Government provides free tuition to medical students to practice in underserviced areas

Toronto, July 24–The Ontario government will provide $4 million for free tuition and location incentives to new doctors willing to practice in underserviced areas, health and long-term care minister Elizabeth Witmer announced today.

“This initiative will provide financial assistance to medical students
and address the needs of rural and northern communities,” Witmer said. “We are working with doctors, medical students and communities to ensure that all Ontarians have access to physician services.”

The tuition grant and the location incentives fund combined will provide students with $10,000 for each year of undergraduate medical training.

In exchange, new doctors will be required to practice in a designated
underserviced area for the same number of years that they were reimbursed. The length of service required is a minimum of three years. Undergraduates will be able to apply to the program in their final year of medical school beginning this fall. Grants and incentives will also be offered to post-graduate medical
students including those who are completing their training this summer.

“We are working aggressively to address the issue of physician supply and distribution,” Witmer said. “This new program, coupled with the implementation of the McKendry recommendations and the work of the expert panel, will help meet the needs of patients across the province.”

The government has committed $11 million annually to implement the short-term recommendations of the McKendry Report on physician supply in Ontario.

The Expert Panel on Health Professional Human Resources, chaired by McMaster University President Peter George, is developing medium and long-term strategies to meet the future needs of Ontarians.

“We are pleased the government has taken another step towards a broader package of needed recruitment and retention measures,” said John Gillis, president of PAIRO, Professional Association of Interns and Residents ofOntario. “We welcome the opportunity to sit on this program's steering committee, and look forward to continuing to work with the government to address the issue of physician supply and distribution in the future.”

Backgrounder

The Ontario government is committed to ensuring that physician services are available to meet community needs. The tuition grant initiative was first announced in the government's Blueprint for Ontario. The Blueprint stated the government would offer free tuition to medical students willing to relocate and practice in an underserviced area upon graduation.

Tuition Grant Program and Location Incentive Funds

The grant and the location incentives fund combined will provide
students with $10,000 for each year of undergraduate medical training. In exchange, graduates will be required to practice in an approved underserviced area for the same number of years they received a grant. In certain communities,the government will also identify undersupplied specialties that will qualify for the grant and incentives. The length of service required is a minimum of three years and a maximum of four years.

Beginning this fall, undergraduate medical students will be able to
apply to the program when starting their final year of medical school, and be eligible until they complete their final year of post-graduate training.

The $10,000 grant covers tuition and additional financial incentives tolocate in underserviced communities. The amount of the location
incentive fund to the student will be the difference between the tuition grant paid to the applicant and a maximum of $10,000 per year. For example, if a candidate had received a total of $16,000 in tuition grants for four years of medical school ($4,000 per year), $24,000 ($6,000 per year) would be made available to the candidate through the location incentive fund. This would result in $40,000 in total grants paid to the candidate.

The grant will be sent directly to the tuition grant candidate once the candidate finalizes the return-of-service contract. Successful applicants to the tuition grant program will also be eligible
for existing incentive grant programs during the return-of-service, as an added incentive, such as:

* Underserviced Area Program (UAP) Incentive Grants

* Northern Group Funding Plans (Alternative Payment Plan)

* Community Sponsored Contracts (Alternative Payment Plan)

McKendry Report and Recently Announced Physician Distribution Programs

On July 23, 1999, Dr. Robert McKendry was appointed as a
fact-finding commissioner to examine the cause and scope of physician
supply and distribution issues in Ontario. This appointment was a joint initiative between the Ministry of Health and Long-Term Care and the Ontario Medical Association (OMA).

Dr. McKendry issued his report in December 1999. In response, the
ministry announced that it would immediately implement Dr. McKendry's
short-term recommendations. As a result, the government has committed to providing up to $11 million for the following initiatives:

* Funding additional postgraduate training in Ontario to recruit back
Canadian medical school graduates who have taken their postgraduate
trainingin the U.S., and require further training to meet Canadian requirements. These positions will be targeted to underserviced areas andundersupplied specialties.

* Expanding the International Medical Graduate program by 50%, from 24
to 36 positions and targeting all new entry positions to specialties
that are needed.

* Doubling the number of community development officers (from 3 to 6)
to help underserviced areas recruit doctors in their communities.

* Expanding the two northern family medicine residency training
programs by increasing the number of entry training positions by 25%
(from 24 to 30), and by more than doubling the number of third year
advanced-training family medicine positions in areas such as anesthesia, obstetrics and emergency medicine.

* Expanding the Ministry's Re-entry/Training/Return of Service program
by 15, from 25 to 40 positions.

Expert Panel

Based on Dr. McKendry's recommendation, the government has
established an Expert Panel on Health Professional Human Resources. It
will advise the Ministry on medium and long-term solutions so Ontario can meet its future health service needs, including additional programs to further improve physician distribution in the province. Dr. Peter George is the chair of this panel, and membership reflects a wide range of expertise that includes northern, rural and urban perspectives. The panel has started meeting and will deliver its report in the summer of 2000.

Other Initiatives to Improve Physician Distribution
The government has also implemented a number of other initiatives to
help small, rural and northern communities recruit and retain
physicians.
These include:

* $70/hour sessional fee: for working nights, weekends, and holidays
in eligible hospital emergency departments in selected northern and
rural southern communities

* Community Sponsored Contracts (CSC)Program: announced in June 1996,
to address recruitment and retention issues for those northern
communities that require 1 to 2 physicians. CSCs ensure annual salaries and benefits for physicians working in those communities.

* Northern Group Funding Plans (NGFP): In November 1998, the Northern
Group Funding (NFGP) Plan for 22 eligible northern communities was
announced. The NGFP provides a stable income for physicians who agree to work in eligible communities with 10,000 people or less. The NGFP
replaced Globally Funded Group Practice (GFGP) Agreements.

* Physician Job Registry: An Internet Physician Job Registry, pursuant
to the OMA/MOH Agreement and administered by the OMA to help identify
and match recruiting communities and physicians.

* Locum Program: Locum programs assist northern and rural communities
experiencing shortages of physician services by providing temporary
medical services and reimbursement of physicians' travel and accommodation within Ontario.

* Underserviced Area Designation: Communities may be designated for
General/Family Practitioners (GP/FPs) if they are experiencing a severe shortage of physicians and long-standing difficulties recruiting physicians.

Underserviced Areas
Designation of communities as underserviced is an ongoing
self-assessment process, wherein communities identify themselves to theministry as being in need of recruitment and retention assistance.

The Underserviced Area Program designates communities as
underserviced when specific criteria are met. Designation allows
physicianspracticing in those communities to receive the benefits outlined above. Factors considered include:

* health care professional data (how many service the community),

* population and physician-to-population ratios,

* previous recruitment efforts,

* local demand for services,

* additional health service needs and resources,

* support of local health care professionals,

* a letter indicating District Health Council support or
recommendation.

Communities across the province may be designated for GP/FPs if they
are experiencing a severe shortage of physicians. However, only northern communities may be designated as “underserviced” for specialists.