Legault stands firm on doctor payment reform, despite minister’s resignation

QUÉBEC — Quebec Premier François Legault insists he will not back down on controversial changes to how the province’s physicians are paid, despite a court challenge by a doctors’ union and the resignation of one of his longtime ministers.

On Thursday, Legault said he anticipated a strong reaction from doctors. No other government has had the courage to enact reforms that have long been necessary to improve health care access in the province, he said.

“I expected doctors to be very emotional, and that’s what we’re seeing right now,” he told reporters in Quebec City. “But at some point, we have to let the dust settle.”

Legault has been under fire since he rushed a special bill through the legislature last week that ties part of doctors’ remuneration to performance targets. He says the changes will benefit the 1.5 million Quebecers who don’t have a family doctor.

Physicians are outraged by the new law, which also prohibits them from using pressure tactics to oppose the changes. They say it violates their individual freedoms, and that the payment reform will sacrifice quality of care in favour of volume.

On Thursday, the controversy cost Legault a member of his cabinet. Lionel Carmant, who had been the province’s social services minister since 2022, announced he would leave the governing party to sit as an Independent member of the provincial legislature.

“The last few weeks have been difficult and have led me to refocus my priorities,” he told reporters in Quebec City. “I have always believed that political engagement should be exercised with balance, clarity, and honesty towards oneself and others.”

Carmant, a physician, expressed discomfort earlier this week with the new law. He said his wife and daughter, both doctors, are angry. “It’s not easy at home,” he said.

On Wednesday, Carmant’s daughter published an open letter in Quebec newspaper Le Devoir, saying she would have no choice but to work in another province if the government doesn’t allow her to “practise freely.”

Laurence Carmant, a maternal-fetal medicine specialist who had been preparing to return to Quebec from Toronto, said the government is accusing doctors of being lazy instead of working to fix a “profoundly broken system.”

“Rather than blaming individuals, which is certainly easier, let’s have a genuine societal debate and rethink the health care system as a whole,” she wrote.

Legault, who attended Carmant’s announcement of his resignation Thursday morning, said he understands that Carmant has to put his family first. Carmant was first elected when the Coalition Avenir Québec formed government in 2018, and is a personal friend of Legault’s.

The new law links 10 per cent of physicians’ pay to performance benchmarks such as appointment and surgery numbers, with the intent of encouraging physicians to take on more patients. It was forced through by the government last week after months of resistance by the province’s doctors.

The bill also includes measures to prohibit boycotts that could affect patient care. According to the legislation, doctors could face fines of up to $20,000 a day if they take “concerted actions” such as deciding in groups of three or more to refuse to teach students or to leave the province.

Doctors immediately began protesting the new law. On Wednesday, the province’s federation of medical specialists filed a request in Quebec Superior Court for a temporary stay of certain parts of the law it says violate fundamental rights.

This includes challenging a part of the legislation that prohibits “concerted actions.” The sanctions in the law are “clearly unconstitutional,” said Guillaume Charlebois, a lawyer for the union.

“Ultimately, this is a ban on doctors resigning, ceasing to teach, retiring, or deciding to practice their profession outside Quebec,” said Marie-Josée Crête, director of legal affairs and negotiations for the union. The legal challenge will be heard next week.

The federation’s president, Dr. Vincent Oliva, on Thursday called on Legault to “halt this catastrophe unfolding before our eyes.”

But Legault said the sanctions are necessary to be able to enforce the law. “I am convinced that despite these emotions, over the coming weeks and months, we will succeed in working together,” he said.

This report by The Canadian Press was first published Oct. 30, 2025.

– By Maura Forrest in Montreal, with files from Katrine Desautels