Adopted on April 24, 2025, Bill-83, An Act to foster the practice of medicine in the public health and social services network1 ("Bill 83"), has the main goal of promoting the practice of medicine within the public health and social services system and, in turn, curbing the expansion of the private health sector, according to the Minister of Health and Social Services (the "Minister").
According to the Minister, more than 835 of Québec's 22,868 doctors currently work exclusively in the private network — an increase of 80 per cent since 2020.2 In this context, Bill 83:
- requires any new physicians in Québec to practice in the public sector for 5 years, before they are eligible to practice in the private sector;
- requires any physician to obtain authorization from Santé Québec to disaffiliate from the public system; and
- authorizes the Minister to require medical students and medical residents in Québec to commit to practicing in Québec after obtaining their licence to practice or at the end of their residency.
This bulletin provides an overview of Bill 83.
Obligation to Practice in the Public Sector
Previously, the Health Insurance Act permitted physicians to opt-out of participating in Québec's publicly funded health insurance plan, administered by the Régie de l'assurance maladie du Québec ("RAMQ"), by becoming a "non-participating professional". Such non-participating professionals are both: (i) permitted to charge patients and third parties directly for professional services that would otherwise be insured by RAMQ (i.e., practice in the private sector); and (ii) prohibited from billing RAMQ for any professional services (except in emergent situations).
Bill 83 has amended the Health Insurance Act to impose an obligation on any new physicians, including both general practitioners and specialists, to practice in the public sector for five years before being eligible to become a non-participating physician practicing in the private sector.
Bill 83 also imposes significant fines in the case of non-compliance. These fines will range from $20,000 to $100,000 per day and per act and double in the event of a repeated offence.
In this regard, Bill-83 amends the Health Insurance Act, as well as other legislation related to the health and social services sector to incorporate this new obligation and associated penal provisions.
Authorization to Leave the Public Sector
Previously, participating physicians who wished to leave the public sector simply had to inform the RAMQ. The Minister stated that around 150 doctors are currently switching back and forth between the public and private sectors, explaining that "150 doctors who don't perform surgery on the public for 60 days can make a huge difference to our waiting list".3
Under Bill 83, physicians now must obtain prior authorisation from Santé Québec, the Crown corporation that runs the health network, to disaffiliate from the RAMQ. Santé Québec is tasked with approving or rejecting each request according to the following criteria:
- there must be a sufficient number of physicians practising in public establishments in the doctor's region;
- the physician's departure must not have a negative impact on patients in the region;
- there must be evidence that the public network is unable to provide this physician with the facilities in their region.
Undertaking to Practice Medicine in Québec
Bill 83 also empowers the Minister, if appropriate, to require medical students, prior to beginning training, and residents, prior to beginning residency, to sign an undertaking with a penal clause to practise medicine in Québec after obtaining their license or after their residency, respectively. Significantly, in the case of such an undertaking, the Minister will have the right to determine the duration and other terms and conditions of the commitment.
In this regard, Bill 83 amends, amongst others, the Act respecting the governance of the health and social services system.
Bill 83, however, does not provide any corresponding obligation on the Minister to provide jobs to these graduates during the period they are required to practise in Québec.
Stakeholders' Reactions
Bill 83 has sparked divided discussions during the Special consultations and public hearings on Bill-83, An Act to foster the practice of medicine in the public health and social services networkincluding from the following stakeholders:
- The Fédération des médecins omnipraticiens du Québec ("FMOQ"): The representative of the FMOQ – being the association representing general practitioners in Québec –argued that Bill 83 fails to address the core issues of the healthcare system—that physicians opt for the private sector due to the bureaucratic burden and excessive workloads associated with the public sectors. Instead, the FMOQ stated that Bill 83 would have the effect of potentially impeding medical care accessibility, and suggested that efforts should focus on retaining physicians in the public sector throughout their careers rather than mandating their stay for the initial five years;
- The Fédération médicale étudiante du Québec ("FMEQ"): The FMEQ – the association of medical students in Québec – stated its disagreement with Bill 83, arguing that medical students should not be compelled to sign early-career agreements, noting that it contradicts Québec's principle of free education and that no other university student is required to do so;
- The Fédération des médecins résidents du Québec ("FMRQ"): the representative of the FMRQ – the association of medical residents of Québec – stated that some medical residents already face difficulties finding a job after their residency, and in its opinion, this issue will persist regardless of the bill's adoption;
- The Collège des médecins du Québec ("CMQ"): The professional order regulating physicians in the province agrees with the principle of Bill 83 and, despite some reservations about the proposed measures, its representative even called for further action by wanting to abolish non-participating physician status altogether. To see the CMQ's full report, click here.
Conclusion
Bill 83 seeks to bolster Québec's public health system by requiring new physicians to practice in the public sector for five years and mandating medical students and residents to commit to practicing in Québec. It will be interesting to follow the implementation of the Bill, its impact on physicians and access to public care.
Do not hesitate to contact Fasken's Health Law team, which remains attentive to related developments.
Footnotes
1. This official final version of Bill 83 is not available as of the drafting date of this bulletin.
2. https://www.cbc.ca/news/canada/montreal/quebec-bill-83-law-doctors-study-public-private-1.7517752
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