Incentives attract visiting doctors to northern Ontario ERs but they're not sticking around

The Temporary Locum Program has helped keep emergency rooms operating in northern Ontario including through the COVID-19 pandemic, but some say it may be working against recruiting efforts that would provide a lasting fix to the doctor shortage.

The province established the program early into the pandemic. It pays premiums to travelling doctors in northern Ontario with the goal of keeping hospital emergency rooms staffed amid a shortage of family physicians.

The program has been renewed several times, the last time in the fall, but it's set to expire again, at the end of this month. 

Doctors and administrators across northern Ontario say they still depend on locums to keep emergency rooms open but paying visiting doctors premiums works against them in recruiting full-time doctors to their communities. 

Ann Fenlon is the medical recruitment and retention co-ordinator in north Algoma, which includes the Lady Dunn Health Centre in Wawa. 

She said they have three physicians but the province says there should be seven.

Fenlon said that at first, she thought the temporary locum program would help recruit doctors, but it hasn't turned out that way.

She said she doesn't have any trouble scheduling locums, with a pool of about 40 to choose from, but those doctors show little interest in taking on full-time responsibilities.

"What we've found is that locum physicians want to be locum physicians," she said.  "They're coming for a reason. They don't want the commitment to a full-time practice. Locuming gives them a good compensation model with no overhead and with maximum flexibility." 

Premiums vary according to location

Fenlon said that in her experience, more newly graduated physicians are also choosing to do locums to gain a breadth of experience and avoid the cost of setting up a permanent practice.

She said she'd rather see Ministry of Health funding for premiums to locums go to helping doctors set up shop.

Recruitment is also fizzling in the Matheson, Iroquois Falls and Cochrane area, according to the chief executive officer of the MICs Health Care Group.

Paul Chatelain said he gets more doctors asking about the incentive to work in the ER than are interested in full-time opportunities.

"It's one of those things once you have it, it's hard to get rid of it right or hard to let go," he said."We go to recruitment fairs looking to hire physicians or recruit physicians, and the first thing they ask is, 'OK, well what's your hourly rate to get paid for the ER department in your community?'"

Chatelain said the premiums vary according to location, but at one of his emergency rooms, it amounts to an additional $75 an hour.

Sometimes the cure becomes part of the problem.-Dr. Maurianne Reade, Manitoulin Health Centre, Mindemoya

Dr. Maurianne Reade is a full-time physician at the Manitoulin Health Centre in Mindemoya.

She said she and her colleagues depend on locums to keep the ER open and it would be disastrous if the program ended suddenly, but there are inequities.

"It is one of the challenges that if the full-time physicians are compensated at significantly less than what the locums are, it can become a disincentive for locums to choose to establish a rural practice," she said.

"Sometimes the cure becomes part of the problem."

A spokesperson for the Ministry of Health said the Ontario government will have more to say about the possible extension of the locum program in the near future.

The ministry said it continues to work with its partners, including the Ontario Medical Association, on a permanent solution to best support the sector beyond this month.