Providing on-call coverage has always been a critical part of hospital-based care in Ontario and one of the most demanding responsibilities physicians undertake. Despite its importance, on-call compensation has not always reflected the true workload, urgency, and time commitment required.
As part of the 2024–2028 Physician Services Agreement (PSA), the Ontario Medical Association (OMA) has proposed a new burden-based Hospital On-Call Coverage (HOCC) program designed to modernize on-call compensation and more accurately reflect the realities physicians face today.
This blog breaks down what the HOCC program is, why changes are being proposed, and how the new model would work.
What Is the Hospital On-Call Coverage (HOCC) Program?
The Hospital On-Call Coverage (HOCC) program was created by the OMA and the Ministry of Health in 2000 to enhance, stabilize, and support the delivery of hospital on-call services to Ontario patients and to provide stability and predictability in physician coverage across the province.
Over the years, the program has been updated, but core components, such as how call burden is measured and how groups are assigned to payment levels, have remained largely unchanged. As a result, the current structure no longer reflects the increasing complexity, demand, and diversity within hospital-based care.
The Problem with the Current On-Call Model
The current on-call model is as follows: each existing specialty is categorized into four levels, and the payment to each group is then based on the group’s specialty of practice (which determines its level), and the number of physicians in the group (which determines the minimum coverage).
Level | Specialty |
I | Family Medicine |
II | Anesthesia, General Surgery, Orthopedic Surgery, Obstetrics and Gynecology, Neurosurgery, Vascular Surgery, Urology, Plastic Surgery, Cardiac and Thoracic Surgery, Psychiatry, Internal Medicine, Paediatrics, Critical Care, Transplant Medicine |
III | Cardiology, Emergency Medicine, Gastroenterology, Hematology/Oncology, Infectious Diseases, Neurology, Respirology, Endocrinology, Geriatrics, Hyperbaric Medicine; Otolaryngology, Ophthalmology; Diagnostic Radiology |
IV | Immunology, Dermatology, Physical Medicine, Rheumatology, Radiation Oncology, Gynecologic Oncology; Interventional Radiology, Nuclear Medicine |
Level I/II | Level III | |||
MDs | Minimum Coverage | Annual Payment | Minimum Coverage | Annual Payment |
5+ | 100% | $181,677 | 100% | $36,335 |
4 | 91% | $164,719 | 95% | $33,911 |
3 | 80% | $145,341 | 91% | $32,701 |
2 | 80% | $145,341 | 81% | $29,068 |
1 | 60% | $109,006 | 54% | $19,377 |
NOTE: Level IV payments are based on utilization of call-in fees, with the average current payment per group of about $5,000.
With feedback, physicians have pointed out many concerns about this model, including:
Specialty-based assignments don’t reflect the real workload: Groups are assigned to a call level based solely on specialty — regardless of how often they must attend in person, respond urgently, or manage high-acuity calls.
- Payment is tied to minimum coverage, not actual work: Groups providing more than the required coverage receive the same funding as those meeting only the minimum, penalizing smaller but busier groups.
- Too few call levels: Only three meaningful levels exist (I/II, III, IV), which cannot capture the full range of call burden across specialties or hospitals.
- No flexibility for new specialties or subspecialties: Emerging areas of practice may not fit neatly into the existing levels.
Together, these issues create inequities and fail to fully recognize the intensity and responsibility of many hospital call roles.
What Enhancements Is the OMA Proposing to the HOCC Model?
To address these long-standing challenges, the OMA has put forward a burden-based HOCC model with three major pillars:
- New factors to determine call burden
Call levels would be based on:
- Hospital after-hours billings
- Required in-person response times
- Most Responsible Physician (MRP) status
- More call levels for better differentiation
Three additional levels would be added, allowing for greater nuance across specialties and hospitals, including explicit recognition of groups that must be on site.
- Per-diem payments instead of annual lump sums
A daily compensation model offers greater transparency and aligns payment more closely with actual work performed.
How the New Per-Diem Payment Structure Works
Here’s a simplified look at the proposed new structure:
Burden Level | Criteria | Response Time | Proposed Per-Diem |
1 | On-site | On-site | $800 |
2 | >20% after-hours | 1 hour | $650 |
3 | <20% after-hours | 1 hour | $500 |
4 | >15% after-hours OR MRP | 3 hours | $250 |
5 | <15% after-hours | 3 hours | $100 |
6 | 24-hour call | $5,000/year per group | ≈$50/day |
This model more closely aligns compensation with actual burden, particularly for physicians providing on-site coverage or carrying MRP responsibilities.
Why the New Per-Diem Model Is an Improvement
The proposed framework:
- Reflects real variation within specialties: Two groups in the same specialty may have dramatically different workloads — and the new model accounts for that.
- Uses objective data: After-hours billings and MRP status provide measurable indicators of burden.
- Rewards groups that provide more than the minimum coverage: The per-diem structure recognizes effort rather than size.
- Minimizes disruption: The OMA has emphasized stability; no group should be adversely affected by reclassification.
- Supports future expansion: New specialties and subspecialties can be integrated more easily.
Additional Proposed Enhancements to the HOCC Program
- New group eligibility criteria: Subspecialties can join the program if they meet defined requirements (CPSO recognition, adequate staffing, separate call rotations, etc.).
- On-Call Committee oversight: A bilateral committee (OMA + Ministry) will review requests for new or expanded groups annually.
- Updated GP rurality and anesthesia premiums: Premiums consolidated and adjusted based on burden level and RIO score.
- Clear dispute-resolution process: A new appeals and arbitration system ensures fair placements for all groups.
What This Means for Physicians
If implemented, the burden-based HOCC proposal would:
- More fairly compensate physicians providing intense or frequent calls
- Improve transparency and predictability
- Reduce inequities within and between specialties
- Support retention and recruitment in high-demand hospital services
This is a significant step toward modernizing Ontario’s approach to on-call compensation, something the physician community has long advocated for.
Need Help Understanding the Upcoming Changes to Hospital On-Call Coverage Payments?
As this proposal continues to evolve, DoctorCare will be here to help physicians understand the changes, assess the impact on their group, and stay informed about next steps within the PSA.
If you’d like help understanding how the HOCC proposal may affect your group, we’re here to support you. Contact us today and learn more about the changes to the Hospital On-Call Coverage in Ontario.
Additional Resources
Quick Reference Guide: Hospital Billing Codes
Blog: Emergency Department Billing: Frequently Asked Questions
