How Family Doctors Are Paid in Ontario (2026): FHO, FHO+ and Primary Care Billing Models Explained

If you are considering practising family medicine in Ontario, one of the most important things to understand is how physicians are paid.

Ontario does not operate under a single billing system. Family doctors work under several primary care payment models, each structured differently. With the introduction of FHO+ in April 2026, the system is evolving again.

This guide explains:

• How OHIP billing works

• The difference between fee-for-service and capitation

• What FHO and FHO+ actually mean

• How Ontario primary care payment models translate into income

If you are researching Ontario GP salary, Ontario capitation models, or FHO+ 2026, this article provides a clear overview.

The Foundation: How OHIP Billing Works

All physician payment in Ontario flows through OHIP (Ontario Health Insurance Plan).

Every insured medical service has:

• A billing code

• A defined payment amount

When a family doctor sees a patient, a claim is submitted to OHIP. Payment is made according to the Schedule of Benefits.

From there, clinic overhead is deducted according to the physician’s contract.

All Ontario primary care payment models operate on top of this system.

The Two Core Ways Family Doctors Are Paid in Ontario

Every Ontario primary care model falls into one of these structures:

• Activity-based payment

• Capitation-based payment

• Salary-based employment

Understanding the difference between these structures is essential when reviewing any offer.

Fee-For-Service

Fee-For-Service is the most straightforward model.

Under this structure:

• You are paid for each insured service you provide

• You bill OHIP per visit or procedure

• Income is directly tied to clinical activity

There is:

• No required patient roster

• No capitation payment

• No model-driven after-hours obligation

This model is entirely volume-based. Income depends on how many patients you see and the types of services provided.

When people search how much Ontario family doctors earn under fee-for-service, the answer depends on workload and service mix.

Comprehensive Care Model (CCM)

The Comprehensive Care Model is largely fee-for-service but includes formal patient enrolment.

Patients are rostered to the physician.

Doctors continue billing most services per visit. However, enrolment allows access to additional incentive payments linked to providing comprehensive, ongoing care.

There is no capitation base payment under CCM. Income remains primarily activity-driven.

Family Health Group (FHG)

Family Health Groups operate primarily under fee-for-service billing within a structured group agreement.

Key features include:

• Physicians practise in a group

• Patients are enrolled

• The group provides defined after-hours coverage

Core income comes from fee-for-service billing, with additional defined payments through the group contract.

Family Health Network (FHN)

Family Health Networks are blended capitation models.

This means physicians are paid in two ways:

• A recurring payment per rostered patient

• Additional payments for specific services

Capitation is a per-patient payment that is adjusted based on demographic factors such as age and sex. Roster size directly influences income.

Most routine visits for rostered patients fall within a defined basket of services.

Physicians still submit billing codes for these visits, but they are often shadow billed. This means the service is recorded but not paid at full fee-for-service value because the physician is already compensated through capitation.

Certain services outside the basket continue to be paid separately.

After-hours coverage is required under FHN agreements.

Family Health Organization (FHO)

The Family Health Organization model has historically been one of the most common capitation-based primary care models in Ontario.

Traditional FHO includes:

• Capitation payments per rostered patient

• Shadow billing for in-basket services

• Fee-for-service for services outside the basket

• Incentive and bonus payments

• Contractual after-hours requirements

Roster size is central to income under FHO.

However, this structure is changing with the introduction of FHO+.

FHO+ Ontario (Launching April 2026)

FHO+ is the new version of the Family Health Organization model and forms part of Ontario’s primary care reform.

It replaces the legacy FHO contract for clinics that transition into the updated agreement.

Capitation remains the foundation, but FHO+ expands how physicians are compensated.

Capitation Remains Central

Physicians continue to receive per-patient payments for rostered patients. Roster size remains a primary driver of income.

Time-Based Billing

Under FHO+, physicians can bill approximately $80 per hour for eligible work, including:

• Direct patient care

• Virtual visits

• Charting and documentation

• Lab review

• Administrative duties

• Roster management

Time is billed in 15-minute increments, subject to daily limits.

This recognises work that was previously uncompensated under traditional capitation models.

Higher Shadow Billing Rates

In-basket services are paid at higher shadow billing percentages compared to legacy FHO, increasing compensation for routine primary care activity.

Removal of the Access Bonus

The previous access bonus structure, which adjusted payment based on patients seeking care outside the group, is removed under FHO+.

Higher After-Hours Premiums

After-hours services receive higher premium payments compared to the traditional FHO model.

Increased Patient Attachment Incentives

Payments for enrolling new patients are significantly increased, encouraging panel growth and improved patient attachment.

Easier Group Formation

FHO+ reduces the minimum number of physicians required to form a group and relaxes geographic restrictions.

What FHO+ Means for Family Doctor Income

For physicians researching Ontario GP salary, FHO+ changes the earning structure in important ways:

• Income is not dependent solely on capitation and shadow billing

• Administrative and indirect care become billable

• After-hours work is better compensated

• Patient attachment is more strongly incentivised

Capitation remains the base, but revenue streams become more diversified.

Salary-Based Roles

Some clinics operate under organisational funding models.

In these roles:

• Physicians are paid salary or sessional rates

• The clinic receives funding directly

• OHIP billing may be limited or used primarily for tracking

Income is defined by the employment agreement rather than personal billing volume.

Primary Care Payment Models at a Glance

Fee-For-ServicePaid per service delivered.

Comprehensive Care ModelPaid per service, with enrolment.

Family Health GroupPrimarily fee-for-service within a group contract.

Family Health NetworkBlended capitation model.

Family Health OrganizationTraditional blended capitation.

FHO+Modernised blended capitation with time-based billing, higher shadow billing rates, improved after-hours compensation, and removal of the access bonus.

Salary ModelsPaid per contracted time.

Understanding Ontario primary care billing models is essential before accepting any position.

The introduction of FHO+ in April 2026 represents the most significant update to Ontario family medicine compensation in years. Capitation remains central, but time-based billing and expanded payment streams reshape how income is generated.

If you are considering practising in Ontario and would like a detailed breakdown of how these models translate into earnings based on roster size and workload, we can provide a tailored overview aligned to current clinic opportunities.