Society of Rural Physicians of Canada - Société de la médecine rurale du Canada
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Regional InformationOntario Region

The Society of Rural Physicians of Canada divides the country into 5 regions. The Ontario Region has been struggling for rural doctors a bit more than some other jurisdictions in the last four years. Some measure of the politics of the rural medical economics of the region are listed here. If you wish to become involved please contact the regional committee chair listed here.
Ontario
Ontario is the least rural of all the provinces (14% by population) and yet has the largest rural area (1,794,832 sq. km. 1996 census Stats Can cat. no. 93-357). Northern parts of the province are sparsely populated and remote with great challenges of physician access.  Paradoxically now the greatest shortage in number of physicians is in southern Ontario, albeit many of the underserviced communities are not conventionally considered as rural. Ontario is also the first province to establish a rural incentive program (1969). Some of these program initiatives differentiate between the North and the South, or otherwise have rigid boundaries. Therefore many thus suffer from distorting influences, particularly at the boundaries of the programs, which have positively affected service provision in some rural areas, and have effectively penalized other rural areas for a dubious net effect.  Under this Under serviced Areas Program (1996) and other areas of the ministry a number of initiatives have evolved.  SRP-ON has most of these contracts in every detail which we will share with members.  Summaries follow.
  1. The ER AFA 1999 has replaced Scott Sessional funding (1995) in 85 designated hospitals.  While an incentive for most (not all) rural hospitals it is a straight volume based scale 24h a day (for service volumes up to 35,000 visits per year.)  The ON-SRPC has further details .
  2. On call stipends for other hospital work exist in both rural and urban hospitals for rotas for OB, inpatients, anaesthesia and the like.  Amounts vary by size of the service covered.  For details check out the 2000 OMA-Govt agreement.
  3. The agreement also prompted a Northern Physicians Retention Initiative NPRI (July 11, 2001) that gives doctors $7,000 annually after four years of service for urban and rural FFS doctors alike.  Northern Urban doctors also get access to $2,500 of CME funding (see below for rural CME funding details).  The incentive is paid yearly at the end of each fiscal to full time Doctors with active staff privileges and participating in hospital on call in the North for 4 years who apply and continue to practice in the North until the end of the fiscal year.   The status of this initiative  past 2006 is undetermined.
  4. Rural CME (1993) reimbursement for up to $5,000/yr. for receipted expenses for small communities more than 80Km from larger referral centres (>50,000 pop). Contract physicians are not eligible for overhead relief in this program (despite the fact that the NGFP doctors do pay overhead). This program has received more funding in the 2004 agreement and is currently under review.
  5. Rural and Northern Group Physician Agreements (RNPGA 2004) have replaced the Community sponsored contracts (1996) and Northern Group Funding Plan (NGFP 1998 and the Small Group Contract of 1997). Remuneration ranges from 174K to 210K depending on the number of physicians and scope of practice, for a 40 hour work week. 1 and 2 doctor communities’ get their overhead paid. Physicians get 37 days off paid (plus 9 statutory holidays) and locum replacement when the physician is away. On-call is paid separately at about $30,000 (community without ER) or at ER rates tied to the number of doctors. Obstetrics is additional $10,000 plus FFS. A rurality bonus tiered of up to $10,000 is also paid. Additional “Primary Care” bonus structure is complex and similar to the Family Health Network below.  A third category of RNGPA will be offered to about 14 small southern communities in 2007.  The ON-SRPC has further details.
  6. Primary Care Reform: A capitation based program which pays by enrolled patient and not services was designed in 2001 and is commonly known as the Family Health Network (FHN). About 60% of payment is based on a per enrolled patient basis.  Additional funding accrues to bonus activities such as inpatients, pap smears etc. Rural input into design was significant and there is adequate provision for payment for the inpatient, anaesthetic, surgical and obstetrical services offered by rural GP's. The funding is complex and a Excel spreadsheet calculator has been made available by the SRPC-ON region for interested doctors.  Family Health Groups (FHG), Family Health Teams (FHT) and Family Health Organizations (FHO) round out the alphabet soup.
  7. Under serviced Area Grants of $2,500/qtr for up to 4 years (=$40,000) for physicians who relocate to designated under serviced areas. People already practicing in the North are not eligible. Eligible physicians in designated southern Ontario rural communities get $15,000. Prospective rural physicians get the expenses of one site visit paid.
  8. Re-entry training 1997: 10 third year family medicine re-entry positions and 15 specialty re-entry positions are available for currently practicing Ontario family practitioners.  In 2000 this increased to a total of 40 slots. For the family medicine positions, the ministry funds a R3 level spot (i.e. at about $47K) in advanced skills (such as advanced maternity care with caesarean, and FP anaesthesia.  FP surgery is not funded as there is no existing Ontario training program) if the physician can document community need. For the 15 specialty positions, the ministry is interested in family physicians wishing to pursue residencies in general surgery, obstetrics and gynaecology, general internal medicine, psychiatry or anaesthesia. Specialty training will be for the duration necessary to meet the qualifications for Royal College of Physicians and Surgeons of Canada certifications. Physicians accepted for re-entry must return one year of full-time service for each year of training. While there is a large interest in the program there was a significant (4 of the 10 FP slots) drop out rate in 1997 presumably due to the low salary (compared to re-entry programs in other provinces, never mind previous income level) and other stressors that the displaced rural doctor had to face. The money goes to the programs, but additional funding is not given to cover the expense the program has in accommodating the extra resident except for the Northern programs (Sudbury and Thunder Bay) as it is recognized that the Northern programs do have a significant additional overhead in maintaining apartments etc.
  9. Rural Locum service for small communities. This is loosely patterned after the Alberta rural locum program and administered by the OMA. Plagued with availability problems and the governments seeming contention that the OMA administer the program at a loss, this program was cancelled in 1997 and was rebuilt at the end of 1998 with slightly different eligibility requirements.  Payment for the locum has become much more generous (expenses plus $500/day plus a share of the fee for service revenue generated in the practice, usually 50/50 of gross, or a flat $750 for contract communities).  This program is being revised in 2007 with enhanced payments.
  10. As the government gets more desperate in trying to cover the bases with an inadequate number of physicians, there is a growing number of secret agreements here and there across the province, that lack systemic application.  In particular there are Alternate Payment Plans that have been given to psychiatrists, general surgeons and GP-anesthetists in some areas.  These seem to have been formed in response to threatened job actions, and have been hastily implemented.
  11. The original long standing undergraduate bursary program for 3rd and 4th year medical students for return in service in under serviced areas was discontinued in 1993   A bursary plan to cover tuition plus an incentive is now available as you leave medical school.  For 2000 it is set at $40,000 and is said to be indexed to account for increases in tuition (currently over $14,000).  A 4 year return to service agreement is required.  UAP grants are in addition.

Pay Scale
The current pay scale is online at www.health.gov.on.ca.


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