In the coming days, a large family medicine group on the South Shore of Montreal may no longer offer appointments to its 11,000 patients registered with Quebec's Guichet d'accès à la première ligne (GAP) — a service Quebec Health Minister Christian Dubé promotes for people who don't have a family doctor.

The move is part of a pressure tactic by Quebec family doctors as they negotiate a funding package that expires at the end of the week

"The GAP package had until now allowed us to hire a nurse, a secretary and a receptionist, not to mention install patient registration terminals for peak periods," said Dr. Alexandre Prud'homme, from the Médi-Soleil clinic in Saint-Jean-sur-Richelieu, Que.

The current package of $120 per patient per year represents more than $1 million for the clinic, where 18 family doctors work.

"I can tell you that, in the last year, there wasn't a single GAP availability of mine that wasn't taken by a patient," said Prud'homme.

The agreement between Quebec and the federation representing Quebec's general practitioners (FMOQ) was signed in June 2022. It offered a bonus of $120 per year for each new "vulnerable" patient registered. The package has proven popular with doctors across Quebec, who have registered more than 940,000 patients at their clinics to date.

In the waiting room of the Médi-Soleil clinic, the concern was palpable.

"I receive 20 calls a day from patients at the GAP wondering what will happen," receptionist Marie-Claude Guérin said.

Jacques Lussier, a retired patient registered with the GAP who was at Médi-Soleil for a medication renewal, called for Dubé to "hold his ground."

"The doctors are simply taking us hostage," he said.

FMOQ president Dr. Marc-André Amyot defended himself Wednesday for encouraging family doctors to stop booking appointments through the GAP as part of a negotiation strategy with Quebec.

The number of appointments offered through the GAP plunged from around 18,000 per week in May to fewer than 6,000 in the first weeks of June, according to available data.

Amyot told Radio-Canada that doctors were presented with several options: continue without the $120 bonus, register patients individually, convert scheduled appointments into walk-ins or "simply stop."

In total, the 9,800 family doctors offer more than 13 million appointments per year to patients, he noted.

Amyot also said that an appointment at a clinic remains less expensive than a visit to the emergency room.

"[The GAP] represents savings for the government," he said. "It costs $400 to see these patients in the emergency room," he said Tuesday in an interview on Radio-Canada's Tout un matin.

He said he hopes to extend the agreement between the FMOQ and Quebec for a few months while waiting for a framework agreement signed with doctors in 2015 to be renegotiated. That framework agreement earmarks $3.1 billion for general practitioners this year.

Dubé told reporters the "GAP is here to stay" and that "Quebecers must get the most for their dollar."

The Ministry of Health has made its own comparative assessment of GAP costs over the last two years.

"The estimated average cost of visits was $175 for patients collectively registered [with the GAP] and $94 for patients individually registered for the same period," Health Ministry spokesperson Marie-Claude Lacasse said in an email.

At the National Assembly, Quebec Liberal MNA André Fortin described the way the Coalition Avenir Québec government has been managing the situation as a "total fiasco," and asked, "how could it have failed so badly?"

In response, Dubé pointed to the former Quebec Liberal government, saying "signing just about anything with the doctors [in 2015] is not our way of working."