Cabinet positions usually get decided after an election but, in the early days of the Quebec provincial campaign, one of the dominant storylines has been who will be the next health minister.

In an unusual move, Premier Philippe Couillard introduced rookie Liberal Party candidate Gertrude Bourdon by saying she would be the next health minister.

His rival, François Legault, leader of the Coalition Avenir Québec (CAQ) party, followed by hinting strongly that Danielle McCann would take the helm of the massive health portfolio after a CAQ victory.

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Even more noteworthy than who the new provincial health minister could be is who definitely will not be health minister.

Taking Gaétan Barrette – who has been Health Minister for the past four years – out of the equation is being widely hailed as bolstering the Liberal chances of re-election.

Mr. Barrette has been a polarizing figure. Still, he is loyal to Premier Couillard and, as such, has been promised the post of Treasury Board president.

A recent public opinion survey found that 81 per cent of Quebeckers, including 60 per cent of Liberal voters, did not want Mr. Barrette to return as health minister. But that poll was commissioned by the CAQ, so perhaps it should be taken with a grain of salt. Not to mention that being a health minister in any jurisdiction is a virtual guarantee of unpopularity.

The Health Minister’s nickname, “Bulldozer Barrette,” is well-earned. He is not exactly a master of tact, but he did get things done.

Mr. Barrette shrunk the provincial health bureaucracy – although he did fall short of a promised “structural and cultural revolution.” He also put the screws to doctors, particularly with rules that forced them to work after-hours and in the ER.

The reforms translated into 1.1 million more Quebeckers having a family physician than when he took office, and the province opened 49 “super-clinics” to take pressure off overcrowded emergency rooms.

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But there are two things that hurt Mr. Barrette’s reputation more than anything: His brusque ways made him look unsympathetic to patients and families, as demonstrated by his dismissive response to media reports that residents of provincial nursing homes were being bathed only once a week; and, while he talked tough with doctors, medical specialists were awarded huge increases in fees.

This put a lot of noses out of joint among health-care professionals, particularly nurses, who have borne the brunt of the government’s austerity measures. The deal is also notable because, before entering politics, Mr. Barrette headed the provincial association of medical specialists.

The CAQ is taking aim at that labour contract with specialists, vowing to rip it up and save taxpayers $1-billion.

Just before the election campaign officially started, there were media reports that Ms. Bourdon, chief executive of the Centre hospitalier universitaire de Québec, would be the CAQ’s star candidate and future health minister.

But, apparently, she had a change of heart because she felt that ripping up a signed deal would be wrong and became a Liberal candidate instead.

The CAQ exacted some political revenge for the flip-flop by leaking Ms. Bourdon’s private e-mail exchanges with the party which, among other things, saw her asking for an 8-per-cent increase in the health budget. That could come back to haunt her if she does end up as Liberal health minister.

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The CAQ also acted quickly to find its own future health minister to present to the public. Ms. McCann is the former head of the Agence de la santé et des services sociaux de Montréal, a large regional health agency.

Ms. McCann made clear that she would have no problem tearing up the contract with specialists and renegotiating a new deal that would be less costly to the treasury.

In the process, Mr. Legault dashed the hopes of Lionel Carmant, a pediatric neurologist at Sainte-Justine Hospital, who was widely touted as health minister material.

If the polls are to be believed, the Quebec election, which will take place on Oct. 1, is essentially a two-way race between the Liberals and the CAQ. The two other major parties, Parti Québécois and Québec solidaire, are given little chance of forming government.

That means that the next provincial health minister will be a woman and a seasoned health administrator. That’s a seismic shift in a province that has had a male doctor in charge of the health portfolio for the past 15 years.

As Premier Couillard (himself a doctor) said: “It’s 2018, time for a new era, a new perspective.”