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As small communities in Ontario struggle to find doctors and nurses, one city has come up with a strategy that appears to have a shot at success: giving them “a bag of money up front.”
That’s the incentive being offered in Huntsville, Ontario, where local authorities are offering an $80,000 signing bonus to any family doctor who agrees to work in the city for at least five years.
Other communities use similar tactics.
Blanche River Health in Kirkland Lake, an eastern Ontario community, is offering $2,000 to anyone, anywhere in the world, who successfully refers a doctor or nurse to work at the hospital.
In Dryden, Ontario, a remote town more than 1,700 kilometres northwest of Toronto, the regional health centre’s long-standing physician bonus program currently includes $37,500 to help with relocation expenses. Combined with separate provincial subsidies, doctors who move to Dryden can get up to $155,000 for a four-year commitment.
Health experts warn that while the moves are understandable given the dire shortage of doctors in Ontario communities, they risk creating a “Hunger Games”-style battle for medical staff, further straining already cash-strapped municipalities.
“It already works,” says councilor
Bob Stone is the local councilman who led Huntsville’s new bonus initiative.
The plan, which was approved by the council in May, hopes to attract ten doctors.
Stone says that after two months, seven doctors have already expressed interest and several more are close to signing a contract.
“It’s already working and we’re so excited about it that we’re going to tell the whole world about it once we actually sign a contract,” he said.
More than two million people in Ontario do not have a family doctor, and that number is expected to double by 2026. As CBC’s Mike Crawley reports, there is growing pressure on the provincial government to make family medicine more sustainable by paying doctors more, including for administrative work.
Stone explained that Huntsville needed to take urgent action. With waiting lists for doctors growing longer and more working physicians retiring, nearly a third of the city’s 21,000 residents are at risk of not having a primary care physician, he said.
Under terms approved by the council, each doctor who takes over an existing practice will get $60,000. Doctors who open a new practice will get $80,000. The funds will come from the city budget, Stone said.
“We’re giving them a bag of money up front because that’s what will really get them over the line to move here,” he said, adding that the bonus is tied to a five-year commitment.
Jorge VanSlyke, president and CEO of Blanche River Health, a company that operates in Kirkland Lake, said the community referral program has led to more questions about available options, but noted it’s too early to say whether the program will work.
“You really need to be the person who considers the successful candidate as a referral. We will then contact you that way and give you the incentive,” VanSlyke says.
“We don’t know yet whether it will be a success, but our goal now is to do everything we can to recruit as many people as possible.”
Incentive programs bad for health equity, expert says
Ian Culbert, executive director of the Canadian Public Health Association, said the growing role of incentives to attract doctors puts communities seen as less attractive in “an impossible situation.”
While such programs have existed for decades in some rural and northern communities, they have noticeably accelerated since the pandemic.
“It’s a very negative force when it comes to health equity. It creates an uneven playing field and it comes from a sense of desperation,” Culbert said.
Culbert does not blame communities for offering bonuses, as they have a responsibility to provide health care to their residents.
The Ontario government announced funding for a new medical school at York University. But as CBC’s Patrick Swadden reports, doctors and advocates in the medical community aren’t confident that more training will solve the province’s primary care crisis.
But he argued that there are better ways to address the rural physician shortage, such as forgiving student loans tied to years of service in a community, or introducing medical students to the benefits of rural work through short-term programs during their medical studies.
He also said the province needs to do more to address shortfalls in per capita health care financing.
According to Dr. Dominik Nowak, president of the Ontario Medical Association, the first step must be to address the overall shortage of family doctors.
Nowak said one in five Ontarians doesn’t have a family doctor, and that could soon be one in four. That shortage has set off a chain reaction where fewer people get an early diagnosis for serious illness, ultimately putting more strain on hospitals.
“This means communities are feeling the pain,” he said.
Nowak supports several measures that he believes would allow doctors to see more patients. One example is adding administrative staff to reduce the paperwork that currently takes up an average of 19 hours per week.
He also advocates a team-based care system, where nurses, pharmacists, physical therapists and others work better together to support physicians.
Nowak called for more provincial support to increase the number of doctors. He condemned bonus-driven recruitment as a “Hunger Games-style framework where communities have to compete for doctors and communities recruit doctors from one community to their own community.”
City offers doctors free riverside housing and clinic space
Meanwhile, the incentive packages are becoming increasingly extensive.
In the community of Marmora and Lake, about 200 kilometres east of Toronto, doctors are offered free housing and riverfront clinic space, among other things.
And in Huntsville, Stone says, there’s more than just cash available: Several restaurants have offered $500 gift cards to visiting doctors, a car dealership is offering a free car for a year, and an area resort is offering a free golf club membership.
Because Huntsville doesn’t want to steal doctors from its neighbors, doctors from Muskoka and surrounding communities are not eligible. However, according to Stone, doctors from other communities are allowed.
“Yes, it’s a competition, and we do our utmost for our own citizens,” he said. “And I feel sorry for others who have the same problems.”
