In response to widespread concerns about primary care access and the need to support community-based longitudinal family practice, Canadian provinces have introduced reforms to primary care physician payment. Agreements announced in British Columbia, Nova Scotia and Manitoba introduced new models that share the structure of a base hourly rate, fees per patient visit, and an annual per-patient payment. The new payment models, although characterized by varying stated objectives, collectively strive to enhance the allure of longitudinal community-based family practice as a career option and may address longstanding disparities in pay between family physicians and other specialty-trained physicians. By fostering the recruitment and retention of family physicians into community settings, these models have the potential to enhance care access. At the same time, the models do not explicitly address other longstanding, structural issues in primary care, and may have unanticipated impacts on service delivery including changes to service volume, attachment of new patients, and health system costs that require careful study.