In a few months, I’ll no longer have a family doctor. The clinic he practises at, in my neighbourhood of Saint-Henri, in Montreal, will soon close its doors. The reason? Not enough physicians to keep it staffed. When it shutters, I—and likely thousands in my community—will join over 1 million Quebecers currently left on their own to sort out their medical problems.
“Quebec’s health-care system,” Montreal Gazette health reporter Aaron Derfel concluded recently, “is now arguably the worst it’s ever been.” It is likely to get worse. Quebec is losing more general practitioners than it produces: they either retire, enter private practice, or leave the province altogether. Those hoping to stay are exasperated by a restrictive framework that dictates where they can practise. The formula that the province uses, established to ensure equitable distribution of medical staff, has instead resulted in multiple Quebec regions—notably Montreal—being severely underserved. Quebecers seeking care often have no choice but to head to already overflowing emergency rooms. And when they get to the ER, patients wait, and wait—then wait some more. Early this year, the Quebec Association of ER Physicians told CTV News that patients were waiting “up to seven hours or longer in some hospitals to see a physician” and on average were spending “close to 24 hours on an ER stretcher, waiting for a bed to open up in the system.”
And after landing that lucky bed, who else do patients wait to see? Nurses. Chronic stress, heavy workloads, and long hours are among the reasons that Quebec, between 2021 and 2023, lost 21,000 health care workers, most of them nurses. The number of newly licensed nurses has now hit a ten-year low. Because insufficient staffing worsens burnout, the cycle continues. According to the Montreal Economic Institute, nearly half of the nurses in the province leave the profession before the age of thirty-five. It was a labour shortage that led health authorities to order the closure of evening and overnight services at the only ER in the Laurentian town of Rivière-Rouge, a situation that would have obliged patients to travel sixty kilometres to the nearest hospital. Town officials went to court and succeeded in receiving an injunction delaying the overnight closure.
Hospitals bleeding workers, record-high surgery backlogs, ambulances with nowhere to leave sick people: this is the norm across the country. Canadians are paying for services they are simply not getting. According to the Canadian Institute for Health Information, health care spending in Canada in 2023 was expected to be $344 billion—or roughly $8,600 per Canadian. That’s up by $9 billion from the previous year. And as spending soars, services deteriorate. Our publicly funded health care system is, in many ways, a defining Canadian value, but according to a recent Leger’s survey, 70 percent of Canadians worry they won’t receive quality health care when they need it. They’re probably right.
In the meantime, the idea of a parallel, private health care sector is becoming more popular. Given the challenges, it’s not surprising that an increasing number of Canadians are willing to cut the line in order to access care. An Ipsos poll conducted for Global News in early 2023 revealed that Quebec residents were most open to private health care options, with 75 percent of Quebecers polled supporting private health care for those with the ability to pay.
How to fix all this? The Canadian Medical Association recently called on provinces and territories to “modernize Canada’s health systems.” But what does that even mean? Experts say we should do more to focus on preventative care rather than react to emergencies. Or we should cap skyrocketing prescription drug costs. Some have called for more innovative remote care or expanding the role of nurse practitioners as a coordinated national effort to address labour shortages. It has also been pointed out that it makes no sense for Canada to keep snubbing internationally trained doctors, many of whom face barriers in being able to practise in the country. Their credentials often aren’t recognized, and we limit the number of residency positions available to them. Quebec has the lowest proportion of foreign doctors in the country, at just 8.2 percent, almost a third the national average. Perhaps one of the most alarming proposals to alleviate the pressure on current hospitals and clinics—and one that would surely accelerate a two-tiered system—is to create privately built and run but publicly funded medical facilities.
But it’s hard to even begin to tackle some of these chronic issues in a fragmented, often dysfunctional system of jurisdictional fiefdoms where health care is funded by the federal government but is largely delivered by the provinces and territories, each with separate practices and policies. A year after the Liberals pledged to increase health funding to Canada’s provinces and territories by $196.1 billion over the next decade, Quebec remains the lone holdout. It refuses to sign the accord out of reluctance to allow federal interference.
The problems are so endemic and complex that many health care critics feel demoralized and paralyzed. Steven Staples, national director of policy and advocacy for the Canadian Health Coalition, acknowledged in an interview with the CBC that health care spending must increase to counter decades of underfunding, but he also pointed out that “we can’t keep pouring hot water into a leaky bathtub.”
Some of these problems, at least in Quebec, were self-inflicted. Back in 2018, the Coalition Avenir Québec’s promised health care reforms were a major reason for their win. Quebecers were angry at the outgoing Liberal government for extending punishing austerity measures which had compromised access to primary care. Among their election promises, the CAQ vowed all Quebecers would have access to a family doctor. Once elected, however, they began to largely focus on divisive identity politics. Four years later, for the CAQ, the most enduring cause for shame from the pandemic were the waves of deaths in long-term care residences after these facilities became epicentres of COVID-19 infections—all of it attributed to the system’s inability to react quickly, in part because of decades of cuts and a severe lack of personnel. Premier François Legault’s repeated statement that protecting French is his number-one duty sounds tone-deaf in a context where two patients died waiting in Montreal-area ERs just months ago.
In response to overcrowded ERs, and in the midst of the health care workers striking for better work–life balance and higher pay, health minister Christian Dubé advised Quebecers against going to the hospital unless they were seriously ill. This prompted the Globe and Mail health columnist André Picard to respond that “telling people that the ER is busy so they should stay away is not a public service, it’s a failure of public policy.”
Quebec’s government is now pinning its hopes on a new provincial agency, Santé Québec, which promises to de-bureaucratize the system by bringing all thirty-four regional health agencies under a single authority. The CAQ insists that centralizing operations will improve wait times and reduce surgery backlogs. The reforms have been heavily criticized by unions, which complain that the government never consulted with front-line workers with direct experience of the crisis, and that it is merely replacing the structure of the failing health care system and not addressing root causes. Some also worry about provisions that would extend the CAQ’s culture war: Santé Québec may remove a health institution’s ability to offer English services if community demographics no longer justify it. Six former Quebec premiers have written an open letter to the CAQ warning against the agency. So far, the government is standing firm.
In the meantime, Quebecers—like all Canadians—pray that a system barely chugging along, operating on human deficit and relying on the daily sacrifices of medical teams, doesn’t come to a screeching halt.
