Despite considerable efforts by the Kawartha Lakes Health Care Initiative (KLHCI), the city finds itself 14.5 family doctors short of its needs.
Lisa Green, president of KLHCI shared her findings with city council recently as the group made its annual budget request.
“It takes an entire community to recruit a doctor,” Green said, “and currently 3,550 adults and 300 children in Kawartha Lakes have no access to a family doctor.”
In 2020, KLHCI was able to recruit one new family doctor, but the need across the region is still significant.
“Bobcaygeon needs 1.5 family doctors, Fenelon Falls 2-3, Lindsay 5-6, Woodville 1-2 and Kirkfield 1-2,” Green said. She notes that 33 per cent of Kawartha Lakes residents are receiving their primary care “outside the city.”
KLHCI receives a budget of $66,143 from the city to cover operating costs and $36,000 to fund their doctor education program which is used for recruiting new physicians. In addition, the city has proposed a Doctor Recruitment Reserve of $50,000 so that when KLHCI successfully recruits a physician they may request funds from the reserve to support a ‘return of service’ agreement with the physician.
A return of service agreement, according to the Ministry of Health website, is a program by which physicians commit to practise in an Ontario community for up to five years in exchange for training or interest relief support. The reserve money might be used for subsidizing rent or staffing costs in return for a doctor setting up practice somewhere in the city. Council would have to approve each reserve request.
“Because of the pandemic,” Green said, “we have had to limit our recruitment to virtual tours highlighting Ross Memorial Hospital to be shown at virtual job fairs for new doctors. We have not spent the $36,000 allocated to doctor education in 2020 and we would like to roll that over for 2021.”
Two recent studies from the United States and Australia suggest that KLHCI is fighting an uphill battle to find physicians willing to set up practice in a rural area like Kawartha Lakes.
According to American-based National Rural Health Association, in 2019 it was difficult to recruit new healthcare professionals to rural areas because “many physicians don’t want to live in small towns, and they may think that facilities are out of date or the work isn’t exciting. The workload may also be higher in rural facilities, where they don’t often have access to specialists who would take on specific cases in an urban setting.”
Brock Slabach, senior vice president of the National Rural Health Association, suggested that “offering incentive or reimbursement programs that would pay part or all of a physician’s student debt has proven a great way to bring these doctors to (rural communities). Paying of signing bonuses is another way to bring in a physician who no longer has loan debt.”
“You can plan for the future by finding rural kids interested in going into medicine,” Slabach suggested, “and encourage them through community outreach programs. They are more likely to come back home after medical school and residency.”
A third suggestion made by Slabach stressed the priority to bring in new doctors as temporary fill-ins to bridge the gap between permanent physicians for the short-term. The hope is the temporary doctor will develop a like for the locale and then accept a permanent job there in the future.
Similar findings, and more, were discovered in a 2019 Australian study by the Rural Doctors Association of Australia, which found there are additional practical challenges facing the recruitment of general practitioners to rural areas.
The RDAA said family practice was the lowest remunerated specialty in Australia. The findings also suggested that family doctors are required to deal with the greatest variety of illness, meaning a certain personality type is required.
“The cost of doing business in rural parts of the country is more expensive and GPs, essentially, are running a private business,” the Australian report stated. “Beyond the systemic issues facing rural family doctors, a variety of human factors can further complicate the decision for those weighing up a career in rural medicine. Issues such as spousal employment opportunities, quality of schooling available for children, and ease of access to extended family naturally impact any decision to relocate.”
The report made clear that many rural GPs battle with a sense of professional isolation.
“The trouble with a lot of rural towns is if you’re the only doctor there — or there’s one or two of you — is you work to death and you burn out,” the report concluded. “You need a situation where you have a number of doctors working in town, doctors who you can discuss difficult cases with or work out a plan for managing difficult cases.”
Locally, Green told council that more doctors fresh out of school are looking for a permanent position rather than locum positions.
This trend could unfortunately limit the KLHCI’s ability to get doctors into the area for a few months where connections could be made and a doctor could become acclimatized to the benefits and challenges of working in a rural environment.