medical visit is more unpredictable than with an adult. As a result, it can take longer. Babies and children can be restless, and time must also be taken to reassure parents, especially when it is their first child, the three doctors interviewed point out.
Toddlers have at least eight medical visits in their first year of life. “The check-ups we do, which are regular follow-ups, may no longer be easy to schedule because we will have to prioritize other patients. Often, it is during check-ups […] that we detect growth delays and developmental delays, which we can then investigate further and ask more questions about,” explains Lessard.
His colleague Rothstein agrees, emphasizing that preventive medicine is even more important for children. “Young children, newborns, and babies are the most vulnerable,” he says. “They are the ones who get sick quickly and need checkups. […] Preventive medicine is what’s really important for these patients.”
The government’s goal is to ensure that the 200,000 vulnerable patients without a family doctor in Quebec are taken care of as quickly as possible. Lessard admits that chronic diseases are “a scourge” on the “health care system at the moment.”
“But we believe that if we prevent, treat, or detect them as early as possible, we will be able to reduce the scourge of chronic diseases, whether physical or psychological. Our patients today are also the patients of tomorrow. If we take care of them from the outset, we will be able to offer a healthier society tomorrow,” argues the family doctor.
Two national pediatric organizations warn against Bill 2. In a joint statement released Wednesday, the Directors of Pediatrics of Canada (DPC) and the Canadian Paediatric Society (CPS) warned that the law “which makes physicians collectively responsible for meeting access targets through punitive measures, will exacerbate burnout among pediatric specialists and compromise access to essential and urgent care for children and youth.”
The CPD and CPS are urging the Quebec government to repeal Bill 2 in its entirety and are calling for a resumption of negotiations. “Every day that this bill remains in force, the immediate and long-term health care needs for the health and well-being of our children are further compromised,” they write.
Quebecers are afraid of losing their doctors. McCullogh says that dozens of patients ask him every day if he intends to leave Quebec.
At Step Clinic, medical directors have received messages from doctors who are considering leaving. This reflects what is happening across the province, with an increase in requests from Quebec doctors to practice in Ontario and New Brunswick.
According to McCullogh, a second wave of exodus could occur, as several doctors are waiting to see the outcome of the stay requested by two federations in the Quebec Superior Court.
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–This report by La Presse Canadienne was translated by CityNews
