The Centre Médical Pour Enfants (CMPE) in the Montreal borough of LaSalle will shut down next spring, a direct casualty of the Quebec government's newly passed Bill 2. The clinic's lease has been officially cancelled, and families of its 5,000 patients are now being notified of the impending closure.
Dr. Rachel Tessier, a family doctor specializing in pediatrics and one of the clinic's owners, expressed deep concern for her young patients. "It's a bit scary to think of all these kids and sad to think of what will become of them," she said. The final decision to close was made less than two weeks ago, once it became clear the clinic could not survive under the new financial constraints imposed by the law.
The Final Straw: How Bill 2 Broke the Clinic's Back
Bill 2, a law imposing a new compensation model on physicians, was the last straw for the already struggling clinic. The legislation moves doctor pay from a fee-for-service model to a capitation system and introduces financial clawbacks unless collective government targets are met.
For pediatric-focused practices like CMPE LaSalle, the impact is disproportionately severe. The government's new patient vulnerability classification system, which colour-codes patients as red (most vulnerable), yellow, or green (least vulnerable), designates most pediatric patients as "green." This means doctors earn less for treating them, despite the often complex and time-consuming nature of pediatric care.
Dr. Danielle Lachance, a co-owner who is retiring next spring, explained the financial reality. "If I make the calculation, I'm getting like 50 per cent of what I made before," she said, referring to the government's own online calculator. "And the fees here, that we have to pay, it's just not working out."
Dr. Tessier's calculation was even more stark. "With the bill as it is, if I'm going to lose 60 per cent of my income, the math just doesn't make sense. I would end up paying to go to work the way it's written," she stated.
A Clinic Already on the Edge
CMPE LaSalle was operating on a challenging financial model even before Bill 2. As a satellite family medicine group, it receives no operating subsidies. The clinic is solely funded by its doctors, who contribute a portion of their earnings to cover overhead costs like staff, rent, and equipment. These fees were already higher at the LaSalle clinic than in other locations, making it difficult to recruit new physicians.
Recruitment was further hampered by government permits (PREMs) that restrict where doctors can practice and extra duties that limit their time seeing patients. With Dr. Lachance retiring, Dr. Tessier would have been the sole doctor-proprietor, a financial risk that Bill 2 made impossible to shoulder.
The Human Cost of a Policy Decision
The closure represents a significant loss for the community, particularly for its vulnerable populations. "In LaSalle, we have a lot of vulnerable patient populations here and if we're not available, they don't have access to private (occupational therapists) and psychologists and all that. I'm kind of all they've got," said Dr. Tessier.
Doctors at the clinic emphasize that pediatric care is fundamentally different and more time-intensive than adult care, a fact they feel the government's model ignores. Building trust with a child and addressing parental anxieties requires longer appointments, which are now financially penalized.
Dr. Lachance, who started at the clinic in 1989, feels a profound sense of powerlessness and sadness. "I'm very sad and I feel also as if I was jumping ship," she said. "I don't have a solution for you. I don't know what's going to happen."
While CMPE LaSalle is past the point of saving, Dr. Tessier hopes its fate serves as a warning. "For us it's game over," she said. "For other clinics, I hope there will be a wake-up call before other people's leases come to term."
