Family physicians in Canada are paid primarily through fee-for-service. In a fee-for-service setting, family physicians are running their own practice as a business. This includes paying staff (e.g., clinical nurse, administrative staff), professional fees, rent for the office space, equipment leasing, utilities, medical supplies, and other costs out of the fees paid by provincial/territorial governments. As of 2017 approximately 28 per cent of family physicians’ gross income goes toward overhead costs.1 Despite playing a foundational role in the health care system, family physicians remain the lowest-paid medical specialty in Canada.2
Inflation has significantly increased the cost of practice administrative overhead, particularly in urban areas. Family physicians are absorbing these increased costs out of billings, which are not keeping pace. Like others living in Canada, inflation cuts into the value of wages for physicians. In order for family physicians’ salaries to keep up with inflation and adequately cover the cost of running their practices, there would need to be a 12 per cent increase in the average gross clinical payment.2,3
The College of Family Physicians of Canada™ (CFPC) calls for alternative remuneration options for family physicians such as blended capitation, where a physician or practice receives a fee per patient, with some limited services maintaining a fee-for-service component. This model is preferable as it incentivizes better care for patients, while the pure fee-for-service model rewards high-volume care and disincentivizes comprehensiveness and management of complexity. Blended remuneration funding models best support the type of team-based, patient-partnered care that is provided in a Patient’s Medical Home (PMH) vision of care.
Furthermore, the business aspect of running a practice fills many family doctors’ days, reducing time available to provide patient care. This additional load puts physicians at significantly higher risk for burnout and occupational stress.4 Blended funding models allow for PMHs to be implemented and can provide family physician-led care teams with additional capacity, such as enhanced administrative support, to allow family physicians more time to focus on direct patient care.
The CFPC supports blended funding models and advocates for fair compensation for family physicians:
- In 2022 the CFPC testified to the Standing Committee on Health (HESA) on April 4th and May 9th, highlighting the problems with the current funding models
- In the Health Human Resources: Policy Recommendations briefing submitted to HESA, in collaboration with the Canadian Medical Association and the Canadian Nurses Association, we recommended the government fund the expansion and establishment of PMHs across Canada
- In 2022 the CFPC submitted a pre-budget consultation to the federal government in which we recommended that the budget support the adoption of and transition to blended payment remuneration models
- In 2019 the CFPC released an updated version of the Patient’s Medical Home vision, where we note that blended funding models are the preferred approach for family physicians to provide comprehensive, patient-centred care
- For several years the CFPC has supported a Primary Care Transition Fund, which would help establish PMHs across the country to improve quality, accessibility, and comprehensiveness of care
- In 2016 the CFPC released a comprehensive document—Physician Remuneration in a Patient’s Medical Home—that examined how certain models of remuneration can improve patient health outcomes and encourage beneficial patterns of care
1 Canadian Medical Association. Physician Workforce Survey, 2017. Accessed August 1 2022.
2 Canadian Institute for Health Information. National Physician Database. 2020. Accessed August 1 2022; https://www.cihi.ca/en/physicians-in-canada
3 Bank of Canada. Inflation Calculator. Accessed August 1 2022; https://www.bankofcanada.ca/rates/related/inflation-calculator/
4 Guck AJ, Buck K. Reducing clinician inefficiency and restoring meaning in practice: A professional coaching approach for family medicine residents. Int J Psychiatry Med. 2021;56(5):319-326.