My small Ontario town is offering $100,000 to attract family doctors. It’s not working.

For 25 years, I worked as a municipal administrator in Clarington, a small town an hour’s drive east of Toronto. In 2002, I moved 100 kilometres east to my hometown of Marmora to retire at my cottage. When our mayor’s term ended in 2018, I saw an opportunity to give back to the community I grew up in. I came out of retirement at 68, and have been mayor of the town since.

Marmora is a bustling little community of 5,000 residents that combines a tight-knit local population with a growing demographic of newcomers of all ages. People came during the pandemic for our recreational land, lakes, walking trails and bustling fishing and hunting scene. We’re a town filled with history, with a developing downtown scene. It’s a beautiful place but, with 40 per cent of our population being 65 or older, we desperately need more doctors.

Ten years ago, we only had two physicians. Wait times to see a family doctor were increasing, because our population was steadily aging and needed more care. So we developed an incentive-based program to entice newly minted doctors to come work in Marmora: we offer a $100,000 signing bonus, funded by our tax revenue, and a fully-paid-for and furnished apartment attached to our medical clinic. We’re the only municipality in Hastings County that offers living accommodations, and I’m told by provincial policymakers that we have one of the best incentive packages in the country.

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These bonuses helped attract two more physicians straight out of medical school, and by 2018, our medical team doubled in size. But our recruiting stalled at two as nearby communities matched our incentives. In 2019, we lost one of our doctors to retirement, and the other chose to relocate and work elsewhere. Now we’re back down to two family doctors, each of whom is responsible for 1,200 to 1,800 patients. Their patients are often long-time residents who joined their roster when demand for family doctors was low. These patients can count on immediate or same-day medical care.

But the other 1,000 Marmora residents who don’t have a family doctor have to travel to get medical attention. They see one of three physicians in the Hastings County clinic 20 minutes down the road, or travel 40 minutes south to Belleville or west to Peterborough, or even 90 minutes east to Kingston General Hospital if they need cancer treatment, surgeries, dialysis, MRIs or X-rays. The closest emergency room is 20 kilometres away in Campbellford. The dearth of medical services in Marmora is frustrating residents: their taxes fund the health care system, but they can’t access care when they need it. Our physicians want to take on more patients, but they’re already overworked.

There is hope. News stories helped advertise that rural communities like ours need doctors and are offering good benefits. We’ve had about a dozen inquiries from medical students and physicians who are practising elsewhere but are looking to move to a remote town after living through years of pandemic restrictions in big cities. One medical student even visited Marmora, but he still has a few years of medical school left. The renewed interest is unheard of, but we’re still waiting to sign that third doctor. Our challenge is finding graduating doctors who are the right fit: people who like Marmora’s rural lifestyle so much that they come with the intention to stay for their entire careers, not just for a few years to pocket the money and perks. This is also why we disburse the $100,000 signing bonus over five years instead of all at once. Meanwhile, we miss out on doctors who opt to set up their practice in busy cities, often because their partners work in tech, finance and law. Belleville is the closest city to Marmora, but it’s 45 kilometres away, and Ottawa and Toronto are more than a two-hour drive away.

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We’ve spent a lot of time at city council meetings thinking about how we could sweeten the pot to attract new physicians. The community can’t afford to throw more money at doctors, and I don’t think that’s what we need anyway. On top of the $100,000 we offer, doctors who sign in Marmora also qualify for rural signing bonuses of $150,000 from Hastings County and $81,000 from the province of Ontario. So a doctor would already gain an additional $331,000 over five years to come and practise in Marmora. But nearby, larger rural municipalities with few family doctors also qualify for these stipends, and they’re offering signing bonuses similar to ours. Quinte West is a larger community of 45,000 people and also offers a $100,000 incentive. The right people are out there, and maybe it’s up to us to find new, creative ways to recruit them. Nearby communities like Belleville have created a recruiting department dedicated to connecting with young physicians and attracting medical talent. We might eventually have to resort to that strategy, too.

Residents want to know they’ll be supported if they or their family get sick, and some people worry we don’t have the resources to promise that. It’s not a problem we can solve on our own—I’m anxious to see how provincial and national leaders will address the nationwide doctor shortage. I think a good start would be to ease the rules around licensing across provinces, which could potentially attract doctors to our rural communities. There is also a huge talent pool in foreign trained doctors who come to Canada as immigrants—we need to make it easier for them to retrain. But these measures are beyond my control. My goal right now is to see everyone in Marmora have access to primary health care.

— As told to Alex Cyr