In the last few years, several Canadian provinces introduced New Physician Payment Models that would allow Family Physicians in primary care to be compensated for direct and indirect patient services.

In October 2022 British Columbia announced a new physician payment model that was then launched in February 2023. The focus was to improve physician support and provide more access to primary patient care. The model allowed family physicians to be compensated for time spent with their patients, number of patient visits, patient panel size, patient services, after-work hours and administrative duties. According to the BC Health Minister Dr Adrian Dix, since the model was launched up to 80% of BC family physicians have signed up for this new payment model.

After evaluating the key components and early outcomes we have seen Manitoba, Saskatchewan, and Nova Scotia follow by introducing their own alternative payment models, with the goal to empower family physicians and enrich patient care.

The Compensation structures include Longitudinal Family Practice Payment models and Blended Capitation models. Although each province has structured each payment model around what works best for the family physicians and their patients' needs, they all share the same key components - focusing on and recognizing all aspects of primary care and increasing the overall compensation for physician's time spent on patient care, their panel size and the delivery of patient services.

British Columbia introduced The Longitudinal Family Physician Model (LFP) a blended model that compensates family physicians who provide longitudinal family medicine care and recognized the factors that contribute to the challenges with primary care. It acknowledges the value of the time being spent with patients and includes indirect and clinical administrative services which also includes teaching. The 2023 data shows that there was an increase of 708 family physicians providing longitudinal care using the new payment model which has also connected 243,000 patients with primary care. This is an alternative option to the fee-for-service model, the model calculates the equal time for direct and indirect care, along with administrative tasks and fee-for-service plus the panel payment - learn more.

Nova Scotia's Longitudinal Family Medicine (LFM) Payment Model launched in 2023 is a 4 year agreement that will be evaluated in 2027. The payment model supports team –based and patient partnered care. Alongside British Columbia and Manitoba, the model allows family physicians to provide more in-depth care for patients who need it, spending the extra time with patients with complex health needs and mental health concerns etc. The payment model includes enhanced remuneration and increases for working evenings and weekends. Payment is calculated on hours worked, services delivered and panel size. The model is flexible allowing the physician to work full-time/part-time and still be part of the payment model - learn more.

Both Manitoba and Saskatchewan launched their alternatives in April 2024. Manitoba introduced the New Family Medicine Plus (FMP) Payment Model which is more focused on building on the existing fee-for-service model. Unlike other provinces that reduce 70% remuneration for fee-for-service, the province has made no change by sticking with the existing tariffs that remain the same, with physicians receiving 100% of the payment plus the new panel payments and remuneration for indirect clinic time. Building on the existing fee-for-service model, the model will allow physicians to receive 100% payment for virtual visits at in-person visit rates. Like British Columbia this increases the access to patient care for many Canadians. The physicians are also able to add $3.50 to in-person visits, this amount is helpful to balance the overhead costs that come with running a clinic, which can be around $42,000 per year. The payment model provides a 21% increase in compensation for physicians working full time under the payment model.

Saskatchewan's full blended capitation model The New Transitional Payment Model (TPM) is a 4 year contract agreement that will be monitored and measured over the next few years. It compensates family physicians by combining the fee-for-service, with a payment for longitudinal care and patient panel (with a maximum payment of up to $144,000) plus the accountabilities built on the Patient's Medical Home vision, (the role of family practice and family physicians in building a relationship with their patients, providing high quality, compassionate and timely patient care). This is a voluntary program and not mandatory, physicians can join or withdraw at any time. The TPM will increase the annual compensation for family physicians who are eligible by 43% - learn more.

The provinces are continuing to monitor and measure the results and although this is still early days, so far, the outcome shows that family physicians are better supported in their communities, and there is an increase in access to primary care. It provides more efficient use of resources by all members of the healthcare team and reduces emergency room visits for minor illnesses/injuries that can be treated by a family physician.

The provinces must look at their own health systems, patient volumes and their patient's needs. There is continued work needed to keep on top of the overhead cost with the increase in inflation, however it is good that provinces have acknowledged the needed support for family physicians and their value to the Canadian Health System.

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These new payment models appeal to many Canadian/International family physicians, making roles in the primary care sector more attractive. They offer better working conditions, which also helps with physician retention. It shows that family physicians are valued, supported and respected in the health care system, and the outcome is access to high quality and timely care for Canadians. These steps are fundamental in providing and connecting more patients with access to primary care. It can only be a matter of time before other provinces follow.