‘Arms races’ to attract doctors straining Ontario municipalities

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Some compare it to an arms race pitting Ontario municipalities against each other and undermining health equity. At least one municipal leader is asking the provincial government to put a stop to the growing practice of municipalities offering cash incentives in a bid to attract physicians to their communities.

“It is an unsustainable model,” said Mayor Matthew Shoemaker of Sault Ste. Marie. “It is not helping the system.”

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As the number of Ontario residents without family physicians grows — now topping 2.5 million —  municipalities are playing an increasing role in attracting new doctors. Some municipalities are offering cash incentives to attract them. This year Huntsville began offering bonuses of up to $80,000 for doctors to relocate there and to commit to staying for five years. Kingston offers bonuses of up to $100,000. Other communities are following suit.

This week, at the Association of Municipalities of Ontario conference in Ottawa, Shoemaker met with Minister of Health Sylvia Jones and asked her government to ban the practice in order to level the playing field for municipalities in recruiting physicians and health workers.

He is far from the only municipal leader concerned about the trend.

“It is a nightmare for smaller communities because we are bound to lose,” said Todd Kasenberg, the mayor of North Perth. “An arms race is how I have been describing it, with no winner.”

The Association of Municipalities of Ontario says the municipal competition to attract doctors, nurses and other health care providers is diverting municipal dollars and undermining equal access to health care around the province at a critical time. It wants the province to take a bigger, more comprehensive approach to the health human resources crisis.

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Sault Ste. Marie’s Shoemaker found himself at the centre of the primary-care crisis in Ontario this year when a clinic there was forced to drop 10,000 patients from its roster because of the acute doctor shortage. A nurse practitioner-led walk-in clinic has helped “plug the hole” in the short term, but Shoemaker said as many as 6,000 more residents risked losing access to care by the end of the year because of physician retirements.

Anxiety over the situation has gripped the community of almost 80,000, he said.

Shoemaker, like other municipal leaders, has been increasingly focused on ways to improve access to healthcare in his community.

He warns that Sault Ste. Marie is not alone. “What is happening in Sault Ste. Marie today is going to happen in every community in Ontario.”

The issue was top of mind at the annual meeting of Ontario’s municipalities.

Like other municipal leaders across the province, Shoemaker wants more co-ordinated help from the province in addition to a ban on the practice of offering cash incentives to attract doctors.

He would like to see a campus of the Northern Ontario School of Medicine University in Sault Ste. Marie to encourage more physicians to stay there. The university already had campuses in Thunder Bay and Sudbury.

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Kasenberg, of North Perth, has other ideas to help recruit doctors to his community. He would like to see the province improve financial support for virtual medicine, something that would help smaller rural communities get residents the care they need. He is also looking to communities such as Renfrew County, whose virtual triage and assessment program is increasing access to primary care and reducing the burden on hospitals there.

Kasenberg thinks the province should set up a health-care innovation fund to encourage similar innovative proposals from hospitals, health teams and municipalities to improve access to care.

Dr. Sarah Newbery, a rural family physician, associate professor and associate dean of physician workforce strategy at the Northern Ontario School of Medicine University, says Ontario is falling behind other provinces when it comes to promoting the province to graduating physicians, something that leaves municipalities trying to market to new doctors on their own.

“It feels a bit jarring to have Wawa, Timmins and Chapleau at these conferences without a provincial presence,” Newbery said.

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The Association of Municipalities of Ontario wants the provincial government to play a more comprehensive role in solving the health human resources crisis, taking some of the burden off individual municipalities. It is calling for a provincial, sector-wide health human resources strategy to improve access to health care across the province.

Among other things, AMO says such a strategy should address issues such as burnout, fair compensation, adequate staffing and the unique needs of communities in rural and Northern Ontario.

Alexandra Adamo, spokesperson for the health minister, said Jones and ministry staff met with more than 100 delegations at the AMO conference “and look forward to continuing to work with municipal leaders to help recruit and attract physicians to come work here in Ontario.”

Adamo noted that the government had added 12,500 physicians to the workforce since 2018, increased the health-care budget by 31 per cent and launched the largest expansion in medical school education in more than 15 years. It has also expanded primary care and reduced barriers for internationally educated physicians.

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