Ontario Mayors Oppose Financial Incentives for Attracting Doctors to Communities

Several Ontario mayors have been calling on the province to ban financial incentives municipalities use to lure in doctors, saying the recruitment tactic is harming communities that can't pony up the cash – especially those in rural and northern regions.

But Sault Ste. Marie Mayor Matthew Shoemaker is going even further, suggesting the federal government should outlaw the practice from "coast to coast."

“I think it should be banned across the country actually," he said in a recent interview.

Shoemaker said his city needs 40 more doctors, including 18 to practise family medicine, and while it does offer a moving allowance of up $10,000, it is not in a position to compete with municipalities that are offering doctors tens of thousands of dollars to relocate.

"I believe that incentives are detrimental, and we do not concur with their use; therefore, we are currently not inclined to engage in an incentive-based contest as we would be likely to emerge unsuccessful from such a rivalry," he stated.

Shoemaker mentioned that he requested Ontario's health minister to step in and halt this practice during their meeting in August. However, he noted that there appears to be little interest in taking action in Ontario without broader national support for prohibiting these incentives.

He stated, 'We aim not to turn into a location where all our physicians are being pulled away.'

A representative from the Ministry of Health stated that the government has significantly invested in connecting more residents of Ontario with medical practitioners. However, they did not explicitly address inquiries regarding potential bans on municipal financial incentives.

Shoemaker isn't the only one raising concern over the use of incentive-based programs to address Ontario's doctor shortage.

Todd Kasenberg, the mayor of North Perth, is also encouraging the province to ban cash incentives, which he calls a "mistake."

"We have entered a competition for military supremacy, and usually nobody emerges as a winner in such races," he stated during an interview.

Kasenberg mentioned that approximately 3,000 out of 17,000 residents in his community located just north of London, Ontario, do not have access to a family physician at this time. The situation could become critical in the coming years due to anticipated retirements unless authorities manage to attract new doctors quickly enough.

"It's a significant problem that has caused considerable frustration within the community and led to a great deal of anxiety," he said.

He mentioned that the town anticipates hosting four medical residents from Western University this year. The council agreed to allocate $50,000 for providing housing assistance to these residents, although Kasenberg expressed personal discomfort with this decision.

He wishes for the recruits to remain in town past their designated time of service.

London Mayor Josh Morgan and Peterborough Mayor Jeff Leal have also publicly criticized municipalities' financial incentives for doctor recruitment.

Ontario's long-standing shortage of primary care providers affects millions of patients in every corner of the province, but advocates say rural communities are hit harder because they have fewer hospitals and walk-in clinics.

Experts have long warned that hefty financial incentives offered to doctors are widening the health-care access gap between poorer rural towns and richer urban centres.

Others argue that although these incentives may be effective in attracting newly graduated physicians and medical residents who need to pay off their student loans, they do not ensure that these doctors will remain in those communities long-term.

“I believe it’s far more effective to support new graduates from a retention perspective by assisting them with managing their schedules, gradually increasing workload, and preventing the risk of burnout,” stated Dr. Sarah Newbery, a family doctor based in Marathon, Ontario—a rural area located 300 kilometers east of Thunder Bay.

If they start off with an overwhelming workload, retaining them will be difficult.

Newbery has considerable experience with retention – she was among the group of six junior doctors who relocated to Marathon almost thirty years back, thereby resolving the town’s long-standing physician deficit.

Back then, Marathon was on the verge of losing its sole emergency department, leaving the future of the whole hospital uncertain. The local physician recruitment committee had actually prepared burlap bags to conceal the hospital signage along the adjacent highway.

"It was likely the community with the least services not just within the province, but possibly across the country," Newbery stated.

She mentioned that the town provided the whole team with $10,000 in bonuses—approximately $1,600 per person—and offered housing assistance which covered up to two years of free rent for certain individuals. However, these benefits weren’t what convinced Newbery and her significant other to remain in Marathon for nearly three decades.

She mentioned that the reason this team of doctors stayed in the town was their shared dedication to enhancing healthcare services for the local population along with their awareness of maintaining a balanced professional and personal life. Currently, Marathon hosts six physicians, and experiences just one vacant position even though many other rural areas are facing severe medical staffing shortages.

Rather than providing monetary incentives, Newbery proposed that the funds should instead be used to enhance the attractiveness and hospitality of towns for physicians over time.

Approximately 525,000 residents of rural Ontario lack access to primary healthcare services, with this figure rising at a rate four times quicker than in city regions. This information comes from statistics supplied by the Rural Ontario Municipalities Association.

Christy Lowry, the association’s chair, said improving access to health care, recruiting physicians and medical workers, and making sure local emergency rooms remain operational are "top priority" for the association.

"All of those pieces are part of what we're focused on right now, and we can see how the lack of these services are negatively impacting our communities and the well-being of our communities," she said.

Lowry, who serves as the mayor of Mississippi Mills—a rural area located east of Ottawa—mentioned that although her town boasts a contemporary hospital offering "excellent services," there is still an issue concerning the scarcity of primary healthcare professionals. This challenge forces some locals to travel all the way to Kingston just to consult with their physicians.

The organization approximates that Ontario cities are investing close to half a billion dollars yearly in healthcare expenses.

In a recent interview, Lowry stated that property tax funds ought to be directed towards essential municipal responsibilities. These taxes were not intended to cover healthcare services.

The issue is the scarcity. We lack sufficient resources, turning it into a contest between one neighborhood and another.

In northern communities, more than 350 doctors — including more than 200 family physicians — are needed to fill current vacancies, and that number is much higher if retirements expected over the next five years are factored in, according to the Ontario Medical Association.

The association's former president, Dr. Dominik Nowak, said that's "unacceptable.”

The shortage had led to fierce competition for physicians.

"There are winners and losers when we have a situation like this and oftentimes the communities that can't afford to recruit and retain are northern and rural communities," he said last month before his tenure ended.

Nowak stated that although municipalities ought to contribute to fostering a hospitable atmosphere for physicians and their families, the responsibility fundamentally lies with the provincial government to guarantee that communities receive adequate healthcare services.

Nowak pointed out that this is indicative of a broader issue," he stated regarding incentive-driven schemes. "The bigger concern is that family medicine is not perceived as an attractive career option for recent medical school graduates anymore.

The Ministry of Health stated that the province has seen an addition of 15,000 doctors along with a 10 percent increase in the number of family physicians since 2018.

A ministry spokesperson named Ema Popovic stated that the government plans to add nearly 1,500 family physicians in rural and northern regions through two separate initiatives. These efforts will involve recruiting doctors who have been trained abroad along with offering educational grants to students keen on practicing medicine in these underserved locations.

She stated that Ontario plans to link every individual in the province with a primary care provider by 2029, which is part of a $1.8 billion initiative.

Recently, the province announced substantial financial commitments to the Rural and Northern Physician Group Agreement for enhancing primary care services. Additionally, they have introduced a new initiative known as the Rural Emergency Medicine Coverage Investment Fund. This fund aims to maintain adequate physician coverage throughout the year and supersedes an earlier temporary scheme that encouraged doctors to take up emergency room positions in rural and remote areas.

The report from The Canadian Press was initially released on May 8, 2025.

Sharif Hassan, The Canadian Press