'Intense' competition pushes eastern Ontario communities to lure family doctors with cash

As mayor of Quinte West, Ont., Jim Harrison says he's offered doctors everything from a boat slip to a temporary apartment in an effort to convince them to move to the city.

Although Harrison doesn't view it as a competition, he said the scarcity of doctors creates a big issue: a competitive market is pitting municipalities against each other in creative attempts to lure family doctors.

"We've got to do everything we can to get the doctor to stay here — not just to come here," Harrison said.

Quinte West, located on the shore of Lake Ontario about 20 kilometres west of Belleville, Ont., currently offers physicians a financial incentive of $100,000 in exchange for a five-year commitment to the city.

Although no official statistics about the incentives doctors are tempted with exist in the province, multiple sources who spoke to CBC said the practice appears to be growing in eastern Ontario.

The Ontario College of Family Physicians estimates more than 2 million Ontarians are without a family doctor, and those shortages are felt more acutely in rural and remote parts of the province.

Faced with a limited supply of physicians and a suite of provincial programs that are not fully addressing gaps in rural and remote areas, municipalities are deploying resources of their own.

In many cases, that comes in the form of direct payments.

Upping the incentive

On March 28, Hastings County council voted to approve a budget that would see its physician incentive program increase from $100,000 to $150,000 for a minimum four-year commitment. It also added another $75,000 incentive to help cover relocation costs for licensed doctors returning from elsewhere in Canada or overseas.

The county north of Belleville, which contains 14 small municipalities, has been doling out the payment since 2006.

At the time, Hastings County intentionally took a "long-term view" by targeting medical school students rather than established doctors, according to the county's chief administrative officer Jim Pine.

Such an approach, Pine said, avoids stealing physicians from neighbouring municipalities.

"We wanted to make sure that we didn't create a problem for another community by luring away or attracting an existing family doctor," he said.

The recent incentive increase isn't unprecedented in Hastings County. It had previously offered $150,000 but reduced the total in 2017, hoping the lower amount would be enough of a draw.

"But because of all the competition, that really hasn't panned out," Pine said.

The competition

In the years since Hastings County implemented its program, neighbouring municipalities have introduced their own.

"The competition factor is very high," Harrison said. "It's very intense."

Nearby Kingston, Ont., for example, also offers $100,000 for the same five-year commitment. Belleville, meanwhile, offers $150,000 for six years.

The council of North Grenville, a township located about 55 kilometres south of Ottawa, passed its own $100,000 incentive in March.

Generally, these incentives are also coupled with breaks on rent or other measures designed to save money for doctors.

Pine said Hastings County has successfully signed 21 candidates since debuting the program, and retained 16.

"When we started all those years ago, we were hopeful that if we were able to attract one to our rural communities, we would have considered it a success," he said.

"It's been a really good program over the years for us."

Onus should be on province, prof says

The distribution of physicians across the province is related to socioeconomic status — in other words, poorer municipalities are more likely to suffer from doctor shortages than richer ones.

Direct municipal cash incentives for doctors may only make that reality worse, said Arthur Sweetman, a professor of health human resources at McMaster University.

Although Sweetman doesn't blame local politicians for using the resources available to them, he said a broader issue arises when some municipalities lack the means to offer alluring cash incentives.

"I don't think that's how we want to be thinking about Canada's publicly funded health-care system," Sweetman said. "The province should be dealing with it in a way that's equitable and not dependent on the tax base of a particular neighbourhood."

Sweetman said he believes the onus for ensuring equitable access to medical care should fall on the province — and that starts with training and licensing more physicians.

Ontario currently administers three programs designed to redistribute doctors to underserved areas, including payments of up to $117,600 over four years, depending on the remoteness of the community.

A spokesperson for the Ontario Ministry of Health said the province is leading the country in ensuring access to a family doctor or primary health-care provider.

"We have launched the largest medical school expansion in Ontario in over a decade," a spokesperson wrote in an email.

The province also touted its work to make it easier for internationally-educated doctors to practise in Ontario.

Communities 'get desperate,' doc says

But those provincial offerings are "pretty paltry" compared to what wealthier communities can scrape together, said Peter Englert, a retired family doctor and the Ontario representative for the Society of Rural Physicians of Canada.

Englert said provincial bonuses for doctors practising in rural areas haven't increased in decades and that makes communities "desperate."

"It's a terrible state of affairs."

Local cash incentives aren't new, according to Englert.

Instead, he said, doctor shortages and provincial policies that make it more difficult for rural practices to turn a profit are driving up competitiveness.

Under those conditions, family doctors become "more mobile," Englert said.

"You're there for a while and then, you know, another community offers a much better deal, and away you go," he said. "You can't blame people for taking a better job."

Increasing provincial incentives would "be a nice little carrot," he said, but that won't solve the issue.

"You're on a level playing field with, you know, large communities and big cities," he said. "Which is really hard for the rural areas."

In Quinte West, Harrison said he's often up against nearby cities with deeper pockets offering bonuses of their own.

"If we have to make an adjustment in some of our prices to attract them, that's something we would certainly consider," he said.