Do you want to know why your family doctor is so steamed? Ask David Phillips, a GP who practises at the Albany Medical Clinic in a middle-class neighbourhood in Toronto. "I had my teeth cleaned last week, and the bill was $90," he fumes. "I give a patient a complete checkup, and I bill OHIP $53.55."

And that's just the beginning of the family doctors' gripes. The stress is a killer. The hours are rotten. They spend way too much time trying to get their sickest patients moved up on the waiting lists. And now the government is trying to reform them.

Primary-care reform is something you may not know much about, except that it will be good for you. Senator Michael Kirby is all for it. Roy Romanow is all for it. Every health-care reformer in the past 30 years has been all for it. And now it is official government policy in Ontario, which has mounted a huge push to move doctors into "family health networks" and away from fee-for-service payments.

In theory, primary-care reform will give us better medicine, cheaper. It will improve access to care and make the system more efficient. There's just one problem. In practice, the doctors hate it.

Ontario's Health Ministry said it was going to get 80 per cent of the province's family doctors signed on to the scheme by 2004. To date, it has signed up less than 4 per cent.

"We're simply not interested in participating," says Douglas Mark, who practises in Scarborough. He's president of the 3,200-strong Coalition of Family Physicians of Ontario, which has basically told the province to drop dead unless it can come up with something better.

In a family health network, a group of doctors work together with other health-care professionals in a team. Their patients get round-the-clock one-stop shopping, and the doctors' group gets an annual flat rate for every patient. The patients have to promise they won't shop around.

But the doctors say the funding formula is too stingy, too complicated, and saddles them with too much risk. They dislike the bureaucracy and the paperwork and the complicated contracts they and their patients are supposed to sign. "The more we see it, the less we like it," says Dr. Phillips.

The real problem is, they don't trust the government, which has been capping fees and hitting them with nasty disincentives for years. They don't even trust the Ontario Medical Association, which has been negotiating on their behalf. They're not crazy about the concept, either. One of the ideas behind family health networks is that some of the work doctors do can be performed by lower-paid professionals. But they don't buy it. "My patients," says Dr. Phillips, "don't want to see a nurse-practitioner. They want to see me."

Doctors are a famously hidebound group. They hate change. That's why some experts want to make primary-care reform mandatory. This would be a bad idea, because life as a family doctor is already severely unattractive. Every province is desperate for more GPs, and Ontario has about the worst shortage in the country. In Toronto, a reasonably attractive place to work, it took two years for Dr. Phillips's clinic to recruit two new associates.

"Family medicine is in crisis," says Dr. Mark. "Ninety per cent of new graduates are not going into comprehensive medicine. They're going to work in walk-in clinics, or emergency wards, or doing fill-in work. They don't want to take on the larger overheads and the large amounts of bureaucracy we face." And fewer graduates than ever are choosing any type of general practice at all. Why go to medical school for 10 years to become a GP, when a dental hygienist can bill more for her time than you can?

If you still think health-care reform is imminent, this story adds up to a whole pile of bitter pills. Talk is cheap, but changing the way things work is excruciatingly hard. Restructuring the system is always much more expensive than everyone thinks it's going to be. When it's done by a bunch of bureaucrats, it generally goes badly. And the "efficiencies" and savings everyone hopes for seldom materialize. Even the government's own point-person on family health networks now acknowledges that changing the system won't save a dime.

For years, provincial governments have beaten doctors with large sticks to contain costs. Now they need carrots to recruit them back. But they don't have carrots. They can't afford them.

"I hope we can save our profession," says Dr. Mark. "We are essentially a species of animal that can no longer reproduce."