London playing "catch-up" in provincewide competition to recruit family doctors

Andrea Loewen says 52 medical offices across the city are sitting empty, waiting to be filled by family doctors whose care is in high demand and needed by over 100,000 Londoners.

Convincing doctors to fill those spaces, however, has become highly competitive and increasingly won by the highest bidder, according to Loewen, the Middlesex-London Ontario Health Team's (MLOHT) recruitment, onboarding and retention lead tasked to bring physicians to the region.

"It's my job to understand how we can correct this. In the short term, we really need to get some family doctors here," she said.

The MLOHT is part of Ontario's effort to ease the effects of the province-wide physician shortage. It works to coordinate and connect different parts of the healthcare system together to make healthcare more efficient and comprehensive.

As of Aug. 28, 2024, there were over 345,000 people registered with 268 family doctors in the city, leaving an estimated 128,000 people without primary care, according to Ministry of Health data. That means to fill the gap, over 100 physicians taking on 1,200 patients each are needed.

Since January, five new family doctors have come to the city, one of whom replaced a retiring doctor, according to the MLOHT.

In the short term, Loewen has her sights set on recruiting 50 new doctors — and fast.

"When people don't have a family doctor, they're going to emergency because they don't have the care they need. They're often arriving into the ER sicker than they should be, past the point of no return," she said, pointing to the Niagara region's battle with high amputation rates caused by untreated diabetes.

The problem, she said, is that the only tool at her disposal for now is having a strong pitch.

Money talks

Addressing the physician shortage on a local level through a dedicated recruiter is a competition in which London is playing catch-up, Loewen said.

Her position was established in December 2023, whereas some municipalities have had physician recruiters for nearly a decade.

Another thing municipalities province-wide have been doing for years is attracting doctors with cash incentives that can range up to $150,000 and include extra perks like free rent.

To London's east and south, Woodstock offers a $5,000 moving allowance, and St. Thomas has been known to offer $33,000 over several years, alongside six months of free rent. 

"We can't get over that hurdle," Loewen said. "Why would you come here if you could get $100,000, or a car and an apartment rental for a year?"

Loewen said if she had the money to incentivize doctors to choose London, she believes getting them working would come in short order given the vacant space available.

That's led her to seek funding from community groups, hospitals and politicians from all levels of government, she said. 

While many politicians have been receptive, Loewen said, there's a lack of agreement on who should be responsible for footing the bill.

Incentive programs should be illegal: Mayor

London's mayor believes the use of incentive programs is a "race to the bottom," he said.

"I think the province should make that illegal. What [the province] should be talking about is stopping cities from competing against each other for family doctors by offering massive incentive packages," said Mayor Josh Morgan.

The physician shortage's effects in London are serious and concerning, however, Ontario cities should not be faced with the choice of either falling behind or using taxpayer money to stay competitive, Morgan said.

This year, the City of London offered up $50,000 in one-time funding for physician recruitment, most of which went to operational costs and travel for recruitment efforts, according to Loewen. Other funding came from groups like the London Economic Development Corporation, London Health Sciences Centre and the Schulich School of Medicine, but none of it can be spent on incentives.

"The solution is having the province bring forward a constructive and coherent strategy to get more family doctors across Ontario rather than pitting [municipalities] against each other," Morgan said, adding that looking into issues like convincing medical school students who graduated in London to stay here and advocating for provincial action are high on his list of priorities.

Family doctor weighs in

To Dr. Devon Shewfelt, a London family physician who has practised independently for eight years, the allure of incentives is understandable — especially for new doctors.

"The truth is, when you're hundreds of thousands of dollars in debt, and it feels really overwhelming and there's a municipality that wants you so bad that they're actually willing to give you money, it speaks very much to fears and worries newly graduated doctors have," said Shewfelt.

Still, he said, other considerations including long-term life goals like starting a family play into location choices for doctors.

Shewfelt also acknowledged doctors are aware of the issues created by the shortage, and it weighs on them.

"I don't even tell people I'm a family doctor in public, because the moment I do that, I know the question of if I'm taking patients is going to come close after," he said.

"It's incredibly uncomfortable because we [doctors] want so badly to say yes, but we can't risk compromising the quality of care for our current patients by overextending ourselves."

The added pressure may be compounding the issue of doctors choosing not to enter family practice, Shewfelt added.

As she continues to advocate for funding, Loewen plans to continue her efforts through outreach. She hopes to connect with Londoners training in medical schools in Ireland and Manchester, UK before a planned trip to the region in October.

"I would love to go to Ireland and Manchester armed with an incentive package," she said.