Physician compensation has been a rapidly growing segment of healthcare costs in Canada since the late 1990s. In comparative terms, Canadian physicians are now well compensated compared to physicians in other high-income countries. This has caused provincial governments to begin constraining physician remuneration. However, physician payment should be examined in a larger governance context, including the potentially changing role of physicians, as provincial governments try to improve quality, increase coordination and improve overall health system performance. Although limited progress has been made through primary care reforms in a few jurisdictions, substantive improvement has been hampered by a misalignment between the policy goals and intentions of provincial governments and existing governance and accountability structures. This creates an environment in which both administrators and physicians feel they have limited input or control, seeding an adversarial rather than a collaborative relationship. Effective reform will require addressing governance and accountability at the same time as physician payment.

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