Earlier this month, the Ontario government signed the 2024-2028 Physician Services Agreement that is intended to increase physician compensation, add incentives for family doctors to take on new patients, expand after-hours care, and help recruit and retain more family doctors in the province. This agreement represents the next step in Ontario’s efforts to connect everyone in the province to a family doctor or primary care provider by 2029. 

“With this historic agreement, Ontario will be able to attract and retain more physicians, incentivize doctors to take on new patients, and make primary care more connected, convenient, and sustainable for years to come,” Sylvia Jones, deputy premier and minister of health, said in a statement.

While the province has the highest rate of attachment to primary care in Canada, an estimated 1.9 million Ontarians don’t have a family doctor.

The current physician services agreement is part of the Primary Care Action Plan that Ontario launched in January 2025. The plan was developed to help health systems achieve better outcomes, lower healthcare costs, and increase reliance on community care to alleviate the burden on emergency departments and hospitals.

Bolstering Primary Care

Ontario has the largest healthcare workforce and the highest compensation rates for primary care physicians across Canada. For many years, however, these physicians have been spending an average of 19 hours per week on unpaid administrative work. Through the current agreement, existing Family Health Organizations (FHOs) will transition to the new FHO+ model that addresses issues including administrative burden and lagging compensation. The new model is built on time-based billing, in which physicians get paid for reviewing lab results, completing paperwork, and doing other indirect care tasks. In addition, the new model has eliminated negation (ie, financial penalties against physicians whose rostered patients accessed care at walk-in clinics).

“The agreement is a significant step toward making family medicine more sustainable,” Zainab Abdurrahman, MD, president of the Ontario Medical Association, told Medscape News Canada. “The new agreement provides for increases to emergency department funding across Ontario and support for in-hospital anesthesia services, such as physician retention. We’re hoping that these changes will make family medicine more attractive to new doctors and help our medical residents see this as a sustainable model in which to practice,” she said.

Additional measures in the agreement include an increased number of entry-level positions for new doctors and mechanisms to enable physicians to perform minor procedures directly in their offices instead of in the emergency room.

Continued Investment Needed

If the agreement is successful, more doctors will be working in rural and northern communities, as new and modified programs will help recruit and retain them in areas with the greatest need.

Patients with complex health issues will receive improved care as doctors will be given bonuses for their enrolment. The agreement also provides for convenient appointment options, including evenings and weekends, by enhancing compensation for doctors who offer after‑hours care.

“We know from a study we conducted that 95% of Ontarians support having a centralized referral process for appointments with specialists or diagnostic tests. This [process] would be especially valuable if it could inform them of appointment wait times,” Jobin Varughese, MD, family physician at the Toronto Metropolitan University’s Integrated Health Centre in Brampton, Ontario, and president of the Ontario College of Family Physicians, Toronto, told Medscape News Canada.

Varughese would like to see the adoption of tools like AI scribes, which would be paid for by the government and could be integrated into physicians’ daily work and electronic medical record systems, rather than being an add-on that they would have to pay for themselves.

He advocates for multidisciplinary care in which a dietitian, social worker, nurse, and nurse practitioner, for example, work alongside a family physician. “In addition, we’d have other specialists coming through the clinic to provide in-house assessments to work toward a situation where people could receive as much of their care as possible under one roof,” he added.

“We need to see continued investment in and sustained focus on physician-led care and a willingness to adapt systems and processes based on what is actually working on the ground,” said Abdurrahman. “We’ll keep working with Dr Philpott, Minister Jones, and the Ministry of Health to ensure that each investment brings us closer to a situation where every Ontarian has access to a family doctor, and every family doctor has the tools they need to succeed. This new agreement supports the comprehensive cradle-to-grave care that patients value and depend on, but it also provides physicians a best-in-Canada payment model that will attract and hopefully retain a new generation of family doctors,” she concluded.

Abdurrahman and Varughese reported having no relevant financial relationships. 

Evra Taylor is a widely published freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.