Ontario report warns of weaknesses in medical training, physician billing oversight, primary care planning
Ontario’s Auditor General is warning that weaknesses in primary-care planning, medical training and physician billing oversight are limiting the effectiveness of key public services.
According to the Office’s 2025 Annual Report tabled this week, the Ministry of Health paid $19.5 billion to about 35,000 physicians in 2024/25 and “relies primarily on tips and complaints to trigger post-payment audits.”
The Ontario Health Insurance Plan (OHIP) system “cannot automatically flag unusual or high-risk billings, such as physicians claiming over 24 hours of work in a day,” says the report, and a system modernisation initiative announced in 2023 has been delayed pending government approval.
Long hours for physicians in Ontario
The audit found that 59 physicians billed 24 or more hours of service for at least one day and that group increased by 39 per cent between 2022 and 2025, according to a report from the Ottawa Citizen. Also, more than 100 physicians claimed to have worked all 365 days in a year. The review also found cases where physicians billed for more than 500 patients in a single day and had not undergone a post-payment audit.
Despite the billings, more than 108,000 Ontarians had been waiting over a year to be matched to a doctor, and the number of people on the wait list as of January 2025 represented only 11 per cent of the estimated number needing a family physician.
Eight staff currently conduct post-payment audits, the same number as in 2017, and post-payment audits can take more than a year to complete, noted Auditor General Shelley Spence in the report. In a 2024 analysis, the Ministry noted that 3–5 per cent of fee-for-service (FFS) claims reviewed had potential anomalies. Based on the $13.3 billion in FFS payments in 2024/25, this translated to approximately $400 million to $665 million in payments that would require additional review.
Ontario Health Teams and local primary-care networks lack authority to require providers to collaborate on system planning, and the province’s central matching program, Health Care Connect, has not met demand, according to the report.
Medical education in family medicine
On medical education in family medicine, the province expanded medical school seats “without first ensuring there were enough training sites or a clear framework to measure outcomes,” according to the audit report. Two new medical schools were approved “without assessing whether existing schools could have been expanded instead.”
Although government plans called for hundreds of additional seats between 2022 and 2024, by the end of the 2025/26 academic year medical schools had rolled out 44 per cent fewer family medicine seats than planned because of a lack of training clinics. Based on its own analysis, the Auditor General’s Office estimated that “about 2,000 family physicians would be necessary to meet this need in 2024.”
In 2024, the provincial government announced it is expanding the Learn and Stay grant to include family medicine. Starting in 2026, the government is investing an estimated $88 million over three years to expand the grants for 1,360 eligible undergraduate students who will commit to practicing family medicine with a full roster of patients once they graduate. This includes $17.7 million for the 2026-2027 academic year.
Ontario is looking to make it easier and faster for health-care professionals from other provinces and territories to work in the province, the provincial government previously announced.
