Following on the heels of Dr. Nancekievill’s impassioned deputation regarding physician recruitment late last year, several members of the public spoke to this issue during the opening night of Prince Edward County Council’s yearly Operating Budget deliberations.
In her deputation, Nancekievill spoke frankly about the dire physician shortage in the County and the imperative need to rectify this. As part of a multi-pronged physician recruitment strategy, Nancekievill argued the municipality needs to implement a competitive physician recruitment incentive to attract the doctors this area desperately needs.
Presenting a counter argument to this was resident Rosalind Adams, the crux of her argument being the implementation of large financial incentives to attract physicians is an unfair advantage that is inaccessible to less affluent, rural and remote communities.
“Medical care should be based on need, not based on the ability to pay a bonus,” she stated.
Commenting on the morality of the issue, Adams argued implementing such an incentive is counter to the intention of universal healthcare.
“While the situation is dire, the doctor shortage is not the root problem. It is a symptom of a broader problem. Another is a doctor shortage in northern Ontario,” insisted Adams. “The root problem is a shortage of doctors in Ontario.
“We need to look beyond our selfish interests,” she added.
Emphasizing that the County is part of a broader community, Adams argued recruiting physicians here only reorganizes the problem of too few doctors in Ontario.
Adams also argued that the bonus system used to attract physicians unfairly funnels money from minimum wage and low earners to physicians who, Adams reports, are in the top two per cent of earners.
“A living wage in the County is about $36,000 per year. After covering operating cost, the average family doctor in Ontario makes about $226,000 per year,” said Adams.
Also speaking to the issue of physician recruitment was Dr. Elizabeth Christie of the Prince Edward Family Health Team. Christie is a family physician as well as associate lead of the PEFHT.
“I’ve been in various other leadership positions within the group of physicians but most important to me, I’m a local. I was born in Picton and grew up in Bloomfield and Cressy then moved away, as so many of us do. As my midlife crisis, I became a doctor and came back here because of requirement funding available at that time,” explained Christie.
Speaking to council, Christie explained the situation she found herself in when, at 41 years of age, she had become a doctor and in doing so accrued $250,000 worth of debt.
“It’s not such a unique story for someone from a small town in Ontario who becomes a doctor and wants to return to small town Ontario,” stated Christie, adding, “it’s really not a unique story at all.”
She further explained that the recruitment package offered to her at the time allowed her to purchase her first home, despite crippling debt.
As with Nancekievill’s presentation to council last year, Christie took pains to illustrate the myriad ways rural medicine differs from its urban counterpart.
“Here, the family doctors are central to healthcare in all areas-in clinics and in additional medical work outside clinics which can require 24/7 on call service,” explained Christie. “These extra clinical efforts include walk in clinics on holidays and long weekends, staffing the local emergency department, inpatient ward, long term care homes, hospice, house calls, home based palliative care…..the list goes on.”
In addition to the aforementioned duties, she noted that most local physicians are also associate professors at Queen’s University.
While for decades, physician recruitment was an easy task in Prince Edward County, the tides have turned now that the pace of physicians leaving the County has increased.
“Despite working for years knowing about the impending departure of 11 physicians, we’ve succeeded in recruiting only four doctors in the last two years,” she said.
Painting a dire picture, Christie depicted 800 County residents without a family doctor at the start of 2022 which will quickly become over 5,000 by the end of 2022.
“We start the year with 800 unattached patients. We now have 1750. By July it will be almost 4000, by end of October, it could be over 5,500,” stated Christie. “Next year, we expect to have 4000 more unattached patients and then 2000-4000 more the year after.”
This year, she stated, PEFHT is hoping to attract at least five doctors to the area.
Importantly, Christie also pointed out that the provincial average for those without a family doctor is only seven per cent.
“I’m confident having 25-50 per cent of the population being unattached to a family doctor would be very rare…the provincial average being 7 per cent,” she commented.
Drawing on the point made by Adams regarding fair and equitable access to physicians, Christie noted she, along with others from the PEFHT, are gravely concerned for those on a fixed budget who may already suffer from food and housing insecurity.
However, she added, there are many of those people here in County.
“The physicians of the County are gravely concerned. Not because our work burden will go up, but as friends and family, we’re concerned about how people with food and housing insecurity will be affected,” she stated. “Many folks from the city can often ask their previous doctor to cover them for now, or at least have a car to drive to the walk-in clinic in Belleville.”
Christie also argued that the numbers presented by Adams were incorrect
“I wish Ms. Adams’ numbers about incomes were accurate but they’re simply not…the fact is newly graduated physicians, particularly in rural areas, have enormous debts, big start up costs and they can’t imagine how they’d live in the County,” stated Christie.
Another concern is the fate of the new Prince Edward County Memorial Hospital.
“If there aren’t enough doctors to staff it, we just don’t know what will happen,” said Christie.
Furthermore she, along with many other doctors, are concerned about the use of the Emergency Department for non-emergencies and the resulting wait times that could affect those who are seriously ill.
“Worst case scenario, we would have to close our Emergency Department. We see this around the province,” she stated.
Christie also noted she is concerned about how lack of local physicians will impact planned growth in the area.
“Finally, we’re gravely concerned about the community,” she said, explaining, “the risk to the development plans underway-and tourism-as the word gets out that the wonderful healthcare system of the County isn’t so wonderful anymore.”
Financially speaking, Christie asserted the municipality needs to invest $150,000-at the very least-for the next five years to be “anywhere near competitive”.
“We have the opportunity to reinvigorate our medical community. If we decline this opportunity, we do so at our grave peril,” she expressed.
Councillor Phil St.Jean inquired as to whether the less tangible assets of the County could be used to draw in new doctors.
“Do you believe a multi-pronged approach would be more effective for us, given we have more attributes than, say, downtown Belleville,” asked St. Jean. “Maybe, could we look at a more complete package that speaks to the lifestyle we have to offer?”
In response, Christie noted the recruitment program is already multi-pronged and still has not been sufficiently successful.
“I can assure all councillors the approach is entirely multi pronged. We absolutely know all those features are key,” she explained. “We see this financial incentive as icing on the cake to put us back into play. If we’re back on financial fair footing, I’m confident we have what it takes to get to where we used to be.”
Councillor Brad Nieman inquired about a rural hospital incentive program that the County has used in the past.
“You mentioned an incentive program for rural hospitals that the County used to have…that you thought we might get back. What was that program and why did we lose it,” he asked.
The program, replied Christie, is the Rural and Remote Recruitment and Retention Program. At one point or another, the County no longer qualified as rural enough or underserviced enough to participate.
“My understanding is the provincial government has a rurality index with which they assess communities. They changed the criteria so we no longer fit within that,” she stated. “They also decided for a period of time that we didn’t qualify as underserviced.”
According to Christie, she had “numerous conversations” about three years ago to warn the Ministry of Health of the County’s impending doctor shortage. At the time, her pleas fell on deaf ears.
Though Christie is confident this area will soon qualify for the program again, as it becomes progressively more underserved, she also fears for the damage that will be done in the intervening years.
Ultimately, Prince Edward County Council decided to allocate the requested $150,000 to support physician recruitment in 2022.
The municipality has offered a $100,000 incentive to prospective physicians, to be paid out over five years in return for a minimum five years of service. $50,000 is earmarked for the PEFHT to support recruiting and marketing efforts.