Light ahead for family doctors? Changes aim to keep them in comprehensive practice

Dr. Adam Thompson is bullish on the benefits of British Columbia’s new payment model, three years after it was rolled out.Since the Longitudinal Family Physician (LFP) model was introduced, the number of doctors providing comprehensive, longitudinal family medicine has increased significantly, he said. Some B.C. towns and cities “are approaching the point where they have enough physicians to attach all of their patients, as a result of the payment model.”As one of the family doctors working under the model, Dr. Thompson said, “It has enabled me to spend more time with patients. It has simplified my billings significantly and reduced my administrative burden from that perspective. It has freed me to have more clinical autonomy and provide better care compared to the old model.”Dr. Thompson co-led negotiations with the provincial government to introduce the model and serves as the current president of Doctors of BC. So he’s a booster.But the numbers speak for themselves—of the approximately 5,000 family doctors providing longitudinal care in B.C., nearly 4,300 had registered for the LFP payment model as of August 2025.LFPs are one of many initiatives across Canada to attract and retain family physicians, providing more patients with needed access to primary care.But payment models are just one part of the story.“Retention in primary care is a system issue,” said Dr. Oduka Okpalauwaekwe, a family physician who researches primary care at the University of Saskatchewan in Saskatoon. He says the factors affecting retention encompass personal, family, community, professional and structural (or systemic) aspects, although he cautions that list is not exhaustive.Solutions to what the College of Family Physicians of Canada (CFPC) calls a “crisis in family medicine” range from easing everyday irritations to major shifts in the practice landscape. What they have in common are solutions to the intertwined issues of better remuneration, less administrative burden and better quality of life and work.Bottom lineThe past four years have seen major changes in the way family doctors are paid in all provinces and territories. (See The afterlife beyond FFS) The aim is not only to keep up with the rising cost of living and running a clinic, but also to address evolution in family practice and increasing complexity of patients.In a review of 23 studies of retention of Canadian family physicians, Dr. Okpalauwaekwe found that the traditional fee-for-service model was a barrier to retention. “It is volume-based rather than person-centred,” he said. “A lot of times, it leaves patients with unmet needs. It makes a physician feel unfulfilled as a clinician who has vowed to be a resource to their patients.”He said alternate payment models that reward physician autonomy and remove some of the business responsibilities enhance retention.Common elements of recent models include better overall compensation; some form of recognition for all aspects of care; compensation for time spent on patient care, panel size and services delivered; and some funding for overhead. But the exact formula differs from one jurisdiction to another.“It is an area of debate what is the best model,” said Dr. Sarah Cook. Dr. Cook, a family physician in Yellowknife, Northwest Territories, is also the president of the CFPC. “If we knew with certainty what the best model was, we probably would have all moved to it. The fact that there are lots of different models out there reflects the fact that this is complex.”Provincial and territorial governments are watching what is happening in other jurisdictions, she noted, to learn what is working.As a result, a growing number of family physicians across Canada are practising under alternate payment plans, either alone or blended with fee-for-service payments, according to the Canadian Institute for Health Information’s 2024 workforce report. Although these alternate approaches have been around for decades, they have found new life.For example, B.C.’s LFP model blends payments for time, patient interactions and the patient panel. Time includes direct care, indirect care such as reviewing test results and administrative tasks.Dr. Thompson said that, under LFP, he no longer has to meet certain targets under the fee-for-service system for patients with specific chronic diseases, allowing him to take a more individualized approach, working in partnership with the patient.In B.C. and most other jurisdictions, the reforms address pay structure—but not how care is provided.One exception is Ontario, where family physician reimbursement is connected with the type of practice. Some models are based on blended capitation and “shadow billing” at a low or zero percentage of fee-for-service. These models—Family Health Networks and Family Health Organizations—also require physicians to practice in groups that are co-located or within a certain geographic area to allow after-hours care.Better remuneration is one prong in improving professional satisfaction, according to the CFPC. In its 2025 member survey, 56% of family physicians said their remuneration has recently increased. While most respondents said they were satisfied in their professional lives, that figure was 61% for those with increased remuneration and 52% for those who had not seen a raise.Despite the promise of new payment models, there remain some issues, said Dr. Wei-Hsi Pang, a professor of family medicine at Queen’s University’s site in Bowmanville-Oshawa-Lakeridge, Ont. Salaries can lead to a lower volume of work, he said. And payment models do not reward years of service. Ultimately, money can’t make up for working long hours instead of seeing your family, he pointed out.Paperwork avalancheOne of the top issues is administration: completing forms for referrals or social benefits, reviewing test results, and writing clinical notes. (See Canada’s war on physician paperwork.) Reviewing patient files from other healthcare providers is also time-consuming. Dr. Pang discussed getting full clinical notes in PDF from hospitals, imaging clinics and specialists, rather than brief text letters or summaries.The burden amounts to 10 to 19 hours per week for family physicians in Ontario specifically, said Dr. Cook. A report this year by the Canadian Medical Association (CMA) and the Canadian Federation of Independent Business (CFIB) found 90% of respondents said this burden contributes to burnout.The burden drains the joy out of practice, said Dr. Okpalauwaekwe, and affects physicians’ work-life balance, which is important to many younger physicians—a generational difference that is showing up in studies of physician retention.Paying physicians for their administrative tasks helps with the burden, Dr. Rebecca Hicks, president of the Ontario Medical Association who is also a family physician in Toronto. In April, the Family Health Organization Plus (FHO+) model took effect in Ontario. It adds hourly rates for direct care as well as up to 25% of physicians’ time spent reviewing results and doing preventive care. As a result, family physicians are shifting to the new model, with more adopting it in April to July this year than had moved to FHO in any other quarter.“I’ve heard from members directly that there’s a lighter feeling to doing that indirect care and administrative work knowing that it’s being recognized and acknowledged as work,” she said, although some spend more than 25% of their time on administrative tasks, which remains unpaid.Another part of the answer lies with artificial intelligence (AI). Canadian family doctors are high adopters of AI, with 46% saying their office had brought in AI, according to a 2025 survey by the Canadian Institute for Health Information (CIHI). That’s higher than the 33% average across seven industrialized nations where family doctors were surveyed. Scribing for clinical encounters was the main use, for 68% of family doctors. AI saves Canadian physicians an average of just over an hour per day, according to the CMA/CFIB report.“That’s really a substantial reduction in time. The other advantage is that it allows the physician to better engage with the patient,” Dr. Cook said.Family physicians in Canada are also using AI for triaging (11%) and to prepare a treatment plan or prescription (8%), according to CIHI.Another solution is to delegate forms and other administrative tasks to non-physicians. But this has been stymied by many systems that require the physician to login, say physicians.Forms, in particular, are a sore point. Referrals can involve a lot of paperwork, requiring physicians to fill out long questionnaires and order additional tests, Dr. Pang said.CFPC is working with the federal government on forms for federal benefit programs.The Disability Tax Credit form, in particular, is “unnecessarily long and complex,” Dr. Cook said. Much of the form could be filled out by the patient. “It’s a really unnecessary use of physician time.” In 2024, completing approximately 330,000 applications required physician time equivalent to nearly one million patient visits, the CFPC estimates.The CFPC has worked with the federal government to allow a simplified form in more cases and broaden the range of professionals who can certify it. But it would like to see adequate compensation for completing the form.The CFPC recently succeeded in getting more compensation for doctors completing the Canada Pension Plan Disability medical report, and it’s working with the government to simplify that report.Quality of lifeBurnout peaked during the pandemic, in 2022, with 24% of female and 21% of male family physicians saying they were burned out, according to data from the CFPC.“There was such an incredible burden on all healthcare providers,” said Dr. Cook.“Systems were not set up to be able to care for people adequately, like virtual care. We didn’t have—and still don’t have—interoperable systems. So the challenges for (family physicians) navigating the system when you can’t do all the things you were used to doing when you saw patients in person were just incredibly stressful.”And inflation was “just going through the roof,” adding skyrocketing costs to the stress, Dr. Pang said.Physicians say the pandemic was the last straw, on top of the other issues affecting quality of working life.Since those difficult days, burnout has declined to 11% of female and male family physicians in 2025. But satisfaction is still not back to pre-pandemic levels.Beyond better remuneration and less paperwork, team practice with allied health professionals is a key factor in improving quality of working life, say physicians. Such professionals can include nurses, nurse practitioners, pharmacists, midwives, dieticians, physiotherapists, occupational therapists, psychologists, social workers and others.Physician organizations are promoting this of course—the CFPC calls it “the patient’s medical home” and the CMA calls it “team-based care.” It’s an integral part of Ontario’s plan to connect every resident to primary care.Dr. Cook works in this type of practice in Yellowknife. She describes a positive and collaborative atmosphere “working together as different disciplines.”“That is the direction we are moving to,” Dr. Okpalauwaekwe said. In his study, “we found that areas with team-based care practices and team-based primary care models enhanced retention more than areas with sole physicians doing dual duties.” But he said some physicians in high-volume practices want to continue with a fee-for-service model because they can earn more.Team-based care improves satisfaction ratings. The proportion of family physicians practising primary care who are satisfied professionally remains low—43% for those who practise alone and have not had a pay adjustment, according to the CFPC’s 2025 member survey. But it’s higher among those who practise primary care in a team (61% for those without a pay adjustment), and even higher among those who practise in a team and have had a pay adjustment (66%).And it’s a factor in retaining physicians even in their early years of practice. Many family physicians do their training in interprofessional team practice only to discover upon graduation that such practices remain less common, Dr. Pang said. Only about 30% of physicians in Ontario are associated with community health centres or family health teams with this interprofessional support, said Dr. Hicks. Funding from the provincial government supports this type of practice, but this is limited.“It’s still very hard to find a practice where you have that kind of team structure,” Dr. Pang said. “You end up being on your own or as part of a group, but you don’t have that allied health support, so it’s a bit of a mismatch in terms of the job as (residents) are trained into it versus the reality once they are in practice.”Newly minted family doctors can feel isolated and lack interprofessional support as a result, he said.As part of the solution, Dr. Pang and Dr. Cook emphasize the value of training family physicians in the communities where many will ultimately work. Ontario is planning to fund more team-based primary care centres, so that option will become more available for family physicians in that province, Dr. Hicks said.

Light ahead for family doctors? Changes aim to keep them in comprehensive practice

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