Dr.Bill was pleased to welcome Dr. Suzanne Strasberg to host our recent webinar, Your First 90 Days in Practice in Ontario. A family physician with more than 30 years of experience, Dr. Strasberg is a Past President of the Ontario Medical Association, a Past Chair of the Board of Directors of the Canadian Medical Association, and a respected Canadian health system leader and physician advocate. Key takeaways from the webinar include insight on:
- Why the leap from residency to practice is more business than clinical
- The contract terms every new physician should nail down
- Three habits to protect your time and prevent burnout
- Why new-to-practice doctors underbill, and what it really costs
- The three most common OHIP claim mistakes to avoid
Completing residency is no small feat. But no matter your specialty, the jump from residency to practice is one of the biggest transitions in a physician’s career. Overnight, you’re expected to run a business as well as practise medicine, and most training programs simply don’t prepare you for that part. Here’s how to make the shift with confidence.
The biggest shift isn’t clinical, it’s the business of medicine
To face the administrative and financial realities of running a practice, physicians who thrive long-term are the ones who stay connected to their original “why,” and who approach the business side of medicine with the same intention they bring to patient care. Decide early what kind of doctor — and what kind of lifestyle — you want, and let that intention be your compass as priorities shift over the years.
Mentorship matters here, too. Finding a senior colleague who understands the business of billing and practice management is just as valuable as finding a clinical mentor. Look for someone who understands your specialty and the kind of career you want to build, and don’t be shy about asking how they got there.
What to nail down before you sign a contract
Whether you locum, join as an associate, buy into a practice, or build your own from scratch, there’s usually a contract that sets the terms. You don’t have to blindly accept what’s offered, it’s important to talk to colleagues, understand what’s standard, and get everything in writing. Your medical association can help you review the details.
Here are some key things to clarify:
Financial and billing structure
- Your billing number and provincial licence: make sure to apply well ahead of your start date.
- Your payment model: fee-for-service, an Alternative Payment Plan, a blended model, or salary.
- How overhead is handled — a percentage split or flat fee — and which expenses the clinic covers.
- Understand after-hours and on-call obligations, plus any third-party or out-of-office payments.
Responsibilities, leave, and insurance
- Your expected hours, patient panel size, on-call rotation, and any teaching or supervisory duties.
- Restrictive covenants — check that any non-compete clause is reasonable in scope, geography, and duration.
- Vacation, Continuing Medical Education (CME) days, and sick leave, plus how coverage works when you’re away.
- For malpractice and liability, ensure the contract addresses your Canadian Medical Protective Association (CMPA) coverage and clarifies whether the employer subsidizes your fees.
- Get your own individual, own-occupation disability coverage early — premiums rise with age and changes in your health. In Ontario, the OMA has group plans to review.
If you’re starting your own practice, you’ll also be signing a lease and other start-up contracts that warrant a lawyer’s review, and you’ll need employment contracts for your staff. The OMA offers templates to help.
Three habits to protect your time and prevent burnout
Administrative burden is the number one driver of physician burnout in Canada. According to Dr.Bill’s Hiding in Plain Sight study of 500 Canadian physicians, doctors spend an average of 7.5 hours a week (a full working day) on non-clinical admin. Seventy-seven per cent say it cuts into time with patients, and 85 per cent tackle it outside working hours. The good news: burnout is preventable with these everyday practice habits.
1. Establish a routine, then build boundaries around it
Fold charting and billing into your active workflow so “admin creep” doesn’t spill into your evenings and weekends. Try to complete your charting and billing before moving to the next patient, so you never forget a code. Set goals for what a good first year looks like so it’s easier to say no to distractions, and honour the hours you set.
2. Optimize your workflow and technology
Stop toggling between clinical care, charting, messages, and calls. Group similar admin tasks into one protected block so you can stay in the zone. Delegate what you can and invest time upfront to customize your EMR with templates, macros, and auto-text. Ask peers about AI scribes and voice-to-text, and other tools that can improve efficiency.
3. Treat yourself like a patient
Apply the same standards for sleep, meals, and exercise that you’d prescribe to a patient. Burnout creeps in slowly, so learn the warning signs. These can include dreading work, feeling spent before a shift ends, or growing impatient with those around you. Make a plan for who you’ll turn to when these signs surface. Explore and take advantage of physician wellness programs at your provincial and territorial medical association.
Don’t leave money on the table: why new physicians underbill
Underbilling usually isn’t carelessness, it’s a natural consequence of managing everything at once for the first time. New physicians tend to underbill because they:
- Don’t yet know the fee schedule well enough to recognize what they’re entitled to bill.
- Underestimate the complexity of an encounter and default to a lower code.
- Rush through billing at the end of a long day and forget add-on codes.
- Simply don’t realize that routine services are separately billable, such as flow sheets, after-hours codes, special premiums.
The key thing to understand is that the system is highly attuned to catch overbilling. But it’s up to you to flag underbilling. Research cited by the CMA suggests physicians don’t bill for at least 5% of the insured services they provide. Pay close attention to codes that are time-, day-, or age-specific to avoid claim rejections for these contexts.
Costly OHIP claim mistakes and how to avoid them
It’s tempting to assume the biggest financial risk is fumbling a complex procedural code. In reality, the money leaks out through small, preventable administrative errors. Incorrect or expired health card version codes alone cost Ontario physicians an average of $10,000 every single year in claims that never get followed up on.
| Mistake | Why it happens | How to avoid it |
| 1. Bad patient data | An expired or missing health card version code means the claim is rejected before you’ve even seen the patient. | Validate eligibility at every visit. Dr.Bill’s platform has live eligibility checks and tools that pull patient data straight from a hospital label to eliminate manual entry errors. |
| 2. Missed premiums | At the end of a long shift it’s easy to default to a basic code and leave after-hours or special-visit premiums unclaimed. | Dr.Bill uses a system with the Ministry rules built in that flags when a premium may apply based on time of day and the codes you’ve selected. |
| 3. Ignored rejections | Busy physicians often let rejected claims slide. OHIP now considers claims “over-age” after three months and, barring exceptions, permanently refuses to pay. | Review your monthly reconciliation report, and correct and resubmit rejections promptly, or delegate that back-and-forth to Dr.Bill’s billing service with experienced agents. |
The bottom line for new physicians
You don’t have to be a billing or business expert on day one. Your focus should be on building clinical confidence and caring for your patients. Lean on the right support systems, including accountants, financial advisors, and a billing platform, so you can spend your time doing the work you trained for, and protect yourself from burnout in the process. Set your boundaries, value your work, and don’t be afraid to ask for help.
What’s next?
If you’re entering primary care, don’t miss Webinar 2: Building Your Primary Care Practice, on Thursday, July 16 at 12:00 p.m. ET, to break down capitation, FHO models, after-hours blocks, and shadow billing for family physicians.
And to help you start billing with confidence, Dr.Bill is offering all new-to-practice physicians three months of complimentary service on our Comprehensive Plan — with full billing-agent support and rejection recovery, and no commitment when the three months are up.
