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Luc Chagnon and his team of emergency-room doctors treat almost as many Quebec patients as Ontario residents in their Ottawa-area hospital. The only problem is his colleagues across the river are getting paid more for providing the same urgent care.

Quebec has long opted out of an agreement among provinces that guarantees Canadians receive medical coverage at no additional charge when they travel within the country. The government compensates out-of-province physicians based on Quebec rates, which are, on average, the lowest in Canada.

Yet, Dr. Chagnon, chief of staff at Hawkesbury and District General Hospital, and other emergency-room physicians on the eastern boundary of Ontario have been for years denied a fee top-up or shift modifiers, amounting to as much as 30 per cent above the base rate, that Quebec doctors receive for treating patients on evenings, nights and weekends.

"It's like our physicians do discount work for Quebec patients," Dr. Chagnon said.

The issue is particularly challenging for emergency-room doctors along the provincial boundary. The lack of hospital facilities and long waiting times in the immediate region across the river means that they are regularly treating Quebec patients at lower rates. Doctors at Dr. Chagnon's hospital are licensed to practise in Quebec and even belong to the Fédération des médecins omnipraticiens du Québec. They don't want to turn away those needing urgent care, or bill them directly.

"Border areas tend to be economically and socially integrated and our doctors respect this reality," said Marc LeBoutillier, chief executive officer of the Hawkesbury and District General Hospital, who added that it's a "flagrant injustice" that doctors at his hospital are being paid less than Quebec doctors for providing similar care.

After much pressure from the province's medical association and years of advocacy by Hawkesbury doctors, the Quebec government late last month pledged to change its rule, applying the modified fee to doctors outside the province.

"I don't think they had too much choice. They were feeling the pressure," Dr. Chagnon said. He remains hopeful that the fees will be applied retroactively.