How does the FHO model work in Family Practice in Ontario? And can non-MD invest in clinics in Ontario?

[Centurion35]

I'm trying to match to Family Med and heard about the FHO model in Ontario. I understand its a capitation model but are patients billed per visit on top of a lump sum payment? How lucrative is it compared to FFS? My understanding is limited but based on what I read, there seem to be limited positions available especially in the GTA. 

Also, does anyone know if MDs are only able to buy or invest in walk-in or FFS clinics or can non-MD medical professionals invest in clinics in Ontario (such as NPs or PAs)? 

[gogogo]

As you state, the bulk of FHO pay is through capitation payments. The average pay per patient per year is $275, though this can vary widely depending on patient age and gender (e.g., you can bill ~$750 per 90+ female patient per year). 

You do also “shadow bill” for each visit, which is 15% of the FFS code that would apply for that visit (which is usually 15% of ~$38). There are some things you can bill the full amount for, called “out of basket,” but most visits won’t include those unless you know how to emphasize them in your practice (e.g., office-based procedures). The max you can shadow bill in a year is capped at about $60,000.

The Ontario government has restricted the number of FHO positions for the last decade, I believe. There are ways to get in, such as networking with a clinic then locuming with them, then getting a job; or, you can pay for the spot of a retiring GP (heard these can cost multiple hundreds of thousands in Toronto); or, you can do the “New Grad Entry Program,” which in my opinion, is abysmal (you are paid a salary of 160k, 180k, then 200k across your first three years, to have a roster of 800, 1000, then 1200, respectively; the catch is that you still have to pay the 20-30% overhead).

If you manage to get FHO, it’s much better than FFS in most cases. As two data points, I worked with a female FHO GP who saw ~15-20 patients a day for 3.5 days and also did some palliative care and teaching stuff on the side; she made 180k after overhead. I also worked with a rural FHO GP who worked ~55h/week and made 300k after overhead, also seeing around 20 patients a day. You can hit those numbers in FFS, but it’s much more stressful because you are in a time crunch and have to see way many more patients. You can actually take your time with patients in an FHO. 

Anecdotal, but I know a non-MD who owns clinics employing physicians, so I’m pretty sure that at least in Ontario, anyone can do it. Seems like it’s a pretty smart way to make close to doctor pay (or more, if you’re good at business) without all the training.

[whatdoido]

3 hours ago, gogogo said:

The Ontario government has restricted the number of FHO positions for the last decade, I believe. There are ways to get in, such as networking with a clinic then locuming with them, then getting a job; or, you can pay for the spot of a retiring GP (heard these can cost multiple hundreds of thousands in Toronto); or, you can do the “New Grad Entry Program,” which in my opinion, is abysmal (you are paid a salary of 160k, 180k, then 200k across your first three years, to have a roster of 800, 1000, then 1200, respectively; the catch is that you still have to pay the 20-30% overhead).

Please correct me if I'm wrong, but afaik, there are quite a few open FHO positions in underserved communities- the caveat being they are "rural"/not Toronto. regardless, it's easy to get a position without buying in/networking

[dooogs]

There are FHO spots available in Southwestern Ontario from retiring physicians