Ontario’s family physicians primarily bill OHIP (Ontario Health Insurance Plan) as their primary source of revenue. There are a variety of different types of models in which you can bill/enroll your patients that pay differently based on your preferred model of care.
Family Health Organization (FHO)
- 6 or more physicians working as a group in close proximity or in the same office space
- Physicians commit to enroll patients
- Regular office hours and 5+ after-hours blocks (3 hours) based on the number within the group
- Physicians sign an agreement to join this model
- Blended capitation model – complement-based remuneration plus bonuses and incentives
FHO Models with Family Health Teams Funding (FHT)
- Family Health Teams are interdisciplinary teams that are funded by the Ministry of Health that are attached to FHO or FHN models. Physicians can join existing FHO/FHN groups with FHT funding, but new FHT applications are currently suspended.
Family Health Group (FHG)
- 3 or more physicians practicing together either in the same office or in close proximity
- Physicians enroll patients
- Regular office hours and 3+ after-hours blocks (3 hours) based on the number within the group
- Signed agreement to join
- Fee for service model with a smaller bonus for enrolling patients
Community Health Centres (CHC)
- CHCs are interdisciplinary teams that serve communities and populations who may have barriers to health services. They focus on addressing the underlying conditions that affect people’s health, such as social determinants of health, diet and literacy.
- The CHC employs multi-disciplinary healthcare professionals such as nurse practitioners, social workers, outreach workers and kinesiology.
- Regular and extended hours
- Physicians who work in a CHC setting are salaried employees.
Walk-In Clinics (Non-Enrolling Fee for Service)
- Agreements, overhead split, and hours can be discussed with the hiring clinic. These are fee-for-service opportunities with set shifts.
Physicians who are looking at retiring are encouraged to contact the regional physician recruiter for a consult and to help create a strategy for attracting the right physician to take over your practice, space and/or patient roster.
Alternate Funding Models
The alternate funding model for physicians in Ontario, known as Alternate Funding Arrangements (AFAs), was introduced to address challenges in maintaining adequate physician staffing, especially in small and rural emergency departments (EDs). Here are the key points:
- Introduction and Purpose: AFAs were introduced in the mid-1990s and officially implemented in 1999 by the Ontario Ministry of Health and Long-Term Care (MoHLTC). The primary goal was to ensure around-the-clock access to emergency services by providing a stable and predictable funding model1.
- Contractual Agreements: Under AFAs, groups of physicians enter into contractual agreements with the MoHLTC. These agreements often involve the Ontario Medical Association (OMA) and may include other organizations such as hospitals and universities2.
- Payment Structure: Instead of the traditional Fee-For-Service (FFS) model, physicians receive a negotiated lump sum payment. This arrangement aims to provide consistent funding and reduce the administrative burden associated with billing under the FFS system1.
- Shadow Billing: In some cases, physicians practicing under Alternative Payment Plans (APPs) or certain primary care funding models are required to “shadow bill.” This means they submit claims as if they were billing under the FFS system, which helps track services provided and may generate additional premiums3.
The Southern Ontario Physician Recruitment Alliance uses Ministry of Health datasets along with up-to-date local statistics to plan for physician needs. This data includes the number of physicians and capacity gaps benchmarked with the population.
