Canada’s rural doctor shortage fix

Visiting my son recently, I discovered how small towns in Canada are offering big perks to attract family doctors

During a recent visit to my son and his family in Canada, I became aware of an interesting development involving general practice in Ontario. It turns out that local municipalities are offering family doctors thousands of dollars and other benefits to work and live in smaller cities and towns in the province.

More than six million Canadians lack regular access to primary care physicians. This problem is particularly prevalent outside of the major urban centres. Docs by the Bay is a physician recruitment programme in Trenton, Ontario.

In response to the workforce deficit, the programme is offering $100,000 to new doctors who establish a full-time family practice in the area. To retain the funds, physicians must commit to working in the region for five years.

Trenton sits on Lake Ontario, a little over 100 miles from Toronto. It is connected by train with Ottawa and Montreal and is about an hour’s drive from the university city of Kingston, so we are not talking about medical jobs in the ‘boonies’. In fact, far from it – the area is the gateway to Prince Edward County, which boasts a number of wineries and lakeside towns.

The programme has recruited 18 family physicians to the region in the last seven years. However, Paula Mason, head of recruitment for Docs by the Bay, recently told CBC [Canadian Broadcasting Company] this task is getting more difficult due to increased demand.

Various physician recruitment programmes exist in Ontario and other provinces, offering incentives that vary based on the unique needs of each community.

In Huntsville, Ontario, doctors are eligible for a $60,000 bonus when they take over an existing practice, and $80,000 for establishing a new one. At Blanche River Health in Kirkland Lake, Ontario, individuals can earn a $2,000 reward for referring a healthcare worker to fill a vacant position.

Where does the funding come from? Lucrative local property taxes allow some municipalities to offer much greater funding than others, which creates inbuilt disparities across a province. It also feeds something of a “race to the bottom”, as towns that can afford it compete with ever-increasing physician incentives.

As we know from here, many general practitioners are prioritising a healthy work-life balance when considering their career opportunities. Factors like job opportunities for their partners, location, and education facilities are important parts of their decision-making process.

Dr Maria Mathews, Family Medicine Professor at Western University and a Canada Research Chair in Primary Health Care and Health Equity, says recruiters need to listen to what family physicians are asking for and make adjustments accordingly.

“New grads don’t necessarily want to run a new practice. They want to come in and take care of patients. So, maybe we need to rethink what the role of the family physician is and the team in which they work,” Mathews told CBC.

In Canada, as in Ireland, most family physicians operate as fee-for-service or capitation-based small business owners, meaning they are reimbursed for their clinical activity by the provincial government. However, there are alternative payment structures, such as salaries, sessional payments, and contracts.

Mathews says she is concerned about high turnover rates for family doctors in the cities where they’ve been recruited. She has studied financial commitments like return-for-service agreements – incentives given to trainees to move to a specific community – and found they don’t always work.

This, in turn, has led to doctor retention programmes by towns and cities.

While I was in Canada, the local Quinte West Council approved a doctor retention agreement that would see eligible family doctors receive $10,000 a year, as determined by the city’s physician recruitment committee.

Some 19 doctors are practising family medicine in Quinte West, with seven of them currently on a $100,000 recruitment contract, leaving 12 current doctors who are potentially eligible for the programme.

Once a doctor currently under a five-year recruitment contract finishes it, they would then become eligible for the retention fee.

In order to qualify, doctors must have a list of at least 1,000 patients. It also emerged at the council meeting that the region offers $10,000 for nurse practitioners and had approved $25,000 for doctors that take on 250 extra patients.

Reading about these generous incentives must make Irish GPs somewhat green with envy.

And for those of us a bit longer in the tooth, the Canadian situation is light years away from when Irish doctors wishing to practise there had no option but to accept posts in sparsely populated rural areas.

Will we ever see recruitment and retention fees like these in Ireland? While it is not something I can see in the next 10 years, given the retention issues facing rural practice in particular, I wouldn’t bet against it happening here.