Choosing the right primary care payment model in Ontario can significantly impact a physician’s income, workflow, and long‑term practice sustainability.

Many physicians are familiar with the basic differences between Fee‑For‑Service (FFS), Family Health Group (FHG), and Family Health Organization (FHO) models. However, very few discussions go into the actual financial implications, including the bonuses and incentives available under each structure.

This article provides a clear comparison of the three models, including the potential revenue advantages physicians can earn under each.

Note: This article reflects the structure of the current models as they exist today. The Ministry and OMA have introduced a new model known as FHO+, which is expected to evolve further in the coming years. When those changes fully take effect, we will update this article accordingly.

Overview of Ontario Primary Care Payment Models

 

Model	Payment Structure	Patient Roster	Bonuses Available
FFS	Pure fee‑for‑service	No	Limited
FHG	Enhanced fee‑for‑service	Yes	Multiple
FHO	Blended capitation	Yes	Reduced preventive bonuses

1. Fee‑For‑Service (FFS)

Under the traditional Fee‑For‑Service model, physicians bill OHIP directly for each service provided.

Key Characteristics:

• Paid entirely based on services performed
• No patient roster required
• No group obligations
• No preventive care bonuses
• No after‑hours premium requirements

Advantages:

• Maximum flexibility
• No administrative model requirements
• Ideal for walk‑in clinics or episodic care

Disadvantages:

• Income tied entirely to patient volume
• No population‑based incentives
• No preventive care bonuses
• No roster‑based funding

2. Family Health Group (FHG)

The Family Health Group model allows physicians to maintain traditional fee‑for‑service billing while gaining access to additional incentives through patient enrolment.

Physicians in an FHG:

• Continue to bill 100% fee‑for‑service
• Enroll patients to their roster
• Participate in a group for after‑hours coverage

Financial Advantages of FHG

Preventive Care Bonus

The Cumulative Preventive Care Bonus rewards physicians for achieving screening and immunization targets across their roster.

The program includes five categories:

• Influenza vaccinations – up to $2,200
• Childhood immunizations – up to $2,200
• Pap smear screening – up to $2,200
• Mammography screening – up to $2,200
• Colorectal cancer screening – up to $4,000

Total potential annual bonus: approximately $12,800 per physician if screening targets are met.

Many physicians report earning between $6,000 and $10,000 annually depending on compliance rates and roster size.

After‑Hours Premium

FHG groups must provide after‑hours clinics for rostered patients.

When services are provided during these clinics, physicians can bill an additional 30% premium on certain visit codes.

Example:

A007 visit = $37.60 
After‑hours premium = +30% ($11 additional)

A physician providing approximately 300 after‑hours visits annually could generate roughly $3,000–$3,500 in additional revenue.

Realistic FHG Income Impact

For a typical family physician with a roster of 1,500–2,000 patients:

Preventive care bonuses: $6,000 – $12,800 
After‑hours premiums: $2,000 – $5,000 

Total additional income potential: approximately $10,000 – $20,000+ annually while still billing full fee‑for‑service.

3. Family Health Organization (FHO)

The Family Health Organization model operates differently from both FFS and FHG.

Instead of relying primarily on fee‑for‑service billing, physicians are paid through capitation. This means physicians receive an annual payment for each enrolled patient, adjusted for age, sex, and complexity.

Key Revenue Components in FHO

Capitation

Physicians receive an annual payment for each rostered patient.

Example (illustrative):

1,500 patients = $250,000 annually 
1,800 patients = $300,000 annually

Actual payments vary depending on patient demographics and complexity.

Access Bonus

FHO physicians may receive an Access Bonus calculated as a percentage of their capitation.

However, this bonus can be reduced when rostered patients receive care outside the group, such as visits to walk‑in clinics.

Preventive Care Bonuses (Current Rules)

Changes introduced through the Physician Services Agreement reduced preventive bonuses for FHO physicians.

Currently, FHO physicians remain eligible for:

• Influenza vaccination bonus – up to $2,200
• Childhood immunization bonus – up to $2,200

Total potential bonus: up to $4,400 annually.

Comparing the Models

Feature	FFS	FHG	FHO
Payment type	Pure FFS	Enhanced FFS	Capitation
Patient roster	No	Yes	Yes
Preventive bonuses	No	Yes	Limited
After‑hours premium	No	Yes	Yes

Which Model Earns the Most?

The answer depends largely on how a physician practices.

Physicians focused on high‑volume visits often prefer Fee‑For‑Service.

Physicians who actively manage preventive care and screening programs frequently benefit from the Family Health Group model because they retain full fee‑for‑service billing while gaining access to preventive bonuses and after‑hours premiums.

Physicians seeking income stability often prefer the Family Health Organization model because capitation provides predictable revenue regardless of visit volume.

The Bottom Line

Ontario’s primary care payment models reward different styles of practice.

• FFS rewards high visit volume
• FHG rewards proactive population health management
• FHO rewards stable patient panels

For physicians willing to actively manage their patient panel and preventive care programs, the Family Health Group model often provides strong financial upside while preserving fee‑for‑service billing flexibility.

Final Note on Upcoming Changes

Ontario’s primary care system continues to evolve.

The Ministry of Health and the Ontario Medical Association are introducing an updated model known as FHO+. This new model will change aspects of physician compensation and access requirements.

This article reflects the current models as they exist today. We will update this guide as additional changes are implemented.