What should you ask a Toronto clinic before you sign after return of service?
Ask for the numbers behind the offer: how many patients are ready on day one, how billing is split, what pays you beyond billing and when it ends, what the funding model is and will become, and what the clinic will put in writing.
Researched by Button Health. Last checked .
Offers can look alike until you put them in the same format. These questions work for any clinic. Put each answer in the same format, so the offers can be compared line by line.
Patients
| Ask | Why it matters |
|---|---|
| How many patients are ready to attach on day one? | Roster size drives both billing and how fast you fill your schedule |
| How were they verified? | A waitlist of confirmed humans differs from a list of web forms |
| Can I see the list during selection? | You can test the number before you sign |
| Who pays for ongoing patient acquisition? | It decides who bears the cost of growth |
Billing and pay
| Ask | Why it matters |
|---|---|
| Is the figure quoted gross billing or my share? | The clinic’s share comes out of gross billing, so the two can differ widely |
| What is the split, and does it change? | Introductory terms and long-run terms can differ |
| What does the figure assume? | Days worked, visit length and roster size change the result |
| What pays me beyond billing, and what ends it? | Anything temporary needs a stated end condition |
| What am I paying for directly? | Staff, EMR, supplies and insurance vary by clinic |
Funding model
Ontario’s models pay differently, and a clinic’s plans for moving between them can affect you.
| Model | Pay basis in official sources | Group size in official sources |
|---|---|---|
| Family Health Group | Primarily fee-for-service, with bonuses and premiums based on enrolment | “three or more physicians” |
| Family Health Organization | Primarily capitation, with some fee-for-service | “six or more physicians” |
| FHO+ | A modernized FHO model, blended capitation in the OMA chart | “Minimum 6 physicians” in the OMA chart |
So ask:
- What model does the clinic operate under today?
- How many physicians does it have, and what is the minimum for the next model?
- When does the clinic apply for any change, and who leads that application?
- What in my contract changes on conversion, including anything that stops?
Block fees
CPSO’s policy defines a block fee as a charge to patients for uninsured services. Physicians “must not” require it before accessing a service, or terminate a patient or refuse a new one for choosing not to pay. If an offer includes block fee income, ask how the clinic follows this policy.
Daily work
| Ask | Why it matters |
|---|---|
| Who answers the phone and books patients? | This determines your administrative load |
| Is there walk-in or personal on-call? | Each affects your hours and continuity |
| Do I choose my clinical days? | Flexibility is hard to add later |
| Who handles EMR, network and front-office problems? | It decides who stops work when they fail |
Return of service
- Has the clinic seen the ministry’s written answer on my situation, or is it reading the guidelines?
- Does the clinic promise anything about hours counting? On what basis?
- If I need to repay, does the contract depend on the ministry’s timing?
The clinic cannot decide these for the ministry. The Toronto catchment question remains open in the published text, so get your answer from the ministry.
Contract terms
- Term, notice and exit costs
- Patient continuity if you leave
- Restrictive covenants
- Who holds the OHIP billing relationship
- Whether every figure above appears in the agreement, not only in an email
Have your own lawyer and accountant review it.
Common questions
Should a clinic promise my Toronto hours count toward return of service?
Be cautious of any such promise. The ministry decides, and the published guidelines do not settle the question. Ask the ministry directly and get its answer in writing.
What minimum group size does an Ontario family practice model need?
Ontario describes Family Health Groups as groups of three or more physicians. The OMA lists a minimum of 6 physicians for an FHO+, and Ontario describes FHOs as having six or more.
Are block fees part of OHIP billing?
No. CPSO defines a block fee as a fee charged to patients for uninsured services, and says patient decisions on paying it must not affect access to care.
Related questions
- How long would $38,000 a year take to cover a return of service repayment?
- Can you serve part of your return of service while working in Toronto?
- What happens if you breach your return of service agreement?
Sources
- Ontario, Primary care payment models (updated February 4, 2026)
- OMA, Primary care comparison chart (April 2026)
- CPSO, Uninsured Services: Billing and Block Fees
- Ontario Ministry of Health, IMG ROS Program Guidelines (dated October 2025, posted at a December 2, 2025 URL)
The offer
Family physician, Bay and College, Toronto.
Compensation
Fee-for-service Family Health Group (FHG), applying for FHO+ next year.
Overhead: 0% for your first one and a half OHIP billing cycles. Then 20% of your OHIP billings (plus HST) at four or more clinical days a week or $30,000 a month in billings. Below that, 25%.
Estimated earnings: $32,000 to $43,000 a month in billings. $25,000 to $35,000 a month after overhead, from OHIP and private fees.
Attachment bonus: OHIP pays you $100 to $120 for each patient you attach who has no family doctor.
Profit share: Builds by about $3,200 a month, up to $38,000 a year, scaled to days worked. Paid by the clinic in June and December, no overhead. Can go toward your annual HOOPP pension contribution.
Paid leave: six weeks a year, building from your first day. A locum sees your patients while you’re away, so nothing piles up.
Professional allowance: up to $5,000 a year for CME, dues and licensing.
Gym membership: paid by the clinic.
About this research
Button Health researched these rules directly from ministry, regulator and other primary sources, and links each one so you can read it yourself. Button Health is a family practice at Bay and College in Toronto that recruits family physicians, so we have an interest in this topic.
This page is general information, not legal or financial advice. Rules change, and your agreement is what binds you.