Ontario’s family doctors could soon have a new compensation system. Here is how it will work

A doctor holds files in this undated stock photo.

Ontario family doctors could soon be subject to a new compensation system as part of the province’s efforts to incentivize physicians to work as general practitioners.

Ontario Medical Association CEO Kimberly Moran tells CTV News that negotiations on the new system are ongoing but that she believes a deal can be reached within months.

She said that while the matter is still under an arbitration board’s review an agreement has already been reached with the Ontario government on “most of the elements.”

The focus of the new system would be to pay doctors for the time they spend doing administration, as well as the time they spend providing medical care, Moran says. Right now, family doctors are not compensated for the time they spend working on administration or with specialists on behalf of their patients.

Instead, doctors operate under either a fee-for-service model, in which they are reimbursed under the Ontario Health Insurance Plan (OHIP) for every service they provide a patient or an enrollment system, in which they are paid a set amount per patient, regardless of how many times they see them.

“What this incentivized compensation model does is that it recognizes the work that’s done by doctors that they have talked about as very challenging and that is a lot of critical administration,” Moran said of the new proposed model. “It directly compensates that for them, so for example if you need referral to a specialization or if the family doctor needs to talk to your specialist about something, like none of that time is compensated. But now its going to be, so that’s great.”

Ontario has long had a shortage of family doctors. The provincial government has pledged to make sure that every Ontarian has a family doctor by 2029 and Moran said she is hopeful the new system will convince more physicians to enter family medicine.

The OMA represents 31,500 practicing physicians in Ontario.

“The hope is that it will attract new physicians to the field, keep those who are practicing now and entice other doctors who have moved away from that kind of medicine back to practice medicine there,” she said.

A spokesperson for Minister of Health Sylvia Jones tells CTV News that the government and the OMA have been been engaged in “good faith negotiations to build a modernized compensation model for comprehensive primary care.”

Jackson Jacobs said that the new model will effectively replace the existing Family Health Organization (FHO) model, which he said is currently “the most widely adopted primary care model in Ontario.”

“The FHO+ model incentivizes enrolling new patients, promotes shifting procedures to clinics instead of emergency departments, and strengthens incentives for after-hours care to expand access. For administrative burdens, FHO+ offers hourly pay for physicians covering direct and indirect care, including clinical administration, in addition to other initiatives our government is undertaking, such as AI Scribe solutions.” Jacobs said.

Model aims to get more doctors into family medicine

Ontario is short on doctors of all sorts but Moran emphasized the importance of family doctors right now.

Right now, 2.5 million Ontarians are without a family doctor.

“What we wanted to do with this model was incentivize family doctors, those who have chosen family medicine,” she said. “To have improved compensation is one of the ways we recruit and retain family doctors. It is going to be important over the next decade to make sure we have enough doctors through all of our specialties. But for this time, right now, where attachment to a family doctor is so critical, we wanted to focus here.”

Moran said that under the existing payment system doctors were not compensated for the total time they spent with a patient who may come in “with four, five, six different things to do.”

She said that the new system “means that if the doctor has to spend 45 minutes with a person who has lots of complexity, its going to be compensated properly.”

Minister of Health and Deputy Premier Sylvia Jones was asked about the ongoing negotiations during an unrelated press conference on Wednesday but declined to comment, only offering that there were “very positive movements” and that progress was being made.

“So, as we expand primary care clinicians, opportunities in communities, we want to make sure that those physicians, those clinicians, those nurse practitioners are well supported and we’re doing that work with the OMA. I can tell you to date it has been very positive,” she said.