Quebec Pediatric Care Faces Crisis as New Law Prioritizes Adult Illnesses
A controversial new law in Quebec, Bill 2, is sparking fears of a major crisis in pediatric care, with family doctors warning that the system will effectively deprioritize the health needs of children and infants. The legislation links physician remuneration to performance indicators, but doctors argue the government’s vulnerability assessment codes systematically disadvantage younger patients, potentially leading to a collapse in access to family doctors for children across the province.
The concerns center on the way the Quebec health insurance board (RAMQ) categorizes patient vulnerability. The system classifies patients as “healthy” (green), “minor chronic illness” (yellow), “moderate condition” (orange), or “major condition” (red). According to medical professionals, babies and children are overwhelmingly labeled as “healthy,” despite their unique and frequent healthcare needs.
“It completely deprioritizes them,” explained a family doctor at the Step Medical Clinic in Montreal. “It’s as if we’re saying that they are the ones who need medical services the least. So deprioritizing them means that they are not likely to have priority access. That’s what worries us the most.”
The Step Medical Clinic, which serves over 21,000 families and approximately 300 children daily, is at the forefront of raising the alarm. Doctors David Rothstein and Alicia Lessard, medical directors at the clinic, are actively seeking to amplify the voices of their young patients.
Under Bill 2, as of July 1, 2026, family medicine departments will be required to prioritize patients with “major illness.” This prioritization will gradually extend to those with “moderate condition” and then “minor chronic condition” by December 31, 2026. This phased approach, according to Craig McCullogh, also a physician at Step Medical Clinic, could leave children without access to a family doctor for an extended period.
“With this law, in the next year, they will assign most vulnerable patients to clinics,” McCullogh warned. “They will start with red patients, then move on to orange, then yellow patients, and it will probably be 2027 before green patients are affiliated with a clinic. So, for the next year, if they do it this way, no child will have a family doctor.”
The Step Clinic has proactively established relationships with major regional hospitals to provide care for newborns without a family doctor, but this system is now threatened. Lessard explained that the new law will force the clinic to reduce time slots allocated to “green” patients – children – to accommodate those with more pressing, prioritized conditions.
The challenges extend beyond simply scheduling appointments. Doctors emphasize the unique demands of pediatric care. Performance targets, designed for adult patients, are difficult to apply to children, whose medical visits are often less predictable and require more time due to restlessness and the need to reassure parents, particularly first-time parents.
“Toddlers have at least eight medical visits in their first year of life,” Lessard noted. “The check-ups we do, which are regular follow-ups, may no longer be easy to schedule because we will have to prioritize other patients. Often, it is during check-ups that we detect growth delays and developmental delays, which we can then investigate further.” Rothstein echoed this sentiment, stressing the critical importance of preventive medicine for young children, who are particularly susceptible to rapid illness and require regular checkups.
While the government aims to address the needs of the 200,000 vulnerable patients currently without a family doctor in Quebec, doctors argue that neglecting preventative care for children will ultimately exacerbate chronic disease burdens in the future. “Our patients today are also the patients of tomorrow,” Lessard argued. “If we take care of them from the outset, we will be able to offer a healthier society tomorrow.”
The concerns are not limited to the clinic level. Two national pediatric organizations, the Directors of Pediatrics of Canada (DPC) and the Canadian Paediatric Society (CPS), have jointly warned that Bill 2 will worsen burnout among pediatric specialists and compromise access to essential care for children and youth. In a statement released Wednesday, the organizations urged the Quebec government to repeal the law and resume negotiations.
The potential impact extends to the stability of the healthcare workforce itself. Reports indicate that Quebec doctors are increasingly considering leaving the province to practice in Ontario and New Brunswick, and McCullogh stated that dozens of patients ask him daily if he plans to leave. Messages from doctors contemplating a move are also reaching the Step Clinic’s medical directors, reflecting a broader trend across the province. A stay requested by two federations in the Quebec Superior Court is currently being considered, and many doctors are awaiting the outcome before making final decisions, raising the specter of a second wave of physician exodus.
The future of pediatric care in Quebec hangs in the balance as the province grapples with the implications of Bill 2 and the potential consequences for its youngest citizens.
