Banning private practice won’t fix Quebec’s health-care crisis

Restricting private practice goes against global best practices and risks harming patient care

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Anyone who has recently needed to use the Quebec health-care system knows it’s falling apart at the seams.

Whether you need to see a general practitioner, a specialist or an ER doctor, waiting is the name of the game and has been for some time. Everyone agrees the current system must change, including Quebec Health Minister Christian Dubé and the Collège des médecins du Québec (CMQ), the province’s medical regulatory body.

But not all solutions are created equal. Both the government and the CMQ appear to believe that doubling down on the same government monopoly model that has failed for decades will somehow produce different results.

One such misguided solution is Bill 83, a proposed law aimed at centralizing health-care planning and limiting doctors’ ability to choose independent practice—that is, to operate outside the public system, often through privately run clinics. Under this legislation, the Quebec government would prevent new graduates from choosing this path during their first years of work, instead handing over doctors’ career decisions to Santé Québec, a new government agency responsible for overseeing public health-care delivery.

Not to be outdone, the CMQ wants to go even further, proposing to ban Quebec doctors from opting for independent practice altogether.

These measures fly in the face of how the best-performing, most accessible universal health-care systems actually function.

The long wait times we face in Quebec are not unique. They are consistent with broader problems across Canada. But Quebec stands out for its particularly rigid restrictions on doctors’ ability to work outside the public system, even compared to other provinces, where more flexibility is often allowed.

That’s why, in its ranking of health systems, the internationally respected Commonwealth Fund places Canada seventh out of 10 for accessibility.

Ahead of us are countries such as Sweden, France and the Netherlands. These countries, much like Canada in their commitment to publicly funded health care, have nonetheless embraced reforms to improve access.

They continue to ensure universal coverage while allowing medical professionals to also work in the private sector, recognizing that independent practice can complement the public system by increasing the number of treatments available. Among OECD countries, this model is the rule, not the exception.

Denmark is a prime example. Its health-care system allows mixed practice, enabling doctors to divide their time between public hospitals and private clinics. Unlike Quebec, which forces physicians to choose one sector or the other, Denmark permits doctors to work full time in the public system and take on additional hours in the private sector.

A study of the Danish model found that doctors who split their time did not reduce their hours in public hospitals. Instead, they simply worked more hours overall, treating more patients and helping reduce system strain.

This shows that giving doctors more flexibility increases treatment capacity without undermining the public system. And while Canada’s health-care system is publicly funded and provincially administered, there is nothing preventing provinces like Quebec from adopting similar models that expand access and preserve universal care.

In Quebec, doctors who opt out of the Régie de l’assurance maladie du Québec, the province’s public health insurer, typically leave the public system not for higher income, but for greater professional autonomy. Many are older physicians who want to continue practising but can no longer tolerate the pressure and rigidity of the public system.

Opening a private clinic doesn’t guarantee riches, as some imagine. It requires significant investment, and if patients don’t come, it’s the doctor who absorbs the loss. Still, many choose this path in hopes of working on their own terms.

Shackling doctors to a flawed and exhausting system won’t fix what’s broken. Quebec should instead follow the example of countries like Denmark and adopt a more flexible, mixed-practice model that expands access, improves outcomes and respects the professionals at the heart of health care.

Emmanuelle B. Faubert is an economist with the Montreal Economic Institute, a non-partisan think-tank with offices in Montreal, Ottawa and Calgary.