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.

(1, 2, 8) Income Stabilization

In Ontario’s healthcare system, certain physician compensation models include “Base Payment for Income Stabilization” as part of their funding agreements. This is particularly relevant for physicians under models like the Blended Salary Model (BSM), Family Health Organization (FHO), and Family Health Network (FHN). These payments are designed to provide financial stability to physicians, especially those practicing in underserved areas while they build their practice in Ontario under these models.

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.