Lessons from a city that solved the family doctor shortage
Updated: Oct 26
Psst: Don’t tell anyone, but there’s a city in Canada where everyone who wants a family doctor has one. There are also several clinics accepting new patients.
“This didn’t happen by accident,” says John Crosby, a family doctor in Cambridge, Ont., who just retired after 50 years of practice. “We had a problem and we worked hard to fix it.”
With 6.5 million orphan patients nationwide, the lack of access to primary care is arguably the number-one problem in Canadian health care today.
Cambridge offers up some lessons on how to fix it.
A picturesque city along the banks of the Grand and Speed Rivers, Cambridge was one of the first relatively urban places in the country to experience a doctor shortage.
Back in the year 2000, the city in the tech triangle was booming, and local business leaders worried that poor access to health care would scare workers away.
They created a task force of community leaders to find solutions. Their first move was hiring a full-time physician recruiter. Local doctors also worked together to ensure Cambridge was a good place to practice medicine, especially family medicine.
Today, the city of 150,000 – a number that’s gone up sharply over the past two decades – has 88 family doctors, including seven taking new patients.
Almost all of them work in group practices, a combination of family health organizations, family health teams, a community health centre, and a nurse practitioner-led clinic. (As in every province, Ontario has experimented with various models for delivering primary care, but the common trait is teamwork, and payment models other than fee-for-service.)
Doctors in Cambridge co-operate in ways rarely seen in other communities. They share on-call shifts across practices, making themselves available to patients after hours in such a way that each physician is on-call only once a month. There is also one doctor in town who does almost all the house calls. The fees collected for home visits are very small, but a doctor with no overhead from a brick-and-mortar practice can make a go of it in terms of revenue.
But back to recruitment.
The role of Donna Gravelle, the sole employee of Doctors4Cambridge, is to help fill every position that comes up, whether it is a doctor retiring or a clinic expanding.
She recruited seven family doctors last year and has at least seven more positions to fill in the coming year.
Ms. Gravelle casts her net at medical schools and job fairs for interns, and personally fields calls from those looking for work.
“Having someone knowledgeable answer the phone makes a big difference,” she says. Too often, this task falls to a beleaguered secretary, even in towns and cities desperate for workers.
Ms. Gravelle says her main job is making sure potential recruits see what their future could be. What matters most these days is work-life balance: a good job, but also a nice lifestyle.
“To be honest, Cambridge sells itself,” she says. “But I’m the tour guide.” The recruiter works to learn what interests potential recruits and takes them to visit schools, sporting facilities, places of worship, or wherever. She can also help spouses find work – often a key factor for couples.
For medical students and residents, there is a week-long tour that includes everything from shadowing local doctors to canoeing local rivers with active seniors, and everything in between.
Locums – where doctors (typically younger ones) fill in for those who are off on holidays, maternity leave, or sick leave – are also a key source of recruitment because they provide a taste of practising and living in the community.
“You have to get them early before they’ve decided where to settle,” Ms. Gravelle says.
Increasingly, communities are offering financial incentives to woo doctors, everything from cash signing bonuses, to free rent on clinic space, to subsidized housing. But Doctors4Cambridge has never done so. Ms. Gravelle says incentives may attract doctors temporarily but they won’t necessarily stay. “Retention matters. We want people to stay in our community long-term,” she says.
Recruitment is getting tougher because there is a lot more competition. But as someone who has been doing this for a long time, Ms. Gravelle has advice for policy-makers: “You have to change the way family medicine is run. More teamwork, but also more attention to work-life balance.”
In other words, we know how to fix this problem. Instead of provinces and cities competing for the scarce number of family doctors available, we need to recruit more potential family docs to the profession and keep them working by creating a decent workplace.
It’s not rocket science; it’s common sense.