Why some Ontario mayors want to ban financial recruitment incentives for doctors

The mayors of four distinct Ontario cities say financial incentives, used by municipalities to attract doctors to underserved, rural and remote communities, should be banned.Civic leaders in the northern steel city of Sault Ste. Marie, the southwestern business and education hub of London, the eastern tourist mecca of Peterborough and the heavily agricultural area of North Perth believe “unfair competition” between communities has become so fierce smaller towns don’t have a chance of luring new family doctors.“We think incentives are bad, and we don’t agree with them, so we’re not at this point supportive of getting into a competition on incentives because it is a competition we will lose,” noted Sault Ste. Marie mayor Matthew Shoemaker.Todd Kasenberg of North Perth thinks the shortages are “a substantial issue,” and incentives are “a mistake.”“They’ve been met with a lot of frustration in the community, a lot of anxiety,” he said on behalf of the 3,000 people without a GP in his town of 17,000.GP NEEDS BY PROVINCEPhysician recruiters use a formula dividing the number of patients without a FP by 1,400. Thus the chart below estimates the shortage of family doctors by province. ProvincePopulation (WorldPopulation Review)# of FPs(Statista)Provincial Health Ministry estimates of the number of patients without an FPPercentage of the population without an FP Number of FPs neededBC5,646,4677,615700,00012.4%500AB4,849,9065,452650,00013.4%464SK1,132,5051,431200,00017.7%143MB1,484,1351,562150,00010.1%107ON15,996,98917,1782,500,00015.6%1786PQ9,030,68411,5492,100,00023.3%1500NB850,0001,181180,00021.2%129NS1,072,5451,279160,00014.9%114PEI177,08120535,00019.8%25NF541,391666163,00030.1%116Read: B.C. targets U.S. doctors and nurses with recruitment ads near American hospitalsTo be sure, recruitment to Ontario’s physician deserts—and other areas like them across the country—has been a major issue for more than two generations.In 2002, for instance, Dr. Ken Sky, then-president of the Ontario Medical Association fronted release of a policy paper on physician resources. It indicated that nearly a million residents would soon not have a family doctor. That number today is two and a half million. More than 500,000 newcomers landed in Ontario last year.This happened despite the myriad of instruments in the toolbox of recruiters, among them memberships in sport clubs, finding jobs for the spouses of incoming doctors, housing and rent subsidies, computers, office space and even snow removal.“None of us wants to get into a billing war,” said one former ministry staffer of the OMA’s paper at the time. “It’s not fair to any province, so we’re trying to develop a co-ordinated strategy for the country as opposed to one province at a time.”“Our ability to attract industry and business, to have quality in our daily lives, is hampered when there aren’t enough physicians in our communities,” said the head of the Association of Municipalities of Ontario.Financial incentives are by far the most significant tool of all. They have ranged anywhere from $5,000 to hundreds of thousands of dollars. For instance, the municipal budget of Thorold, Ont. (near Niagara Falls) has earmarked $300,000 to finding three new doctors.Municipalities shouldn’t have to come up with money to find their own doctors, say the four mayors. The money should come from the province or federal government instead.The Ontario government’s Northern and Rural Retention Initiative to help entice physicians into establishing full-time practices in eligible, underserviced communities provides incentives of between $84,000 and nearly $125,000 over four years based on a scale of factors measuring a town’s “rurality.”The situation may be causing stress between municipalities, but it seems to be motivating cooperation among recruiters, who would prefer if the mayors thought of physicians less as a cost centre and more of a revenue generator.Jill Croteau, manager of Niagara Region’s physician recruitment program, says the mayors have been pushed into their stance by “internal reasons, internal budgets.” She believes efforts are needed to recruit more from the U.S., the U.K., Ireland and Australia.“The incentives are a driving factor for a lot of communities,” she told the Medical Post by phone from her office here. “I know in some of our communities it’s used as an economic driver.“Developers are more apt to build a medical space if there’s a sense of security that doctors will come and stay there.”Croteau’s been a recruiter for 14 years and a driver in the formation and growth of the Canadian Society of Physician Recruiters (CaSPR), Southern Ontario Physician Recruitment Alliance (SOPRA) and Ontario Physician Recruitment Alliance (OPRA).CaSPR is a not-for-profit society of individuals across Canada. It’s 152 members offer “a means . . . to share best practices, techniques and tools relating to all aspects of physician attraction and retention.”The group recently hosted a repatriation event in Ireland at its six medical schools. Over 300 Canadian students attended.“We’re connecting with them before they decide on their specialty and reassure them that we’re here to welcome them with open arms,” she said.“This wasn’t happening before. If we did a road show for medical students and all specialties for residency, it would make better use of our time as recruiters and would help to drive learners to the right resources . . . at the right times.“With Ontario working together with OPRA, we are pooling municipal dollars to achieve our goals. The province is not interested in funding recruitment of doctors (to specific communities)SOPRA, a “collaboration” of 12 municipalities in the region, “creates awareness of their practice opportunities and shares in marketing and building a pool of incentives.” It works to attract Canadians studying abroad and doctors from the U.S., U.K., Ireland and Australia through simplified licensing and repatriation.(Recruiters, it’s website notes, “are funded by different organizations throughout Ontario, ranging from municipal government departments or public health units to chambers of commerce, family health teams and hospitals.”)OPRA, according to its website, is “committed to transforming how primary care doctors are recruited, retained and supported. By engaging both local and internationally trained physicians, we are expanding our efforts to meet the urgent healthcare needs of Ontario’s communities.”OPRA is currently looking to “modernize” the visits to each of the province’s medical schools sponsored by the Professional Association Interns and residents of Ontario (PAIRO). The sessions brought together communities looking for doctors with those about to graduate. In a seeming refute of the mayors, the group describes physicians as “one of the most powerful economic development tools a community can invest in.”A 2020 Canadian Medical Association study found physician offices contributed nearly $14 billion to Ontario’s GDP in 2019, while supporting 167,000 jobs. In addition, every dollar invested in recruitment can generate $12 to $30 in return through physician billings, job creation and economic activity. Full staffs also help avoid costs ranging from $20,000 to $50,000 per locum to keep operations running when there are shortages.“The cost of instability adds up financially and socially. . . . Let’s treat recruitment—and retention—for what it truly is: a smart, strategic investment in our future,” the study said.Calls to the health ministry and Peterborough mayor’s office were not returned.

Why some Ontario mayors want to ban financial recruitment incentives for doctors

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