The respondents all raised valuable, informative points in response to our Invited Essay. There was convergence around the need to alter governance structures at the same time as payment arrangements for physicians to achieve higher-performing health systems within Canada. At the same time, there were different views on how best to address the disconnect between levels of physician remuneration and accountability for healthcare performance and delivery. In addition to ongoing efforts to improve governance, such as the recent amendments to the government–physician agreement in Alberta, individual provincial governments can and should take the lead in initiating and evaluating further payment and governance experiments.

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