The Ontario Medical Association (OMA) warns that Ministry of Health letters received by hundred of physicians will have a “chilling effect” on doctors’ willingness to work additional hours.
The letters flag unusually high billing activity, but acknowledge that “billing data alone may not fully capture the circumstances of an individual physician’s practice.” They encourage recipients to review their claims and documentation, and warn that further review is possible. The letters do not provide numerical thresholds or comparison data, allege wrongdoing or announce a formal audit.
In an interview with Healthy Debate, OMA president Dr. Rebecca Hicks said the association was not informed before the letters were distributed and has yet to receive clarification about how physicians were selected.
Hicks, a practising family physician, said the number of days a doctor bills may not reflect the full scope of medical work, including reviewing results, contacting patients after hours or providing frequent on-call coverage in rural communities.
“I think it’s a very blunt metric that doesn’t really capture what it is that physicians are doing on a daily basis for their patients,” she said.
The letters, received this week, identify Ontario Health Insurance Plan (OHIP) claims that differ from those of physicians with similar practice profiles. One letter reviewed by Healthy Debate flagged a high number of days worked in a year as “anomalous behaviour.” Another recipient said his letter cited a high number of patients seen in a day.
The Ministry described the letters as part of routine monitoring to protect OHIP’s integrity.
“Do we understand that there needs to be oversight of public funding?,” asked Hicks. “Of course. But that oversight needs to be transparent, it needs to be fair, and it needs to be clear.”
Dr. Sahil Koppikar, a rheumatologist at Women’s College Hospital and assistant professor at the University of Toronto, said he was surprised his letter flagged “too many patients seen in a day.”
“This fails to capture the model we are working in, the teams we have, the way we have set up our clinics compared to other physicians,” he said, noting his Toronto clinics generally involve eight to 18 patients, while periodic outreach clinics in Timmins sometimes involve 20 to 25 patients daily.
Koppikar added that receiving the letter has made him and other colleagues less willing to take on additional work at the expense of their well-being to help the system.
Dr. Pawel Zalewski, a medical oncologist at Lakeridge Health, said his cancer centre is one of the busiest in Ontario and operates three satellite clinics to bring treatment closer to patients. He added physicians review results and support patients outside scheduled appointments.
“Often, we see results and discuss with patients during weekends,” Zalewski said. “Those of us here who received this letter are discouraged by this short-sighted approach.”
Dr. Adam Stewart, a family physician in Madoc, received a letter flagging how many days he worked. He said his responsibilities extend beyond appointments to reviewing test results, hospital reports and referrals.
“I am in my EMR nearly every day of the year. It feels like being forced to drink from a firehose that never shuts off,” Stewart said.
Stewart questioned how the notices align with Ontario’s FHO+ family medicine model, introduced in April 2026 to compensate eligible physicians for direct patient care, indirect care, and clinical administration.
A 2025 Auditor General report recommended greater use of data analysis in physician billing oversight and described an initiative involving educational letters about high daily service hours. The Auditor General’s office says it typically follows up on audit recommendations approximately two years after a report is tabled. As its report was released in December 2025, no follow-up has yet been conducted, and the office could not comment on whether the recent letters are connected with its recommendations.
Meanwhile, Ontario’s $3.4-billion Primary Care Action Plan has connected more than 511,000 people to primary care, according to the province. A recent OMA poll found one in three Ontarians reported longer specialist waits.
Hicks said the notices reflect a contradiction between Ontario’s push to improve access to care and the concerns of physicians being asked to take on more work.
“And so we have this push on one side to ensure that we are seeing patients, and then the reward is a warning letter,” she said.
“So in the end, while these letters were sent out to physicians, the people who end up suffering the aftereffects of letters like this are patients.”
The Ministry of Health had not responded to a request for comment at the time of writing.
