A family doctor in Madoc, Ont. is speaking out about an “intimidating” letter he says that he received from the Ministry of Health questioning the “high number” of days he worked over the last year. Approximately 2.5 million Ontarians are currently without a family doctor and the province has previously introduced changes to its primary care payment model that are intended to give family doctors more time to care for patients. Yet, at the same time the Ministry of Health appears to be flagging some family doctors for “high number of days worked in a single year.” Dr. Adam Stewart is among the physicians who recently received a letter from the ministry’s Payment Accountability and Fraud Control Unit identifying what it described as “abnormal” billing patterns. The Ontario Medical Association tells CTV News that they believe “hundreds” of similar letters have been sent to physicians across the province. In an interview, Stewart said the letter, which did not specify how many days he worked or what threshold triggered the warning, left him questioning what the province expects from doctors. “What do they really want us to work less days?” he said. “I know I’m an accurate, honest, hardworking physician, so I know I have nothing to hide.” Stewart first received the letter on Oct. 27 and subsequently posted videos to his social media channels drawing attention to it. The letter said the ministry had identified a high number of days worked under his billing number, adding that patterns of this nature were “uncommon” and warranted “careful review.” It also noted that physicians are “responsible for all claims” submitted under their billing numbers, regardless of who submits them. Stewart described the letter’s tone as “intimidating,” saying it essentially left him with a “watch your back” impression without specifically explaining what he had done wrong. OMA says warning is ‘disappointing’ The nature of family medicine means a doctor’s work rarely ends when the last patient leaves the clinic, Stewart said. He explained that physicians routinely review test results, hospital reports, referrals and prescriptions, while responding to patient questions through their electronic medical records (EMRs). “Unless I leave the country and purposely turn off my phone and email, I am in my EMR every single day,” he said, stressing that being regularly active does not mean he is physically seeing patients every day. Ontario Medical Association President Dr. Rebecca Hicks said that the letters are “incredibly disheartening,” particularly when physicians are working evenings, weekends and holidays to meet patient needs. “To have a physician who is doing exactly what the system is designed to do be flagged for an unusual billing pattern is disappointing,” she said. The government, for their part has “made significant progress” in the second year of its $3.4 billion Primary Care Action Plan, where they touted 511,000 patients recently connected to a primary care provider. Hicks says it’s because of those drastic changes that fellow doctors have increased their capacity to help address the province’s shortage. “We’ve stepped up. We’ve done the work, and we’ve increased our capacity despite the fact that we were working incredibly hard already. And now the reward is a warning letter,” she said. The association is seeking an apology and answers from the province about how physicians were selected, what criteria were used to flag their billing and what the ministry intends to achieve through the letters. “We’ve been asking our family doctors to take on more and see more patients and attach more patients, and yet they are then receiving letters like this. It’s a contradiction,” she said, adding that “the people who lose out are patients.” Province says warning is ‘educational’ Stewart’s concerns come as Ontario moves forward with its modernized Family Health Organization (FHO+) payment model, which took effect April 1, 2026. The model maintains core capitation payments while introducing hourly compensation for eligible direct patient care, indirect patient care and clinical administration. It also provides payment for eligible telephone care delivered outside the physician’s office. In a statement to CTV News, the Ontario Ministry of Health said it regularly communicates with physicians about OHIP billing practices and that the latest outreach was prompted by physicians whose billing was higher than expected based on claims data. “To be clear, the outreach is educational and does not assume billing was inappropriate,” the ministry said. “Abnormal billing” includes more than 15 hours of billed services in a single day, and more than 100 unique patients billed in a single day. A spokesperson for the government also acknowledged that physicians have different practice models, specialties, patient populations and service arrangements that can legitimately result in higher billing volumes. The ministry pointed to its Patients Before Paperwork initiative, saying changes introduced through the program have saved physicians more than 95,000 hours. It said it continues to work with OMA to modernize the billing system. Stewart, who already has about 1,700 patients, said he worries the letters could make physicians reconsider how much additional work they take on, particularly when they are already stretched thin. “They just attached half a million patients off wait lists to family doctors, but they didn’t make 500 or 1,000 new family doctors, so we’re all having to work a little bit harder,” he said. He believes physicians who received the letters deserve a clearer explanation from the province. “The government, the minister of health, and maybe the premier probably owe every single doctor who received this letter a sincere apology, a letter of appreciation, and a thank-you for all the hard work you’re doing,” he said.
