The provincial ban on doctors charging extra for medical services will have one unintended consequence: some doctors will no longer be vaccinating patients.

Many doctors have been charging patients extra fees for a variety of services, including vaccinations. This is because Medicare only covers the cost of medically-necessary vaccinations if provided at a CLSC or a hospital.

The government does not pay doctors who provide this service in their own offices.

As a result many doctors, such as those at the Children's Care Clinic in Pierrefonds and the Melville Pediatric Centre in Westmount, have been charging patients $10 or $20 for vaccines to cover their expenses.

But with the ban on accessory medical fees, Dr. Mitchell Schiller said doctors either have to swallow the cost -- or not provide the vaccine.

"The proper administrations of vaccines requires correct handling, storage and the administration and disposal of vaccines. These are not inconsequential charges," said Dr. Schiller.

The ban on accessory fees comes into effect on Jan. 26 and is being blamed for gastroenterologists no longer performing endoscopies in their own offices and for pharmacies no longer allowing nurses to provide services.

Quebec ordered the ban after the federal government sent the province a letter on Sept. 6, 2016 saying transfer payments would be reduced by the amount of money doctors have been charging patients.

Provincial Health Minister Gaetan Barrette later said doctors have been charging patients roughly $83 million a year in incidental fees.

Schiller said doctors will stop providing services patients and will have no choice but to head to a hospital or CLSC.

"Once we can no longer charge our overhead costs will skyrocket, because effectively all our patients will no longer have to go to the CLSC and we will have to absorb all the costs related to that," said Schiller.

Doctors at the Melville Pediatric Centre are encouraging patients to contact their MNA.

"Some of our patients call and they are often told they can't get their vaccines now, on time, so with the additional flow of patients, I suspect there will be later delays," said Schiller.

The Quebec Federation of Medical specialists is anticipating other delays.

"I understand that the population is angry -- I would be too -- but we really are angry," said Dr. Diane Francoeur. "What is the purpose of having an agreement before we negotiate? With the accessory fee, we haven't been negotiating yet -- the first meeting is [Friday] --and the agreement is going to be effective next week."

Schiller said doctors don't want to not provide vaccines -- but they shouldn't have to take a sizable pay cut either.

He said it's especially galling since doctors only started the vaccination fees at the urging of health officials. 

"They said look, the waiting lists at the CLSCs are too long, can you help absorb some of the work, and we were happy to do so," said Schiller.

"They actually encouraged us and said yes, as long as your charge is a minimal, nominal charge, please go aheand and this is going to help defray or at least alleviate some of the pressure."

He is also concerned about the impact this decision will have on public health.

"If parents are hesitant at all sitting in the office when we discuss and promote the vaccine they're very likely to get the vaccine at that moment. However if I ask them, okay please leave my office, then go make an appointment, then go to the CLSC, the chance that some of them may decide not to do it... increases the risk that some kids may not get vaccinated," said Schiller.

He added one possible alternative is for the Quebec Pediatric Association to compensate doctors for administering vaccines in their offices.


The list of fees the Quebec government is forbidding

Quebec Health Accessory Fees by CTV_Montreal on Scribd