Have you ever wondered how much your family doctor is paid? Are not all doctors driving fancy cars, sipping fine wines, and taking afternoons off to golf?

Most people are surprised to learn how little family doctors are paid for all of the services they provide.

In 2015, Dr. Shawn Whatley wrote a pair of excellent articles that detail how much family doctors are paid. His articles can be found here: (i) HERE and (ii) HERE .

The following article demonstrates two different examples of how family doctors are currently paid in Ontario.

EXAMPLE #1 (“Fee For Service” Billing):

For decades, “Fee For Service” has been the traditional way that doctors bill OHIP for their services. Under this model, a doctor is paid a specific amount of money for a specific type of visit or procedure. A full list of services can be found HERE .

There have been some changes since Dr. Whatley’s articles in 2015 and the payment amounts posted above, though. When I originally wrote this article in 2015, the Ontario government had unilaterally cut physicians’ payments. At that time, the government paid family doctors $32.64 for a typical visit. As of 2024, the government (OHIP) pays a family doctor $37.95 for a typical visit.

Let us explore this further. Imagine a patient visits her family doctor for belly pain. Here are all the steps that are involved in such an assessment:

  • Patient calls the doctor’s office to book an appointment. (Remember: telephone lines and reception staff cost time and money, all paid by the doctor).
  • Patient visits the office, checks in with reception staff, is taken to exam room and prepared for the visit. (Again, staff are all paid by the doctor. Clinic rent, electricity, medical tools, equipment, etc. are all paid for by the doctor).
  • The doctor assesses the patient. (Remember: the doctor went to school for ten or more years of education and training after high school in order to earn the expertise to care for her patients, not to mention the years of experience she has gained since).
  • The doctor orders blood work and an ultrasound in order to help diagnose the cause the of patient’s belly pain. (To do this, the doctor needs to complete the appropriate paperwork to order the tests. All of this takes time, computer costs, faxing and/or telephone costs, and more staff time).
  • The doctor may need to write a prescription for medications for the patient. (This takes time and expense of either paper or fax for the prescription).
  • The doctor needs to write a detailed note in the patient’s chart to document the visit. (This takes more time and computer costs).
  • When the test results come back for the blood work, the doctors’ staff receive them and put them in the patient’s chart, and then the doctor reviews them. (This takes staff time and doctor time).
  • When the ultrasound result is received, the staff puts the report in the patient’s chart and then the doctor reviews the results. (This takes staff and doctor time).
  • The doctor then either calls the patient with the results or has her staff call the patient with results. (Again, this all takes doctor time, staff time, and telephone costs, all paid by the doctor).

For all of this time, cost, and expertise, the family doctor is paid a total of $37.95

But not quite, she still has to pay approximately 30-40% of that to cover overhead costs, and then 46% of what is left over to income taxes!

Effectively, a family doctor only takes about $16 for a visit!

Furthermore, the family doctor can only bill OHIP for one issue per day. So, if the patient also asks about an unrelated rash, or blood pressure control, or any other issue in that same visit, the doctor is still only paid the same $37.95.

EXAMPLE #2 (“Capitated” Billing):

In recent years, most family doctors are now paid for their services via “capitated” payment models. In a “Family Health Organization (FHO)” model, a family doctor is basically paid a flat rate for looking after a patient for a year. This flat rate includes a specific list of services as well as some additional bonuses and incentives.

The amount of the flat rate varies depending on the age and sex of the patient. For instance, the doctor is paid $92.63 per year to look after a 20-year-old male patient; whereas she is paid $512.93 per year to look after an 80-year-old female. On average, for the entire population, this works out to about $207 per year ($17.25 per month) per patient. This is a flat rate payment regardless of whether a patient visits the doctor twice versus ten or even twenty or more times per year.

In return for this total flat rate payment of $207 per average patient per year, the family doctor agrees to provide all of the following over 130 services:

  • A001: Minor assessment
  • A003: Full Annual Physical
  • A004: General Reassessment
  • A007: General Assessment
  • A008: Mini assessment
  • A110 & A112: Periodic ocular-visual assessments
  • A777: Pronouncement of death
  • A901: House Call Assessment
  • A903: Pre-operative Assessment
  • A990, A994, & A996: Special Visit to Office
  • B990, B992, B994, & B996: Special Visit to Patient’s Home
  • C882: Palliative Care type of visit
  • E075: Geriatric General Assessment Premium
  • E542: Reimburses for supplies and equipment required for most procedures
  • G001, G003, G004, G005, G009, G010: Various urine tests
  • G011 & G012: Nail fungus cultures
  • G014: Rapid Strep test for throat infections
  • G123: Paravertebral Nerve Blocks
  • G197, G202, G205, G209, G212: Allergy skin tests
  • G223, G227, G228, G231, G235: different types of nerve block procedures.
  • G271: anticoagulant supervision
  • G310, G313: codes for EKG (heart) tests
  • G365: PAP Smear test
  • G370, G371: Joint injections
  • G372, G373: injections into muscle
  • G375, G377: injections into skin
  • G378: insertion of IUD contraception device
  • G379: intravenous injections
  • G381: chemotherapy injection
  • G384, G385: trigger point injections
  • G420: syringing of ear for wax
  • G435: Eye pressure testing
  • G462: Polio vaccine injections
  • G481: Cardio-hemoglobin procedure
  • G482, G489: drawing bloodwork
  • G525 Hearing Test
  • G538, G539: Immunization injections
  • J301, J304, J327: Spirometry lung tests
  • K001: extra time required for a service
  • K002: interviewing relatives
  • K003: Interviews with Children’s Aid Society or legal guardian
  • K004: Family Psychotherapy
  • K005: Mental Health Counselling
  • K006: Hypnotherapy
  • K007: Individual Psychotherapy
  • K008: Diagnostic interview with child or parent
  • K013: Counselling and patient education
  • K015: Counselling Relative on behalf of patient.
  • K017: Annual Health Exam for child
  • Q990, Q992, Q994, Q996: Special visit premiums
  • R048, R051, R094: Excision of malignant skin lesions
  • Z101: drainage of skin abscess
  • Z110: Extensive Debriding of finger/toenail
  • Z113, Z116: skin biopsies
  • Z114: removal of foreing body from skin
  • Z117: liquid nitrogen for skin lesion(s)
  • Z122, Z125: removal of cyst, hemangioma, or lipomas
  • Z128, Z129: removal of finger/toenail
  • Z153: debriding and dressing major wound
  • Z154: Suture of facial laceration
  • Z156, Z157, Z158, Z159, Z160, Z162: excision of various skin lesions
  • Z169, Z170, Z171: curetting or electrocoagulation of skin lesions
  • Z175, Z176: suturing skin lacerations
  • Z314, Z315: cauterizing and packing nosebleeds
  • Z535, Z543: sigmoidoscopy and anoscopy
  • Z545: incision of hemorrhoid(s)
  • Z611 inserting a urinary catheter
  • Z847: removal of foreign body from eye
  • Any of the above provided via telephone and video visits

Again, all of the full details of each of these services can be found HERE .

As explained above, every single one of these visits, procedures, and services requires staff time, doctor time, and overhead costs, including the costs to buy all of the medical supplies and equipment. (Just as one example, it is worth noting that the supplies, nursing time, and staff time required to perform a skin biopsy amounts to a total cost of more than $20 each).

In addition to the flat rate payment, the doctor also earns an additional 19% of the traditional Fee For Service payment. This is also known as “shadow billing”. Using the most common example of a general assessment by a family doctor, the doctor would be paid a mere addition $7.20 (19% of $37.95) for the visit.

Given all of the above, and considering all of the education, training, skill, experience, responsibility, time overhead costs, and taxes required to provide care for a patient, do you feel a family doctor deserves to be paid:

$37.95 per visit?

$17.25 per month?

Sounds like a bargain – not to mention unsustainably undervalued.

(UPDATE: I originally wrote this in 2017. As of 2024, there is a Family Doctor Shortage Crisis. Clearly, this was/is unsustainable).

– Adam Stewart

(originally published April 2nd, 2017)

(updated February 21st, 2024)