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Every reform tells a story, and Bill 2 tells one of exhaustion. It reflects a government running out of ways to keep its healthcare system alive. For years, Quebec has promised efficiency, access, and accountability, yet each reform has produced more bureaucracy, fewer physicians, and growing mistrust between professionals and the state. Framed as a project of collective responsibility, Bill 2 aims to expand access by linking physician compensation to performance indicators and redistribution of labour. It replaces collaboration with control and reveals how far the government is willing to go to sustain a system under strain. The move toward tighter oversight and enforcement signals a deeper problem within Quebec’s model of public governance, where the struggle to preserve universal care now risks weakening its very foundation.
The Institutional Path to Bill 2
The emergence of Bill 2 did not come about in isolation. Rather, it is a product of years of failed attempts to rescue a health-care model stretched beyond its limits. For more than two decades, the province has sought to rebuild its primary-care networks through successive reforms, most notably with the creation of Family Medicine Groups in 2003 and the introduction of Bill 20 in 2015. Both treatments aimed to expand access to healthcare and improve efficiency, yet chronic shortages and inefficiencies persisted.
Landa et al. note that despite continuous waves of restructuring, the availability of front-line physicians in Quebec continues to decline, resulting in reduced accessibility and worsening patient outcomes. The province now records the lowest doctor-to-population ratio in Canada, along with long waits for basic services and uneven access to family medicine. Pay remains less competitive than in neighbouring provinces, while workloads and administrative demands grow heavier. This long record of reform fatigue suggests a deeper governance problem: the state manages decline rather than reversing it, relying on constant redesign rather than rebuilding capacity.
Government Rationale
Much of the public conversation around Bill 2 has focused on its controversy, but to understand its impact, it’s worth asking why it exists in the first place. Premier François Legault – a former businessman and leader of the centre-right Coalition Avenir Québec1 – frames Bill 2 not as a punishment, but as a pragmatic response to a health system under strain. The bill argues that residents face record-high wait times, with nearly two million people lacking a family doctor. At the same time, fiscal constraints make salary increases both politically and financially unrealistic. Persistent regional disparities further strain the system, as urban centres attract physicians while rural areas remain underserved.
The government’s policy brief outlines Bill 2 as an initiative of collective responsibility, designed to improve access by tying doctors’ pay to measurable outcomes and redistributing medical labour according to need. In practice, this model replaces traditional fee-for-service payments with a system in which doctors receive a fixed annual amount per patient under their care and can earn additional bonuses if their clinic meets government-defined targets. This includes shorter wait times, improved continuity of care, or expanded hours of availability—essentially rewarding efficiency while promoting fairness in how care is delivered across regions. What appears to be sensible reform, however, signals a more profound shift in governance away from partnership and toward managerial control as the default tool of state control.
Politics of Control
This is not merely a reform in administration, but a reform in authority. The government’s rhetoric turns a structural governance failure into a question of physician discipline, casting doctors as obstacles to the public good. As Arpin, Gautier, and Quesnel-Vallée argue, Quebec’s reforms increasingly rely on the corporate logic of governance that prioritizes numerical accountability over professional trust. Under this framework, physicians are no longer treated as partners in social work but as variables in a performance algorithm—a pattern Landa et al. identify as endemic to Quebec’s last two decades of reform, during which constant restructuring has provided neither access nor stability. Their research shows that successive reforms, such as the creation of Family Medicine Groups and Bill 20, imposed new organizational requirements and performance expectations but failed to deliver improvements in accessibility or continuity of care, underscoring how restructuring repeatedly substitutes for capacity-building. What appears as sensible reform, therefore, marks a deeper reconfiguration of state power. Collaboration is displaced by coercion, and health policy becomes less about healing systems than discipling those who sustain them.
Public Reaction and the Crisis of Legitimacy
The backlash to Bill 2 was immediate. Within days, the College of Family Physicians of Canada (CFPC) issued a statement condemning the Coalition Avenir Québec government for its “authoritarian legislation” and “unremitting attacks” on the profession. The CFPC accused Quebec Premier Legault’s administration of forcing the bill through the National Assembly without meaningful consultation or negotiation, warning that the reform would worsen burnout and deepen an already critical shortage of family doctors. The message captured a breaking point; Physicians’ criticism had shifted into a broader challenge to the government’s legitimacy to lead Quebec’s healthcare system.
Public reaction followed quickly. On November 9th, more than twelve thousand doctors, residents, and medical students filled Montreal’s Bell Centre in one of the largest professional protests in Quebec’s history—a clear rejection not just of a single law, but of being governed through compliance rather than collaboration. What might have been a policy dispute had become a confrontation over the very basis of authority in the health system. Mr. Legault’s subsequent response to the protests only reinforced this divide. Rather than acknowledging the scale of discontent, he dismissed the protest as misplaced energy, suggesting doctors should “send representatives to negotiate” and insisting the reform was simply about providing “more services to Quebecers.” This revealed a striking disconnect between the government’s self-perception and the reality of its policy. His inability—or refusal—to recognize that disillusionment ultimately emphasized the arrogance driving the province’s reform agenda.
As Arpin, Gautier, and Quesnel-Vallée observe, Quebec’s reforms increasingly operate through a centralized, politicized model of governance, in which administrative oversight replaces mutual accountability, resulting in the erosion of professional trust under constant supervision. The public reaction to Bill 2 thus reveals more than anger; it reflects the cumulative effects of a governance style that has exhausted its legitimacy.
Projected Systemic Consequences
Early signs suggest that Bill 2 is triggering shifts that could initiate lasting implications for Quebec’s health system. Amid a compensation dispute that ties fifteen per cent of physicians’ income to performance, many doctors have expressed interest in leaving Quebec. Ontario Premier Doug Ford quickly capitalized on this uncertainty, using a press conference to invite Quebec physicians and nurses to relocate, emphasizing neighboring provinces’ eagerness to recruit. Nearly three hundred doctors applied for an Ontario license within a month, with the College of Physicians and Surgeons of Ontario reporting more than thirteen times its typical volume of applications.
Such outward migration threatens to deepen burnout and reduce service capacity, aligning with concerns central to Canadian primary care research regarding how shortages of primary care providers, combined with rising patient demand, rapidly undermine continuity of care, increase reliance on emergency services, and accelerate pressure on the system. Laverge et al. show that rising administrative workload already produces significant stress, disengagement, and reduced access to care; a punitive reform climate is likely only to intensify these pressures. As more physicians consider exit, regional inequalities will likely widen, and privatization pressures may grow, revealing a system no longer commanding the trust needed to sustain it.
Quebec’s struggle over Bill 2 ultimately raises a larger question about what it takes to sustain a universal healthcare system. The province’s reliance on oversight, sanctions, and administrative control reflects not only the limits of its fiscal and organizational capacity but the erosion of trust that once anchored cooperation between the state and professionals. Physicians’ resistance through public demonstrations and rising migration signals are not simply reactions to a single reform, but rather symptoms of a more profound institutional fatigue. A system cannot function on compliance alone, and whether Quebec can rebuild these foundations will determine not only the fate of Bill 2, but the future of public healthcare in the province.
Edited by Catvy Tran
The opinions expressed in this article are solely those of the author and do not reflect the position of the McGill Journal of Political Science or the Political Science Students’ Association.
Featured image by Bevan Goldswain
- The Coalition Avenir Québec (CAQ) is a centre-right nationalist party founded in 2011 on a platform of state efficiency, administrative reform, and stronger executive control over public services. For more context, see Daniel Béland, “The Right and the (Provincial) Welfare State”. ↩︎
