The College of Family Physicians of Canada says that about five million Canadians don't have a family doctor. A 2007 Commonwealth Fund international health policy survey found 30 per cent of adult Canadians wait six or more days to get an appointment with their regular doctor, compared to 20 per cent in the United States and Germany and four per cent in New Zealand. (CP PHOTO/Kevin Frayer)

Peterborough and Belleville are two Ontario cities with much in common. They're both at the midway point of the Toronto-Ottawa corridor. The local economies include manufacturing, clean industry and food processing. Both have populations of older residents that number above the national demographic average. They're competitive, too: Belleville has the Bulls and Peterborough has the Petes, a rivalry that ribald Junior Hockey fans savour with relish.

There's fierce competition to attract family doctors to the two communities as well — and that's where the similarities end.

Peterborough is wooing established doctors who want to make a move for reasons of lifestyle. Belleville is setting its sights on medical students and luring them with cash.

Belleville Mayor Neil Ellis said his community is classed as under-serviced by the province and needs 15 to 20 new doctors to meet the need for family physicians. And given that many established doctors have as many as 5,000 patients, "you almost have to find two students, or two new doctors to replace one who is retiring," he said.

John MacDonald spearheads doctor recruitment in an area serving 135,000 residents in the city of Peterborough and surrounding county.

John MacDonald, who spearheads doctor recruitment in an area serving 135,000 residents in the city of Peterborough and surrounding county, estimates there are 10,000 to 14,000 people still without a family doctor in his neck of the woods. Three new doctors are confirmed for 2008, with two or three more in negotiations. Still, MacDonald estimates there's a need for 10 additional full-time equivalents to meet current demand and absorb any future retirements.

Waiting times, he said, are hard to quantify. With new doctors tending to be more discerning in their patient selection criteria, some may find the wait longer than others.

Show them the money

MacDonald notes that northern communities have long offered cash incentives in an effort to attract health-care professionals. However, in recent years — and in tandem with the doctor shortage that is nothing short of a crisis across the country — this trend has begun to shift southward.

Ellis, running on a platform of doctor recruitment, won the right to wear the chain of office in Belleville in the fall of 2006. The first-time mayor quickly rolled up his sleeves and, with the backing of council, secured funds to offer a bursary to medical students who agree to practise in Bellville after graduation.

Under the terms of the Belleville program, initiated in March 2007, a $150,000 bursary is paid out in annual instalments of $25,000 over a six-year period. Graduates must agree to stay for a minimum of five years, otherwise they forfeit the payment due for year six and all money paid up to that point would have to be returned in full — plus interest.

According to Ellis, a graduate ducking out early is a risk the community is prepared to take. "Hopefully [the grads] are going to stay after the five years. It gets them here, [they] become part of the community, and hopefully the majority of them will stay."

The program's success is attracting national attention. After the first graduate was signed in the first few days of the initiative, the target was quickly revised upward from five doctors to 13, which the mayor expects to reach early in 2008.

"I was hoping to sign five new graduates in the first year," remembered Ellis, who now hopes council soon will approve additional funds to attract his ideal — 20 signed recruits. "We could be there by summer."

There has been no backlash from taxpayers. The recruitment program is funded by dividend payments from Belleville's 13-per-cent stake in Veridian, the utility that serves a host of communities in that part of the province, rather than by tax dollars directly.

The city could have used the utility dividend to ease municipal tax rates instead of funding the medical bursaries — however, Ellis said, "for most homeowners, the savings would be negligible." Instead, the city will see a gradual phasing-in of 13 new doctors who will likely stay the minimum five years — maybe longer — easing the immediate shortage of local medical professionals.

"The first one is coming this summer," Ellis said. "Another for 2008 has just been signed, and a third is expected. The majority [six] will be starting in '09, with one in 2010, two in 2011 and one in 2012."

Community spirit

Peterborough has achieved a measure of success with its own recruitment program, although in less dramatic — or expensive — fashion.

MacDonald, the retired educator who assumed the recruitment role in partnership with the Greater Peterborough Area Economic Development Corp., began to actively recruit about six years ago and has attracted, on average, three new family doctors each year. However, the city has also been losing one to two doctors each year to retirement, "so the net gain has continually been a challenge," MacDonald said.

Peterborough takes aim at established doctors looking to move, but is careful not to poach health-care professionals from other communities. Using $150,000 in grant money from HRDC as startup capital, MacDonald and his team built a recruitment system and a website to promote the benefits of starting a practice in the area.

"You don't have to go out and find them, they find you," MacDonald said with a smile, noting that the website has proven to be an extremely effective tool for attracting doctors.

Once an inquiry is made, MacDonald personally introduces candidates to their potential new community. Incentives such as help with relocation expenses, discounted professional services and free rounds of golf are a nice touch, but pale in comparison with the real attraction: The community itself. Peterborough is rich in green space and the arts, with both a university and a college, and it's also close to cottage country.

Professional attractions include a state-of-the-art regional hospital opening in June. Potential opportunities to freelance at the new Peterborough Regional Health Centre (PRHC) complement the availability of specialists now being recruited to staff the facility, giving family doctors the assurance of available specialists for patients in need of a higher level of care.

MacDonald added that Peterborough's leadership role in the development of family health teams provides a stable medical environment for the family doctor, including enhanced levels of compensation.

Cash versus community debate

MacDonald noted there has not been the political will in Peterborough to offer major cash incentives. He said he finds that established doctors are more interested in what the community has to offer, including its lifestyle and employment opportunities for a spouse. Beyond that, they seem to be "happy with a month or two worth of overhead" as a financial incentive, he said.

He also questioned the wisdom of "buying" doctors with municipal dollars, and the commitment of a graduate who comes primarily for the money. He said cash could prove to be a worthy incentive for the first year or two, but by year three and beyond a doctor is making good coin from his practice. The annual incentive would seem like pocket change, suggesting a comparatively inefficient use of municipal funds, he said.

Plus, he's wary of sparking bidding wars.

"Where will it end?" MacDonald asked. "The 'have' municipalities will have the doctors, the 'have-not' municipalities won't."

In answer to such criticisms, Ellis of Belleville said: "We are not buying doctors. What we are doing is supporting their education."

The community's leaders crunched the numbers and determined, on average, that a med student training to be a general practitioner (GP) will have $25,000 to $35,000 in educational expenses a year for six years. Thus the goal was to pursue students intending to enter family practice, and to offer them a bursary representing the average cost of their education.

"Our research shows that med students are interested in the money, not services," Ellis said, noting that one local developer came up with the idea of providing a house, free and clear, for two years. However, with the student community, it proved a non-starter. On the other hand, the chance to have their student loans covered has proven quite attractive, and the program has exceeded all expectations, Ellis said.

Ellis now feels confident that, provided council approves extra funding, Belleville will reach the magic number of 20 signed recruits by July. That would represent a $3-million investment, assuming 100-per-cent retention, paid out over a 10-year period based on staggered introduction of new family physicians into the community.

"I was just talking to a potential recruit, who is married with a new baby," Ellis said. He expects such a family dynamic to result in the doctor putting down roots in the community, noting that within the initial five-year commitment, that child will have started school.

Ellis also plays the personal service card, visiting med students and shadowing prospective recruits when they visit his city.

"In some communities, you can't even get an appointment with the mayor," said Ellis, who in contrast sometimes spends up to two full days with a new recruit. "The students think it's a nice touch."

"Retention is a key component," Ellis added, saying that while the cash "gets them here, it's the community that keeps them here."

Peterborough might agree with the Belleville mayor's statement, if not with his tactics. The gamble for Peterborough is whether the subtle, measured recruitment of established doctors will meet current and future needs.

The implementation of family health teams and the new hospital are distinct advantages, and 14,000 people have been taken off the waiting list for a family doctor over the past two years. However, Peterborough also has an aging population with a median demographic that is one of the highest in the country, so demand for services is rising at the same time that established doctors are retiring.

Who has the better prescription? Time will tell. With doctors in limited supply, short of outright poaching, local officials say it's every community for itself for the foreseeable future.

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