The Québec Region has had significant rural attrition of physicians in the last four years. If you wish to become involved please contact the regional committee chair listed here.
The Québec system sponsors both fee for service and salary models with "La Regie du l'assurance maladie" being the payer in all instances. The basic FFS tends to pay well for office work and not for hospital work. So if you set up near Montreal and wish to do just office work since 1982 they will pay only 70% of the standard FFS rate. Since 1993 you can be bumped up to 100% if you:
- Are there long enough. Initially it was 3 years, then it was 10, late 2002 legislation made it 20
- do enough designated community work (AMP's) examples include work a shift a week at the CLSC (community health centre), work in the ED, work at the home for the aged, obstetrics, a rural locum (say in Val D'or).
In 2004 due to wide spread vacancies, you can set up even in Montreal at full scale if you get a certificate of compliance from the region indicating that the area is understaffed. You will still need to do your AMP's. Only the Eastern Townships and areas surrounding Québec City will penalize you 30% for setting up practice. Doing your time (3 years in remote regions, 5 in periurban rural) or 20 years seniority, will exempt you from this penalty.
For years, remote areas would get more money at 115% of the urban fee schedule as long as you work there. This was increased in 2000 to 125% of the schedule from the fourth year of practice for Hospital and institutional work. In 2004 this goes to 130% increasing to 135% in the fourth year and subsequent years of practice. Remuneration for the office in remote areas increases to 120% and to 125% in the fourth year and subsequent years of practice.
For periurban rural areas 105% of the urban fee schedule will apply. For 30 selected high priority periurban rural areas a bonus of $20,000 over two years will apply.
GP's are subject to new legislation in the fall of 2002 which includes contractual requirements for AMP's for all with less than 20 years of seniority.
Primary care reform is under way in the form of GMF's being piloted in many regions in 2002.
For specialists remote pay in 2000 was increased to 140% after 3 years of rural tenure.
There are numerous programs at the academic level that are geared to introduce medical students and residents to practice in rural areas. These are detailed on the Québec elective pages. Students can also get $10,000 bursaries in their last years of medical school if they sign a return of rural service agreement.
A standard office visit as of November 2003 is $32.30 (code 8871). The entire Québec fee schedule is available now in French on the web here.