Ontario Rolls Out FHO+ as Family Doctor Shortage Keeps Growing

Ontario's primary-care system entered a new chapter on April 1 with the rollout of FHO+, a modernised compensation framework for physicians working in Family Health Organizations. The model, negotiated as part of the 2024-2028 Physician Services Agreement between the province and the Ontario Medical Association, attempts to address a long-standing complaint: that family doctors do significant amounts of administrative and indirect work, including reviewing labs, coordinating with specialists, and answering patient messages, that previous payment models did not adequately recognise.

The change comes against the backdrop of an access crisis that has been deepening for years. The Ontario College of Family Physicians estimates that an estimated 1.9 million Ontarians, roughly 12 per cent of the province's population, do not have a regular family doctor. Median wait times from a general practitioner referral to specialist treatment have, by some recent measures, reached 30 weeks. The pressure on emergency rooms, walk-in clinics, and provincial budgets has been intense.

What FHO+ actually changes

The FHO+ model retains the core capitation structure of the existing Family Health Organization, which pays physicians a base amount per enrolled patient adjusted for age and sex. The new model adds compensation streams designed to reflect the modern realities of family medicine, including indirect care that does not happen in a face-to-face appointment.

The OMA has called it the "best-in-Canada payment model" for family medicine and has highlighted the new agreement's role in attracting and retaining a new generation of family doctors. Ontario currently faces a projected shortfall of family physicians, driven by a combination of retirements, residency choices that increasingly favour specialty fields, and the high overhead costs that solo and small-group family practices face.

The province has framed FHO+ as part of a broader strategy that also includes expanding nurse practitioner-led clinics, integrating pharmacists into primary care for minor ailments, and accelerating the integration of internationally trained physicians. None of those individual measures is enough to close the access gap on its own, but the province argues that the package together represents the most significant primary-care reform in nearly two decades.

National policy backdrop

The Ontario change is happening alongside a broader federal policy adjustment. Effective April 1, medically necessary primary care is no longer tied as closely to who delivers it under the Canada Health Act framework, allowing nurse practitioners and pharmacists to deliver more services without those services being treated as outside the universal-coverage envelope. The change is intended to support universal access, reduce private fees, and broaden the definition of acceptable primary-care providers.

Practical implications vary by province. In Ontario, the federal change supports the province's existing strategy of expanding nurse-practitioner-led clinics and pharmacist-delivered services. In British Columbia and Quebec, both of which have been expanding pharmacist scope of practice, the change accelerates work already underway. In Atlantic Canada and parts of the Prairies, where access pressures are particularly acute, provincial governments will need to decide how aggressively to deploy non-physician providers.

The wait-time problem

Even with FHO+, wait-time data continue to alarm. Recent Fraser Institute and Canadian Institute for Health Information data show median waits from referral to treatment at historically high levels in several specialties. The 30-week median, while not uniform across all specialties, is far above the benchmark wait times that provincial governments have officially endorsed.

Wait-time pressures are partially the consequence of the family-doctor shortage. Patients without a regular GP often present in emergency rooms or walk-in clinics for issues that would normally be handled in a primary-care visit, displacing other patients and delaying specialist referrals. Some hospitals report significant numbers of "alternative level of care" patients waiting for community placements, which removes capacity from acute care.

What the OMA says

The Ontario Medical Association has welcomed FHO+ as a meaningful step but has been clear that compensation reform alone will not solve the access crisis. The OMA has argued for additional measures, including a faster pathway for internationally trained physicians, expanded residency positions, and dedicated infrastructure funding for primary-care clinics.

The association has also highlighted concerns about administrative burden. A growing share of family-doctor time is consumed by paperwork required by insurers, employers, schools, and other agencies. The OMA has been advocating for a province-wide effort to reduce that burden, including by standardising forms and making greater use of digital tools.

Provincial comparisons

Ontario is not alone in trying to fix primary care. British Columbia rolled out its own significant compensation reform for family medicine in 2023, moving from a strictly fee-for-service model to a hybrid that better reflects time spent on complex patients. Early evaluations of the BC reform have shown gains in physician retention and modest improvements in attachment rates, although that province also continues to face serious access pressures.

Nova Scotia has been experimenting with collaborative-care clinics that pair physicians with nurse practitioners and pharmacists. Saskatchewan and Manitoba have expanded scope of practice for non-physician providers. Quebec's challenge is structurally different, given its mix of family medicine groups and the unique role of CLSCs, but the same underlying pressures, including aging physician workforces and high specialty-training preferences among medical students, are present.

The federal role

The federal government's primary lever in primary care is funding. The 2023 federal-provincial health funding agreement included substantial new transfers tied to specific priorities, including primary-care access. Carney's federal cabinet has signalled openness to additional bilateral agreements with individual provinces, but has been clear that the day-to-day operation of primary care remains a provincial responsibility.

Health Minister Mark Holland's office has welcomed Ontario's FHO+ launch and pointed to the federal recognition of nurse-practitioner and pharmacist roles as a complementary measure. Holland has also signalled that further federal funding linked to access metrics is possible in upcoming budget cycles, although the federal fiscal environment is constrained by the cost of CUSMA-era trade adjustments.

The patient experience

For patients, the changes will be felt unevenly. Those already enrolled with a family doctor in an FHO will see administrative changes but no direct impact on appointment availability or services. Patients without a family doctor are unlikely to feel any short-term improvement; even if the new compensation model attracts more physicians into family medicine over the next several years, the lag between residency choice and full clinical practice is significant.

The most immediate access improvements are likely to come from non-physician providers. Pharmacist-led care for minor ailments, nurse-practitioner clinics, and virtual-care services are expanding in Ontario and across the country. Some patients will find these services adequate substitutes for physician care; others, particularly those with complex conditions, will continue to need a regular family doctor and may face long waits to find one.

What's next

The Ontario government has signalled additional primary-care announcements throughout 2026. Construction of new collaborative-care clinics is underway in several mid-sized cities, and the province is expected to publish updated attachment-rate data later this year. The OMA and the province continue to negotiate on specific implementation details of FHO+, including audit and reporting requirements.

At the federal level, the next major policy moment will be the federal budget, which has not yet been formally scheduled. Health policy will be one of several files competing for fiscal space, alongside defence, housing, and trade-related supports. The Carney majority gives the government room to make those choices, but it does not change the underlying fact that fixing primary care will require sustained funding and policy commitment over many years, not a single announcement.

For now, FHO+ represents a meaningful shift in how Ontario pays its family doctors. Whether that shift translates into measurable access improvements for patients will depend on choices the province and the federal government make over the rest of the decade.