1. Family Health Organization (FHO)

A blended capitation model where physicians receive a base payment per enrolled patient, with additional incentives and bonuses.
Key Features:

• Group Practice: Requires 6 or more physicians working in close proximity or within the same clinic.
• Patient Enrollment: Physicians commit to enrolling patients.
• After-Hours Care: The group must provide 5+ after-hours clinics (3 hours each) based on its size.
• Compensation: A mix of per-patient payments, fee-for-service billing, and bonuses for preventive care and chronic disease management.
• Agreement: Physicians must sign a contract to participate.

2. Family Health Network (FHN)

A model designed to deliver comprehensive primary care through a smaller group-based practice, blending capitation with fee-for-service elements.
Key Features:

• Group Practice: Typically requires a minimum number of physicians to work collaboratively.
• Patient Enrollment: Physicians are responsible for enrolling patients to maintain continuity of care.
• Blended Payment: Combines capitation payments with fee-for-service billing, encouraging proactive care and appropriate service use.
• Quality Incentives: Provides bonuses for meeting established quality and preventive care targets.
• Contractual Commitment: Physicians sign formal agreements outlining care delivery expectations.

⚠️ Note: Although you can join a FHN, no new FHN’s are being formed in Ontario.

Family Health Teams (FHTs) – FHO/FHN with Additional Ministry Funded Support

A FHT is not a physician payment model, but an interdisciplinary healthcare team attached to an FHO or FHN model, providing additional resources to patients of the group, some of which can include:

• Mental Health: Access to counseling, therapy sessions, and support from mental health professionals.
• Diabetes Education: Structured programs for self-management training, monitoring, and education on lifestyle adjustments.
• Dietician Services: Personalized nutritional counseling, meal planning, and guidance for managing chronic conditions.
• Physiotherapy: Rehabilitation services aimed at improving mobility, managing pain, and supporting recovery from injuries.
• Additional Allied Health Supports: May also include services such as occupational therapy and wellness coaching, complementing the core offerings.

⚠️ Note: While physicians can join existing FHO/FHN groups with FHT funding, new FHT applications are currently suspended.

3. Family Health Group (FHG)

A hybrid model combining fee-for-service with additional incentives for patient enrollment.
Key Features:

• Group Practice: Requires 3 or more physicians working together in close proximity.
• Patient Enrollment: Physicians commit to enrolling patients.
• After-Hours Care: Requires 3+ after-hours clinics (3 hours each) based on group size.
• Compensation: Primarily fee-for-service, with small bonuses for patient enrollment and preventive care.
• Agreement: Physicians sign a contract to participate.

4. Community Health Centres (CHC)

A salaried model focused on underserved communities, integrating healthcare with social services.
Key Features:

• Interdisciplinary Care: Employs physicians alongside nurse practitioners, social workers, outreach workers, and kinesiologists.
• Salary-Based Compensation: Physicians are paid a salary rather than billing OHIP.
• Community Focus: Serves marginalized populations, addressing social determinants of health (e.g., housing, literacy, nutrition).
• Extended Hours: Many CHCs offer regular and extended clinic hours.

5. Walk-In Clinics (Non-Enrolling, Fee-for-Service)

Physicians working in walk-in clinics do not enroll patients and bill OHIP on a fee-for-service basis.
Key Features:

• Compensation: 100% fee-for-service (physicians bill OHIP directly for each patient visit).
• Agreements: Overhead costs and revenue splits are negotiated with the hiring clinic.
• Set Shifts: Work schedules depend on clinic availability and agreed terms.

6. Alternate Funding Models (AFAs & APPs)

Models that provide stable, predictable income in settings where traditional fee-for-service is less effective.
Key Features:

• Stable Funding: Physicians receive a negotiated lump sum payment rather than billing OHIP for each service.
• Group Agreements: Involves contracts with the Ministry of Health, often in collaboration with the Ontario Medical Association (OMA), hospitals, or universities.
• Shadow Billing: Physicians under APPs may still submit claims to OHIP for tracking purposes, potentially earning additional incentives.
• Support for Rural/Underserved Areas: Helps maintain access to critical services in challenging settings.

7. Comprehensive Care Model (CCM)

A fee-for-service model for a single physician to enroll patients, generally serving as an interim arrangement until the physician can join a Family Health Group (FHG) or Family Health Organization (FHO).
Key Features:

• Individual Enrollment: Designed for one physician to enroll patients independently.
• Fee-for-Service with Bonuses: Compensation is primarily fee-for-service but includes small bonuses for patient enrollment.
• Interim Solution: Often used as a temporary model until transitioning to a group-based model (FHG/FHO).

8. Blended Salary Model (BSM)

A hybrid compensation approach where physicians receive a guaranteed base salary supplemented by fee-for-service or incentive-based payments.
Key Features:

• Guaranteed Base Salary: Offers financial stability and predictability independent of patient volume.
• Incentive Opportunities: Provides additional earnings based on performance metrics, patient outcomes, and service provision.
• Team Integration: Often supports collaborative, team-based care environments.
• Predictable Income: Balances secure salary with extra compensation for high-quality or increased service.
• Streamlined Administration: Reduces billing complexities by integrating salary components with selective fee-for-service elements.

Specialist Physician Compensation Models

1. Fee-for-Service (FFS) – OHIP Billing

The traditional model where specialists bill OHIP directly for each service provided.

Key Features:

• Most surgical, procedural, and consult-based specialists use this model.
• Billable rates are set by OHIP through the Schedule of Benefits.
• Specialists may work in hospitals, outpatient clinics, or private offices.

⚠️ Challenges: Unpredictable income, high administrative burden, and dependence on patient volume.

2. Alternative Funding Arrangements (AFAs) & Alternative Payment Plans (APPs)

Specialist groups can receive lump sum payments from the Ministry of Health instead of billing OHIP per service.

Key Features:

• Provides stable and predictable funding.
• Common in rural and underserviced areas (e.g., emergency medicine, psychiatry, internal medicine).
• Many academic hospitals use APPs for specialists, particularly in teaching and research roles.

🔹 Example: The Hospital On-Call Coverage (HOCC) Program provides stipends for specialists required to be on-call.

3. Academic Health Science Centre (AHSC) Alternative Funding Plans (AFPs)

Physicians affiliated with academic hospitals (e.g., UHN, Sunnybrook, McMaster, Western, Ottawa) can receive funding through AHSC AFPs.

Key Features:

• Used for teaching, research, and clinical care in university-affiliated hospitals.
• Physicians receive a salary-like payment instead of fee-for-service.
• Includes performance-based funding for education and research contributions.

4. Hospital-Based and Session-Based Funding Models

Many specialists work in hospital-funded positions where compensation is based on sessions or service agreements rather than OHIP billing.

Key Features:

• Hospitalist Programs – Internal medicine specialists, geriatricians, and general internists often work under hospitalist contracts.
• Psychiatrists in Community Hospitals – Some psychiatrists receive sessional funding for outpatient clinics and inpatient units.
• Critical Care Physicians – Many ICU specialists work under session-based funding for shifts in intensive care units.

For more information please visit Ontario Medical Association