It’s time for sweeping health care reforms
By Lethbridge Herald on December 16, 2025.
Jason Sutherland
Quoi Media
The federal government’s pledge of $5 billion over three years in this year’s budget for a dedicated Health Infrastructure Fund is a much-needed investment that will aid provinces and territories in building and upgrading hospitals, medical schools and other healthcare facilities.
While the funding addresses health infrastructure needs, it still leaves governments to solve their most pressing healthcare problem – Canadians’ lack of access to timely healthcare services.
As provinces search for solutions, British Columbia and Quebec are taking divergent paths when it comes to physician pay and working conditions.
While B.C. is only tinkering around the edges, Quebec’s bold reforms are the kind of drastic action provinces need to take to fundamentally change healthcare systems to ensure patients have timely access to services and better health outcomes.
From long queues in emergency departments to lengthy waits for some surgeries and difficulties accessing a family doctor, lack of access to essential healthcare services is at a crisis point in Canada.
While doctors are not responsible for provinces’ health systems, they play a vital role. Beyond providing patient care, they are responsible for making many of the decisions on how public money is spent – deciding which patients are admitted to hospital, when they are discharged, how they are managed and which drugs they are prescribed.
Their compensation takes up a significant chunk of provincial health budgets – with most doctors working as independent contractors paid on a fee-for-service basis, billing the province for each service they provide to patients.
As governments look for ways to improve healthcare access, doctors’ prominent role in the healthcare system makes them an obvious focal point for reforms to the way they work – possibly working more off-hours or seeing more patients with complex medical conditions that take more time.
No province has taken up the task as vigorously as Quebec.
Last month, its National Assembly passed Bill 2, legislation that makes radical changes to the way doctors are paid, where they can practice and how they manage their patient loads. The highly contentious Bill has now been paused after doctors there successfully lobbied to have the bill delayed and amended. For system reform efforts, this is bad news. Here’s what the Bill includes:
It gives the government the ability to regulate targets for the number of patients each doctor manages and bases a part of doctors’ pay on performance measures.
It also upends the fee-for-service model, allowing the government to pay doctors a fixed amount per patient depending on their health and vulnerability.
Moreover, it gives the government the power to impose severe penalties on groups of doctors taking concerted action to protest the changes – a significant measure given doctors’ widespread and vehement opposition to the legislation.
While it is anticipated that the legislation and changes in how the province manages its doctors’ practices and method of pay will be in court very soon, the magnitude of the legislated reform cannot be understated in Canada where physicians have been paid the same way for decades.
In sharp contrast, British Columbia has opted for a carrot-like approach.
Responding to recent job actions by obstetrician/gynecologists, a region of B.C. is advertising for temporary obstetrician/gynecologists with super-sized payments.
The rate is currently advertised at $7,117 per 24-hour period – a significant sum of public money given that in 2024 the median annual salary for obstetrician/gynecologists was $405,190 in B.C.
The advertisement also offers extra money for working after-hours and paid accommodation.
While B.C.’s approach is bound to attract applicants – possibly even unhappy Quebec obstetricians/gynecologists – it does little to change physician practices.
Instead of addressing any of the underlying problems in healthcare delivery – like access, costliness, quality and equity – the only certain outcome is that B.C. residents will pay more for the same services.
The Quebec government and doctors’ unions continue to be at loggerheads over the legislation (their current agreement is only ‘in principle’), and it is hard to predict which changes will stick. Other provinces will find themselves in the same boat of having to take drastic action to spur doctors to work differently.
While it is too early to know whether Quebec’s heavy-handed approach will improve patient access and outcomes – or fix issues around costliness, quality and equity – it is clear that provinces need to go beyond half measures to deliver the reforms their healthcare systems need.
It is time for governments to think big and be bold about making sweeping healthcare reforms. Canadians have waited long enough.
Jason M. Sutherland is the UBC Professor of Health Services and Policy and Director of the Centre for Health Services and Policy Research in the School of Population and Public Health at the University of British Columbia.
©Quoi Media
27-26
no problem if immigration is in talks. To many people for no enough doctors – simple