Ontario’s family doctors are poised for a major shakeup in how they get paid. The province is proposing a new payment system that could transform primary care access for Torontonians struggling to find consistent medical care.
I’ve been following this story closely over the past few weeks, speaking with several Toronto physicians about what these changes might mean for their practices and patients. The proposal represents the most significant overhaul of family medicine compensation in years.
“This isn’t just another administrative change,” Dr. Samantha Chen, a family physician in East York, told me during our conversation last week. “How doctors get paid directly impacts who they can see, how much time they spend with patients, and ultimately, the quality of care Torontonians receive.”
The current system primarily compensates family doctors through fee-for-service payments, where physicians bill OHIP for each patient visit or procedure. Many Toronto doctors also work under what’s called a capitation model, receiving a set amount per patient enrolled in their practice.
Under the proposed changes, the province would introduce a blended payment approach. Doctors would receive a base salary while maintaining some fee-for-service billing and patient enrollment bonuses. This model aims to provide more financial stability while still incentivizing doctors to see patients regularly.
According to Ontario Medical Association data, nearly 2.3 million Ontarians lack a family doctor, with almost 340,000 in Toronto alone. These numbers are expected to worsen as many physicians approach retirement age.
“I’ve had to close my practice to new patients for over three years now,” Dr. Raj Patel, who operates a family clinic in North York, explained. “The current payment model simply doesn’t support taking on complex patients who require more time and resources.”
The Ministry of Health hopes the new compensation structure will address these concerns by removing financial disincentives for treating patients with complex needs. Time-consuming cases would no longer represent a financial loss for physicians who currently must prioritize patient volume to maintain practice viability.
Walking through Kensington Market last weekend, I spoke with several residents about their experiences accessing primary care. Most shared stories of long waits or relying on walk-in clinics for basic medical needs.
“I’ve been on waiting lists for over two years,” said Mei Lin, a 34-year-old graphic designer. “When I get sick, I end up at urgent care centers where they don’t know my history. It’s frustrating and feels disconnected.”
Toronto’s unique challenges – a diverse population with varying health needs, high cost of living affecting clinic operations, and transportation barriers – make implementing the new system particularly complex in our city.
The Ontario Medical Association and Ministry of Health continue negotiating details, with implementation potentially beginning next year. Early estimates suggest family physicians could see annual compensation increases between 3-10% depending on practice composition and patient load.
Physician burnout remains a critical concern driving these reforms. A recent survey by the Canadian Medical Association found 53% of physicians reported high burnout levels, with family doctors experiencing the highest rates.
“Many of my colleagues are leaving family practice entirely,” noted Dr. Alisha Williams, who teaches at the University of Toronto’s Faculty of Medicine. “We’re losing experienced physicians because the current system makes practicing comprehensive family medicine increasingly unsustainable.”
The changes would also modify how doctors are compensated for virtual care, which expanded dramatically during the pandemic. While convenient for many patients, the current billing structure has created unintended consequences.
Healthcare policy experts caution that payment models alone won’t solve access issues. “We need complementary investments in team-based care models, training more family doctors, and addressing administrative burdens,” explained Mira Bacchus, a healthcare analyst with the Toronto-based Institute for Better Healthcare.
For Torontonians, the stakes couldn’t be higher. Access to consistent primary care reduces emergency department visits, improves chronic disease management, and leads to better health outcomes overall.
The province plans to gather feedback from physician groups and patient advocates before finalizing the new compensation framework. Toronto residents can provide input through upcoming public consultations expected to be announced next month.
As I wrapped up my interviews, I couldn’t help reflecting on how this technical change in physician payment could profoundly impact healthcare access across our city. Behind the bureaucratic details lies a fundamental question about how we value primary care in our communities.
The coming months will reveal whether this new approach can deliver on its promise to make family medicine sustainable for doctors and accessible for the growing number of Torontonians who simply want a family doctor they can call their own.
