Ontario family physicians are increasingly being asked the same question:

Which model actually fits how I want to practice?

The answer depends less on “which pays more” and more on how you want your day to look.

Some physicians prefer a high-volume clinic with full control over pace and income. Others want a stable roster and predictable workflow. And more recently, many are looking for a model that better reflects the full scope of family medicine, including all the work that happens outside the visit.

This is where understanding the differences between FHG, FHO, and FHO+ becomes important.

A quick note on income:

There is no single “average” income in any of these models.

What physicians earn depends heavily on:

• roster size and patient complexity

• clinic efficiency and visit volume

• preventive bonuses and incentives

• uninsured services and additional work

• overhead and clinic structure

The ranges in this article are illustrative and based on common practice patterns, not guarantees.

High-level comparison

Here’s the simplest way to think about the three models:

• FHG → best for volume, flexibility, and direct fee-for-service income

• FHO → best for stability, panel management, and continuity of care

• FHO+ → best for comprehensive care, work-life balance, and being paid for the full scope of work

Family Health Group (FHG):

The high-autonomy, volume-driven model

FHG is an enhanced fee-for-service model. It appeals to physicians who want control over their schedule and a direct relationship between the work they do and how they are paid.

What it looks like in practice

A typical FHG physician might:

• work 4 to 5 days per week

• see 25 to 40 or more patients per day

• run a mix of episodic and longitudinal care

Income (illustrative range)

Typical gross annual billings:

• avg. $480,000 to $600,000+

This reflects a high-efficiency, high-volume practice pattern.

Additional income sources

FHG physicians may also earn:

• preventive care bonuses (e.g., cancer screening targets)

• chronic disease management incentives

• a comprehensive care premium on eligible services

These can add meaningful income depending on performance and patient population.

Where FHG works well

• Strong control over schedule and workflow

• Clear link between activity and income

• High earning potential with efficient volume

• Less dependence on roster size

Where it can be challenging

• Income tied heavily to patient volume

• Limited compensation for indirect or administrative work

• Can lead to pressure to maintain a busy clinic

Quick summary

FHG is best suited for physicians who:

• like a fast-paced environment

• prefer autonomy

• are comfortable with volume-driven income

Family Health Organization (FHO):

The stable, roster-based model

FHO is built around capitation, where physicians are paid primarily for managing a defined patient panel.

It supports continuity, prevention, and long-term care.

What it looks like in practice

A typical FHO physician might:

• work around 3 to 4 days per week

• manage a roster of 1,000 to 1,800 patients

• balance visits with preventive and chronic care

Income (illustrative range)

Typical gross annual income:

• avg. $250,000 to $340,000 for smaller to mid-sized rosters

• avg. $340,000 to $460,000+ for larger, efficient rosters

Additional income sources

FHO physicians may earn additional income through:

• preventive care bonuses

• chronic disease management incentives

• access and continuity-related incentives

• shadow billing

• selected fee-for-service services

These can significantly impact total income depending on practice style.

Where FHO works well

• More predictable income compared to FHG

• Supports longitudinal, relationship-based care

• Less reliance on daily visit volume

• Incentivizes prevention and chronic disease management

Where it can be challenging

• Indirect care and admin work are not well compensated

• Structural limits on certain fee-for-service activities (often experienced at the group level)

• Income can be affected by outside use (negation in current model)

Quick summary

FHO is best suited for physicians who:

• want stability and predictability

• value continuity of care

• prefer a panel-based practice

FHO+ (Starting April 2026):

The modernized comprehensive care model

FHO+ builds on the FHO structure but better reflects how family medicine is actually practiced today.

It recognizes both direct and indirect care.

What is changing

FHO+ introduces:

• hourly payment for eligible work (around $80 per hour)

• compensation for indirect care and some administrative work

• removal of negation

• higher shadow billing rates

• increased after-hours premiums

• continuity expectations around 75 percent

What it looks like in practice

A typical physician might:

• work 3 to 4 days per week clinically

• manage a roster of 1,000 to 1,800 patients

• spend more time on coordination, follow-up, and team-based care

Income (illustrative range)

Typical gross annual income:

• avg. $290,000 to $390,000 for smaller to mid-sized rosters

• avg. $390,000 to $520,000+ for larger, efficient rosters

Additional income sources

In addition to capitation, FHO+ includes:

• hourly billing for clinical and indirect work

• enhanced shadow billing

• preventive and chronic care incentives

• after-hours premiums

This creates a broader and more balanced income structure.

Where FHO+ works well

• Better alignment with real-world family medicine

• Compensation for indirect care and coordination

• Reduced reliance on visit volume

• Improved overall sustainability

• Less financial friction from outside use

Where it can be challenging

• Requires more structured time tracking

• Includes continuity expectations

• Still includes limits on certain fee-for-service activities at a group level, though less central to income

Quick summary

FHO+ is best suited for physicians who:

• want a sustainable, long-term practice model

• value work-life balance

• want to be paid for the full scope of care

Income comparison:

• FHG
  
  avg. $450,000 to $600,000+ annually
  
  driven by volume and efficiency

• FHO
  
  avg. $250,000 to $460,000+ annually
  
  driven by roster size, incentives, and panel management

• FHO+
  
  avg. $290,000 to $520,000+ annually
  
  driven by capitation, hourly payments, and broader compensation

Work-life comparison

• FHG
  
  high flexibility, but income tied to volume

• FHO
  
  more balance, with moderate structure

• FHO+
  
  strongest alignment with sustainable practice and modern workflow

Final thoughts

Each model serves a different type of physician.

FHG offers autonomy and strong earning potential for those comfortable with volume.

FHO provides stability and supports traditional family practice built around patient panels.

FHO+ reflects the direction primary care is heading. It acknowledges that care extends beyond the visit and begins to compensate physicians accordingly.

For physicians thinking about long-term sustainability and balance, FHO+ is likely to feel like a more complete model.