$100,000 and a Gym Membership? How Some Small Towns Are Attracting Doctors to Their Communities

Canadian municipalities are offering family doctors thousands of dollars and other benefits to work and live in smaller cities and towns, health care recruiters and municipal leaders say.

More than six million Canadians do not have regular access to a family doctor, a problem that is linked to poor health outcomes and increased strain on the health care system.

This problem occurs mainly outside major urban centres.

Docs by the Bay, a physician recruitment program in Trenton, Ontario, is offering $100,000 to new physicians or medical assistants interested in setting up a full-time family practice in the area, Paula Mason, manager of physician recruitment, told The current guest host Susan Bonner. Doctors must work in the region for five years to keep those funds.

“The competition is very fierce,” says Mason.

The program has brought 18 family physicians to the region over the past seven years, but it’s “getting harder every day” because of increasing demand, said Mason, who is also a past president of the Canadian Society of Physician Recruitment.

According to Mason, there are now more physician recruitment programs in Ontario and elsewhere, and incentives vary by province and also depend on the specific needs of the community.

In Huntsville, Ontario, a physician can earn a $60,000 bonus for acquiring an existing practice and $80,000 for starting a new practice. If someone refers a healthcare worker to fill a vacancy at Blanche River Health in Kirkland Lake, Ontario, he or she can earn $2,000.

“We’re all competing for the same pool of candidates. So it’s a matter of making your community stand out,” Mason explained. “If you bid $25,000 and the community next door bids $50,000 … money talks. If you go to $50,000 and they go to $75,000, where does it end?”

Trenton residents have also banded together to offer doctors benefits such as signing bonuses, club memberships, free car use and lower rents.

Municipal inequalities

According to Peterborough Mayor Jeff Leal, recruitment programs are typically funded by municipal tax dollars, which vary by city, creating differences.

“Municipalities that have lucrative [property tax] “The assessment centers can provide more help than other municipalities,” Leal said.

He calls municipalities competing with each other to offer doctors high financial bonuses a ‘race to the bottom’.

Leal says the province should implement a rule similar to the Ontario Municipal Act, which banned bonuses for industrial commercial developments, and advocates for fairer solutions in physician recruitment.

Peterborough’s recruitment bonus package includes $15,000 plus something called the “Whole Town Village” incentive program for new doctors who add up to 650 patients to their list. There’s also the “Hometown Proud” program that rewards doctors originally from Peterborough with bonus funding when they return to practice there.

Leal calls access to primary care “the most important building block” for a person’s overall health and hopes that incentives like these will improve working conditions for physicians and address staff shortages and burnout.

Caring for healthcare workers

Many family doctors prioritize a healthy work-life balance when considering their career options, says Mason. Factors such as job opportunities for their partners, support for their children, safety and location are important parts of their decision-making process.

Dr. Maria Mathews, a professor of family medicine at Western University and a Canada Research Chair in Primary Health Care and Health Equity, says recruiters should listen to what family doctors are asking for and tailor their applications accordingly.

“New graduates don’t necessarily want to run a new practice. They want to come in and look after patients. So maybe we need to rethink what the role of the GP is and the team they work in,” Matthews said.

Most family physicians in Canada operate as small business owners on a fee-for-service basis, receiving reimbursement for their clinical activities from their provincial government. However, there are alternative payment structures such as salaries and session payments and contracts.

Many family physicians want to work as members of an integrated health care unit, Matthews says. She says those recruitment efforts and incentives should be extended to other health care professionals as well.

“If we only recruit one type of player, the GP, we forget about the rest of the team and that creates a lot of inequality within the team when you finally do bring one in,” said Matthews.

Conservation is the key

Since the key to quality primary care is continuity between providers and patients, Matthews says she worries about high turnover rates for primary care physicians in the cities where they’re recruited. She’s studied financial commitments like return-for-service agreements — incentives given to trainees to move to a specific community — and found that they don’t always work.

“Many of them will choose to break the agreement or simply buy out the contractual obligation. That leaves the community without a doctor or with a doctor who doesn’t stay long,” Matthews said.

She says it’s important to track this information and the effectiveness of the programs because huge amounts of government money are spent on recruitment.

Matthews is concerned about the shortage of primary care physicians in communities across the country, including large urban centres such as her hometown of London, Ontario.

“I think it just indicates that there is a shortage and that it is being felt in places where we previously didn’t think there was a shortage.”