Specialist Physician Practice
Compensation Options
Specialists in Ontario may be compensated through a fee for service system or through an Alternative Funding Plan (AFP) or Alternative Payment Plan (APP). AFPs/APPs are contractual arrangements between the Ministry of Health and Long-Term Care and a group of physicians, and may include other organizations such as hospitals and universities. Some AFPs/APPs also include funding for teaching and research.
These agreements provide flexibility in practice, encourage co-ordination and integration of medical services, and stabilize compensation for highly specialized groups, specialists and sub-specialists. AFPs/APPs have become more attractive and desirable to many physicians seeking a more balanced working life, regular hours, and acknowledgement of patient acuity, geographical challenges, and financial security.
Over the years, a variety of compensation models have been developed and used by AFPs/APPs. Presently, most agreements are blended models that combine a base rate, incentive/premium payments and possibly a fee-for-service component payment. There are several remuneration methods:
- Global/block funding based on specific services or locations
- Blended funding models which include a base payment for clinical services, teaching, research, administration or indirect services plus a premium payments which could be based on a percentage of the value of Fee-for-Service billings
- Bed utilization rate
- Sessional payment plus fee-for-service billings
AFP/APP Models
There are a variety of models used to cover:
- specific communities and under-serviced specialties
- individual departments in a single hospital
- entire services of all physicians at a single hospital
- services of all full-time specialists at an academic health science centre
- province-wide gynaecology oncology, radiation oncology and medical oncology services
- emergency services in hospitals, specialist services in the north and agreements with specialists and subspecialists associated with academic health science centres
- regional trauma hospitals to ensure the 24-hour availability of high level care for patients with serious trauma (Trauma Team Leader global funding agreements)
- Academic Health Science Centres, for clinical services, education and research
- services such as psychiatry, the Regional Surgical Network, neurosurgery/neurology and anaesthesia in northern regions
For more information on Alternate Payment Plans click here