Primary care is considered the front door to our health-care system. Whether you're going for a general check-up or have just been diagnosed with cancer, your family doctor makes sure you get the tests, treatment and care you need.

But not all family practices in Ontario are created equal.

Most Ontarians don't realize it, but over the last decade and a half, there has been a transformation around how primary care is delivered. Much of the change has involved how doctors are paid and organized.

In the early 2000s, most doctors in Ontario were paid by the visit (fee-for-service) and most ran their own independent practices. The system was designed for a time when people went to the doctor because they felt sick. But people are living longer now and many have complicated diseases that last a lifetime and require nuanced management.

Not all family practices in Ontario are created equal.

Canada was lagging behind other countries in access and quality of care, so the Ontario government increased spending in primary care. They gave family doctors large financial incentives to start working in groups and pool their resources to provide after-hours care.

Doctors who agreed to join a group were asked to formally take responsibility for their patients and "enroll" them into their practice. The provincial government also offered doctors bonuses if their patients didn't see family doctors outside the group. There were also bonuses for meeting targets for cancer screening and immunizations.

Some of the doctors in the new groups are still mostly paid by the visit. But just over half of doctors in these new groups get most of their income from an annual payment for each patient (capitation). The annual payment is based on the age and sex of the patient and is the same whether they see the patient 10 times, once or not at all.

In theory, this new payment system gives physicians more flexibility to spend longer with patients if needed and to provide advice by phone or email if that is more efficient.