A primer on Ontario primary care groups

Soon after getting accepted into medical school, students training to become family physicians in Ontario are well-aware of the fee-for-service (FFS) model option.

It’s a traditional model which pays physicians based on the number of services or procedures they provide. Many doctors lament this model as it puts those of them who want to spend more time with their patients at a clear disadvantage.

“FFS is a model that is driven by seeing as many patients as you can in one day and then you earn more money,” says Dr. Nili Kaplan-Myrth, a family physician based in Ottawa. “Family doctors who are practicing FFS across the country are absolutely burned out and done with medicine.” She feels capitation is a better model, which pays by the number of patients on a doc’s roster, regardless of the number of patient visits: Doctors are given a certain amount of pay every month for those patients and you’re also entitled to some shadow billing. It also improves healthcare by incentivizing more one-on-one time between patient and doctor. “It gives you the freedom to spend more time with patients and to not worry about ‘have you seen 20 people today or 10 people today?’” 

Dr. Nili Kaplan-Myrth says FFS is also disadvantageous for women doctors. “There's a gender bias because when we have more patients as a woman physician, we generally have more patients who are women and children and seniors who need more time than a five-minute visit.”

Family physicians interested in capitation have several options—Family Health Teams (FHTs), Family Health Organizations (FHOs), Family Health Networks (FHN) and Family Health Groups (FHG)—but they can vary based on their benefits and how difficult it is to join one. 

Family Health Groups 

Family Health Groups (FHG) is still fee-for-service but offers after-hours care that is shared among a group of doctors. Payment from providing after-hours care is then shared among a group As such, the FHG model allows docs to earn more money than through a fee-for-service model. Dr. Kaplan-Myrth noted this model allows physicians to earn some preventative care bonuses not available in traditional fee-for-service. A 2016 CMAJ study found that after the traditional FFS model, FHGs are the most popular capitation model by physician headcount. 

Family Health Teams

Meanwhile, an FHT is a model in which the Ministry of Health pays for Allied Healthcare Services provided, as well. FHTs were introduced in 2005 in an effort to improve community care. Family physicians, nurse practitioners, registered nurses, dieticians and other workers responsible for providing primary healthcare services comprise FHTs. “A lot of doctors would love to be in an FHT where you're working with other allied health professionals, but there are very few of them and they heavily guard their own positions,” says Dr. Kaplan-Myrth. Of the 45% of family physicians who have transitioned to capitation in Ontario, around half are in an FHT.

Family Health Organization

FHOs are similar to FHTs, but are only made up of family physicians. They’re also limited to areas with high demand, such as rural areas. Dr. Kaplan-Myrth went through the process of joining one earlier this year. She says she was met with not only regulatory red tape but hostility from fellow physicians. “It was extremely difficult because the province of Ontario had frozen who could join an FHO for the last decade or so.”

Family Health Networks

For physicians who are interested in a mix of FFS and capitation, an FHN may be an option worth considering. Doctors in an FHN, which is generally comprised of three or more physicians, are paid mainly by capitation, but can also receive some bonuses or premiums depending on the number of patients under their wing. 

We want to learn more about the individual experiences of family physicians who have joined an FHT, FHG, FHO or FHN. If you’re interested in sharing your experience, please get in touch with Srivindhya Kolluru.