Ontario SGFP praises proposed new compensation model for Ontario’s family doctors

Family medicine in Ontario has reached a critical turning point.This week, details are being shared about a refreshed family medicine compensation model, proposed as part of the 2024–2028 Physician Services Agreement. Developed through over a year of collaboration between the Ontario Medical Association’s Negotiations Task Force and members of the Section on General and Family Practice (SGFP), the model reflects extensive feedback from family physicians across the province.A model grounded in fairnessRevisions to Ontario’s main capitation model, the Family Health Organization or FHO, were long-overdue. Family doctors have long voiced concerns that the nearly 20-year-old model no longer reflects today’s practice. It’s been neither rewarding nor sustainable for new graduates or those in community practice.The new model eliminates the controversial “negation” mechanism (Ontario is the only province with this punitive measure), reinstates bonuses for patient attachment, and introduces an hourly rate for both direct patient care, administrative work and essential indirect work, such as charting, care coordination, and follow-up. These changes support fairer compensation, better reflect the realities of providing primary care, and represent a significant step toward addressing gender pay disparities through time-based billing.Importantly, the SGFP was clear that the new model needed to preserve existing capitation rates while introducing targeted investments in an hourly rate that could result in an average overall business income increase of 18%. It also boosts shadow billing and after-hours premiums and introduces new incentives focused on attachment and access; both critical elements for improving continuity and coverage in primary care. The new model has been coined the FHO+.Aligning with national momentumAcross Canada, provincial governments have been responding to a shared crisis in family medicine. From British Columbia to Nova Scotia, new agreements have emerged to address the shortage of comprehensive family physicians and to stabilize the system. Ontario, by contrast, has been overdue for meaningful change. The FHO+ is Ontario’s long-awaited response to the progress made in other provinces. Adapting to the practice realities of family medicine today is a critical opportunity to stem the flow of family doctors leaving or avoiding comprehensive primary care altogether.We know this erosion has had a direct impact on patients—contributing to the growing number of unattached individuals without regular access to a family doctor, and driving burnout across the profession. FHO+ supports the Ontario government’s stated priority to ensure family medicine remains the front door to the health system, by attaching more of the population to consistent, longitudinal care.If implemented well, this model could be the lever Ontario needs to rebuild its health care system around accessible, comprehensive, cradle-to-grave family medicine. We know this is what patients want—and deserve.Optimism, tempered by realismThe FHO+ signals meaningful progress. For the first time in years, many family physicians will feel seen, heard, and valued. The FHO+ is not just a funding mechanism, it’s recognition that the way family doctors practice has changed with the needs of patients, and it provides a commitment to the sustainability of comprehensive family medicine. The SGFP has been steadfast in the need for immediate and significant changes, and there is hope that the FHO+ will bring some relief to the profession.But it’s not a panacea.We know that over two million Ontarians still lack a family doctor, and this number continues to grow. Physicians report burnout, workload stress, and administrative burdens that remain unaddressed. FHO+ is a major milestone, but not the final destination. Key issues such as long-term funding for infrastructure, administrative supports, and equitable access in underserved areas require continued focus in our advocacy and actions.What’s next?The arbitration process continues. Critical decisions, especially those related to accountability and continuity, are expected from Arbitrator William Kaplan this fall. The SGFP and the OMA are advocating for solutions that support good practice rather than penalizing the profession. The vast majority of family doctors are consistently providing high-quality care. Accountability measures should reflect that reality and not undermine trust.A pivotal momentThis is a moment to acknowledge how far we’ve come in Ontario. And the SGFP is acutely aware of how far we still need to go to fully address the family medicine crisis.FHO+ represents alignment between family physicians, the OMA, and the provincial government. It is a reminder of what collaboration and tenacity can achieve. But lasting change will only come with continued vigilance, strong advocacy, and mutual support.We have an opportunity and a responsibility to rebuild the foundation of family medicine in Ontario and contribute to a broader renewal across Canada. Let’s make it count.Dr. David Barber is the SGFP chair for Ontario and Dr. Salesh Budhoo is the SGFP tariff lead.

Ontario SGFP praises proposed new compensation model for Ontario’s family doctors

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