In the wake of what he calls the "debacle" of Bill 2, a Montreal family doctor is issuing a stark prescription for Quebec's ailing healthcare system: abandon a quarter-century obsession with centralized control and return power to local clinics and communities.
The Diagnosis: A System in Critical Condition
Dr. Michael Kalin, a family physician and owner of GMF Santé Kildare, argues that the foundational reforms pushed by successive governments have critically weakened Quebec's medical front lines. He points specifically to the plans of former Liberal health minister Gaétan Barrette and current CAQ minister Christian Dubé, which promised efficiency through new, powerful centralized agencies.
"The chairs on the deck of the Titanic have been shuffled again and again, but the ship is still sinking," Kalin writes, summarizing the result. Instead of improved care, he notes a consistent decline in key outcomes: worse access to family doctors, longer specialist wait times, and shattered public confidence. The system now struggles with everything from overwhelmed emergency rooms to the simple task of booking a blood test.
The Treatment Plan: Immediate Reversals and Local Power
Kalin's first orders are to immediately rescind several recent bills he views as punitive and counterproductive. He calls for the abolition of Bill 83, which threatens new medical graduates with fines of up to $100,000 per day if they leave the public system. He argues this ignores the reality that the government fails to offer these same graduates enough jobs to stay.
He also demands the cancellation of Archaic PREMs (Restricted Practice Permits) and AMPs (Mandatory Medical Activities), which he says force family doctors to spend up to 30% of their week on contracted work outside their clinics for the first 15 years of their careers, preventing them from taking on more patients.
His core remedy is a decisive shift away from centralized bureaucracy. He warns against the expansion of Santé Québec's power under Bill 15, which consolidates decision-making 250 kilometres away from the communities it serves. Instead, Kalin advocates for empowering local Family Medicine Groups (GMFs) with long-term funding, allowing them to hire their own staff and manage budgets to meet local needs.
Building a Healthy Future: Trust, Tools, and Technology
The solution, according to Kalin, lies in re-establishing local governance and voices. He believes institutions should be run by local directors and user committees that understand their community's linguistic, cultural, and historical legacies. "We need more front-line workers, not inspectors and managers who control from a distance," he states.
On technology, he is critical of the province's chosen digital health record platform, Epic, citing its budget overruns, delays, and operational issues. He highlights the bilingual Combined Health Record (CHR) developed successfully by the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal as a preferable, locally-grown alternative.
Ultimately, Kalin's prescription is clear: Remove the layers of bureaucracy burdening family physicians, and the result will be healthier patients and happier doctors. He urges the government to learn from the errors of the last 25 years, strengthen interprofessional teams, and give doctors the tools to do their jobs with fewer constraints. For this Montreal doctor, that is the only path to a healthier population.
