Signing bonuses. Fancy houses. Inflated salaries.
They sound like the type of offers made to woo professional athletes to a team.
But a growing number of Canadian communities facing a critical shortage of doctors are pulling out all the stops in a desperate attempt to lure health-care professionals to their area.
"Financial incentives like signing bonuses are quite common," said Karl Stobbe, president of the Society of Rural Physicians of Canada.
"Sometimes it's called moving expenses, sometimes it's called a signing bonus. They're almost expected by a lot of graduates."
On Friday, Ontario announced a new plan to address the physician shortages by lifting some restrictions on the ability of foreign-trained doctors to quickly begin practising once they come to Canada.
Other provinces are also looking at ways to reduce doctor shortages and alleviate the growing pressures on the health-care system.
The problem has become so serious it has created an escalating battle between cities that are now fiercely competing to lure doctors. For instance:
Controversy erupted in several towns in British Columbia last month after Clearwater, a small town in the interior, began offering payments of $1,000 a day plus expenses to attract replacement doctors to work in the community on a temporary basis. The changes were widely criticized by towns such as Cache Creek, which said the incentives would set a dangerous precedent and encourage doctors to practise in the community that offered the most money.
Nova Scotia's government announced last month a $616-million package designed to reduce the shortages and entice doctors to work in remote areas. Specialists who set up a practice in rural areas will be eligible to receive a bonus of $40,000 after three years.
Officials in St. Thomas, Ont., announced in March that they would pay family doctors $33,000 for each new doctor they successfully recruited to the area.
In Ignace, a small town in Northern Ontario, officials bought a home worth nearly $200,000 to house doctors.
David Smithson, a third-year medical student at the University of Western Ontario, said it's common for communities to use cash at job fairs to lure new doctors to a particular area.
"There definitely are financial incentives out there and I think they're becoming more prevalent," he said.
The problems with shortages have been getting so bad that cities such as Kelowna, B.C., had to declare a "code purple" emergency crisis in March after the emergency department was overwhelmed with too many patients.
Emergency physicians in Sault Ste. Marie, Ont., were threatening to walk off the job for months because of a lack of specialists to provide services to patients. Last month, the doctors negotiated a temporary solution for doctors in Toronto to provide follow-ups for patients with urgent conditions requiring specialist care.
"Our data would certainly suggest that there are huge areas of underservice in terms of the physicians right from University Avenue [in Toronto]to the far north. It's everywhere," said Rocco Gerace, registrar of the College of Physicians and Surgeons of Ontario.
Dr. Stobbe said that unless the country adopts a national strategy to train, license and spread new doctors around the country, the crisis is unlikely to wane. That's because under the current system, cities and provinces that can afford to offer financial incentives may succeed at luring doctors away from underserviced areas, he said. That discrepancy could hit rural and remote areas hard, since they tend to have fewer resources and limited access to necessary medical services.
"The per capita supply of doctors in rural areas is half of what it is in the cities," Dr. Stobbe said. "Those doctors tend to do more. It's usually the same doctor working in the clinics, staffing the hospital, in the emergency room and delivering babies."
But Mr. Smithson said financial incentives won't necessarily persuade a new doctor to settle in a particular area.
"I think it all depends on individual circumstance," he said. "That financial part of it isn't always the be all and end all." Dr. Stobbe said financial packages are a temporary solution to a large problem playing out across Canada.
"The rural communities end up on the short end of the stick," he said. "What's needed is some sort of national approach to physician human resources."
Carly Weeks