Objective: To consider the policy issue of physician reimbursement by examining the events that preceded the Ontario Gyneco­logic Oncologists moving from a fee-for-service environment to an .alternate payment plan in 2001. Methods: The sources of information included a literature search, reviewing Canadian newspapers, interactions with key leaders in the field (Ontario Medication Association, University physicians), and meeting minutes from both university and provincial groups considering alternate payment plans. Results: The problem for Ontario Gynecologic Oncologists involved the goal of providing excellent clinical care, undergraduate and postgraduate education, research and administration in the midst of problems with recruitment, retention and remuneration. Multiple causes for this problem included limitations in health care spending and a fee for service payment schedule that did not ade­quately reimburse complex care. This funding problem got on the agenda as a result of a front page article in the national newspa­per and letters of concern solicited from local members of the provincial parliament. The policy formulation needed to account for alternate financial options and the roles of institutional structures such as the universities, Cancer Care Ontario and the Ontario University Health Science Centers. The influences on the evolution of the new funding policy included the actors, their interests, the values, research on the topic and institutions. Conclusion: The tensions between the goal of excellence in care, education, research and administration and difficulties with recruitment, retention and reimbursement, led the Ontario Gynecologic Oncologists to seek an alternate mechanism of reimburse­ment from the fee-for-service model.