Specialist Practice Models
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 coordination 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 that 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, read the Ministry's Resource Manual for Physicians.