Every Life Counts - Q & A

Why is there a shortage of family doctors?
Today, the number of graduating doctors does not equal demand. For the next five to six years 704 students will graduate yearly from Ontario's five medical schools. An increase in medical seats in 2005, by the province, has added about a 100 seats along with 52 more at a new medical school in Sudbury and Thunder Bay. Since medical training takes six years, four years of med school and two years of residency, these additional students will not graduate until 2011.
Only about half of them will become family doctors. The others will pursue a minimum of two more years of study to become specialists. Even with more medical students, including International Medical Graduates (IMGs) admitted to residency training programs, we can not expect the shortage of family doctors to end any time soon.

How serious is this shortage?
Currently 140 communities in Ontario are designated as under-serviced by the Ministry of Health and Long-Term Care. This includes Chatham-Kent. Collectively, these communities are searching for 788 family physicians and various specialists. This does not include other communities not deemed under-serviced. A good example is London which has its own active, community-supported recruitment campaign. In Chatham-Kent, 19 family doctors are needed to support the 20,000 residents who have no doctor. A further 9 specialists are required as well.
To recruit these doctors, it will take a community investment of $2.7 million to both offset the costs doctors face in relocating to our community, establishing their practices and support the Rosemarie Miller Scholarship fund. This bursary, started in Wallaceburg, is being expanded to the full municipality. It helps pay for the medical education of local students who commit to practice locally.

What happens when doctors retire?
Two things happen. A replacement doctor will take over the practice or the retiring doctor will simply close the practice. The physician’s patients will no longer have a doctor.

Why is retirement such an issue?
The fact that 1/3 of our doctors are within retirement age complicates the doctor shortage because as new doctors are recruited, current ones will retire. It is not, however, simply a matter of replacing each retiree. There is also an interesting anomaly in this. It takes two family doctors to replace each retiring one, given that new graduates are not willing to work the long hours that have been typical for the medical profession. The London Free Press, on May 5, 2005, explained, that, "younger doctors are working fewer hours than older physicians."
Almost all communities in Ontario face the issue of retiring doctors. Given the critical nature of this situation, many are increasing their recruiting programs.

What are other communities doing?
If there is something that has marked the early days of the new century, it has been the formation of medical recruitment committees in communities across the country. This includes those which make up the municipality of Chatham-Kent. In Blenheim, Chatham, Orford/Highgate, Ridgetown, Tilbury and Wallaceburg, dedicated volunteers are now serving on recruitment committees in the search for a solution to the shortage of doctors in each area of the municipality. Towns and cities across Ontario, and the country for that matter, are devising plans and creating pools of available funds to offer incentives to attract as many doctors as they can. It all starts with hosting visiting doctors, something that can become expensive given the need to recruit such a large number of doctors.

What is the Medical Recruitment Division Doing?
Since its establishment in 2002, supported by the Municipality of Chatham-Kent and Chatham-Kent Health Alliance, the Division has provided logistical resources to the local recruitment and retention committees. Under its mandate it also takes a leadership role in contacting and establishing relationships with doctors considering relocation. These outreach activities also include developing relationships with medical students and residents. Its many activities also include hosting visiting doctors, creating events to showcase the municipality, participating in organized recruitment tours and providing a level of dedicated, ongoing service to the community. In 2005, the Division’s efforts have resulted in the recruitment of 11 general practitioners and specialists. The Division is often called on by the medical departments of Chatham-Kent Health Alliance to assist in recruiting specialists. It also provides assistance to the Chatham-Kent Nurse Retention and Recruitment Committee. The Division’s operational costs are underwritten by the Municipality and Chatham-Kent Health Alliance. This covers operational expenses, such as offices, staffing and related supplies but does not cover incentives, hosting or other costs that are required in the recruitment process.

Why is the Foundation involved in this effort?
The current fundraising campaign is a joint effort of the Chatham-Kent Physician Recruitment and Retention Committee and the Foundation of Chatham-Kent Health Alliance. The Foundation is providing leadership in the design and management of the campaign. The Foundation’s involvement signals the importance that its Board of Directors places on ensuring that every person in our community has unrestricted access to medical care. It also recognizes the depth of experience and competence that the Foundation brings to this project and its abilities to carry out a professional, organized campaign. Because the Foundation is involved in this campaign, contributions to the Physician Recruitment Fundraising Campaign will also be afforded the same recognition as contributions to the Foundation. In some cases, this could elevate donors in the Foundation’s public recognition programs. Deciding to participate and lead the campaign was not taken lightly by the Foundation’s Board. Its role is to provide the Health Alliance with funding for needed equipment. Its volunteer Board is dedicated to ensuring that Chatham-Kent has the best medical facilities available; an important aspect of this is to ensure that the Alliance has the specialists that it needs and that all in our community have equal access to our hospitals and equal access to ongoing medical care.

Why do we have to pay to recruit doctors; doesn’t the government do this?
Although the government ultimately pays doctors for their services, on behalf of its citizens, the government does not provide recruitment services nor does it play a role in where its graduating doctors practice. Doctors are free to practice where they wish. In the business world, companies needing workers will often carry-out recruitment programs. Once they have selected new employees they will customarily cover relocation costs. A considerable portion of the incentives offered to doctors are related to relocation and practice establishment costs. Doctors must pay to move their families and to setup new offices. They must also pay the costs of downtime during their moves and in establishing their offices. Incentives grew out of the realization by communities that such relocations can be expensive and that offering to provide financing would give them an advantage when competing with other communities.

Does the government provide money for doctors?
For communities designated as under-serviced, including Chatham-Kent, the Ontario government provides various grants that can include reimbursement of a doctor’s education costs and some offsets of doctor hosting programs. In order to receive this funding, doctors must locate to an under-serviced area and agree to practice there for a determined length of time. If they decide to leave prior to the expiration of this time limit, they will have to refund some of the funding. This program is designed to give under-serviced communities an advantage. However, the funding from the province does not cover all of a doctor’s establishment expenses. Communities, realizing the competitive situation they are in, know they have to offer additional incentives. To be competitive and to attract more doctors, Chatham-Kent must continually review its practices to stay competitive. This campaign is vital in making sure the community has the funds it needs to be effective in doctor recruitment.

Aren’t most doctors rich?
It is true that practicing doctors earn above average incomes. However, this is once they establish their practices and it does not happen overnight. Graduating doctors face a considerable debt load that has accumulated over the ten years it has taken for them to become doctors. In its January 11, 2005 issue, the Medical Post estimated that tuition and living expenses for four years of medical school can now add up to $125,000. The publication added: “Another issue is physician wellness. With debt loads the size of mortgages, can new doctors enjoy a healthy, balanced lifestyle? High numbers start out with a big black cloud over them. According to a recent Canadian Association of Residents and Interns (CAIR) survey, 36% of residents have extreme levels of stress from their financial situation. Almost one in four residents say if they could do it again, they would choose a career outside of medicine.” For new doctors, the incentives that Chatham-Kent will be able to offer as a result of this Campaign will offset the costs of relocation and that of establishing a new practice and put graduates on a better financial footing so they can concentrate on patient care and community wellness.

What is the impact that the doctor shortage has on our local businesses?
A doctor shortage can be detrimental to a community’s growth and can often deter the needed investment that creates jobs. Employers avoid communities in which the costs of medical care, because of a shortage of primary care, is sufficiently higher fearing that this will negatively impact their operations. "Physician shortages clearly impact on our economic development initiatives. Business and industry make investment in locations that are efficient and cost effective. The increased human resources cost to industry for staff recruitment and lower productivity, due to inadequate access to medical care in under-serviced areas, is a significant factor in location decisions," explains Greg Borduas, Director of Economic Development Services, Municipality of Chatham-Kent. It is a thought shared with Stephen G. Hyndman, President of the Ontario East Economic Development Commission. “Shortages of family physicians in under-serviced areas is negatively impacting our business community and the recruitment of highly skilled personnel. More significantly, the shortage of family doctors is affecting productivity through increased absenteeism; employees need to invest even greater amounts of their time, and by default their employer's time, accessing medical services for themselves and their families through hospital emergency departments and walk-in clinics.” “The business community in Belleville has stepped forward to invest directly in activities that will attract new family doctors to the community. This is not just a philanthropic venture on their part - it is frankly good for business! The doctor shortage definitely impacts our competitive advantage, and must be corrected if we as a province hope to maintain our place as one of the world's leading economies.”

I have a doctor, should I be concerned?
Every one in our community must be concerned. Those fortunate to have family physicians could quickly find themselves without one, for any number of reasons, and face the reality that a replacement doctor is just not available.

Those with family doctors who find themselves in critical medical conditions and visit the emergency rooms at Chatham-Kent Health Alliance too often face long waits. Too often the emergency room is the only place those without family doctors can find medical help. It is also important to understand that emergency departments cannot provide the sustained, continual care that local residents need.
Approximately two-thirds of the population visit Chatham-Kent Health Alliance emergency rooms on a yearly basis. This level includes patients with nowhere else to turn. Their appearance at the emergency rooms stress capacity. In many cases, had these patients a family doctor, these visits would not be necessary.

Why are doctors so important?
It is true, many people seem fine without a doctor. Is this good? There are 2,000 diseases that share the same symptoms, some are life-threatening. Ailments that are not treated properly, or patients that do not receive proper sustained care, often see their illnesses increase in severity or become chronic.

In the case of a chronic situation, ongoing monitoring is needed to avoid serious consequences that lessen the enjoyment of live and life expectancies, all the while increasing personal and societal costs.