Why financial incentives aren’t enough to deal with health-care staffing shortages

As many provinces and territories deal with health care worker shortages and emergency departments overcrowding, politicians are turning to financial incentives to retain or hire staff.

In the past seven months, at least five counties have announced tens of thousands of retention bonuses or other employment perks to retain or attract doctors and nurses.

But is financial compensation the right recruitment tool?

Some researchers and recruiters say, based on studies and their own experience, that one-time financial incentives are not effective enough in keeping health care workers in their jobs.

“Financial incentives have always been, and will continue to be, first aid solutions,” said Maria Matthews, a professor in the department of family medicine at Western University in London, Ontario.

Nurses unions and national health leaders have said fiscal stimulus is just one piece of the puzzle needed to fix the persistent problem pressure on health care.

Working conditions, wages and long working hours are all matters that need to be addressed, they said.

“What is important to these doctors and nurses? In 2022, it’s quality of life,” said David Estey, a University of Calgary emeritus professor of social work, who has studied the issue.

“If they work in hospitals that are chronically understaffed…and these working conditions persist for a long time, I don’t think the financial incentives have the power to deal with the nature of the work environment.”

Why financial incentives are the best solution

According to her, provincial and territorial governments have relied on fiscal incentives for decades Study 2015 co-authored by Matthews. These incentives vary from province to province, and they also vary based on the specific role and need in the area.

Ontario, Alberta, Newfoundland, Nova Scotia, and Prince Edward Island are the most recent provinces to announce some form of financial compensation for new or existing family doctors or nurses.

It’s a move Matthews has seen many times before, adding that politicians are turning to financial incentives because they can be introduced relatively quickly.

“The problem will not be solved just by giving people financial incentives. Because if that is the case, we will not lose the nurses,” Este added.

There are notable differences across the compensation initiatives recently announced by county governments and funded by taxpayers.

Ontario and Newfoundland and Labrador Retention rewards For nurses to retain existing staff. This is different from the new money for family physicians recently announced in rural communities AlbertaAnd the Prince Edward Island And the Nova Scotia.

“I think governments, both regional and federal, are looking for an immediate solution because the need is immediate,” said Dr. Vista Michelle Warren, president of the Alberta Medical Association and a family physician in Sunderland, Alta.

Can financial incentives help?

There are many reasons why hospitals are feeling extra pressure, closing them or forcing patients to wait for hours. experts He said One of those reasons is that those without a family doctor are adding to long waiting times in hospitals across the country.

Last month, about 25 percent of patients who went to emergency rooms at the Richmond Hill and Cortelucci Vaughan hospitals north of Toronto did not have a family physician, to me Dr. David Rauschwerger, medical director of McKinsey’s Division of Health Emergencies.

This is much higher than the five percent previous to the pandemic, he said.

Politicians in Alberta and Nova Scotia hope their newly announced bonuses and other hiring efforts will push doctors and specialists to work in predominantly rural or underserved areas. PEI officials have expanded their incentives to include family physicians or certain specialists who hold jobs anywhere in the province.

In studies conducted in Canada since the 1990s, rewards for employment are often cited as not being as important as other areas—such as workplace conditions and community facilities—for physicians.

Researchers who conducted 2019 study In an interview with 91 doctors, administrators, community members and couples in Alberta – they found that health care professionals rated financial incentives as ‘somewhat important’ for hiring and not at all important for retaining a physician in the community.

In contrast, community members rated incentives as highly rated as attracting physicians.

This echoes the results 1999 . studywho said that despite the “widespread reach,” there is little evidence that financial-based approaches are particularly effective.

Another common practice in many provinces and territories is what’s known as a service return agreement or grant, which is usually offered to recent graduates or internationally trained doctors to help offset some of their training or other costs, experts said.

It often happens when an individual signs an agreement to go and work in a community for one to three years in most counties, Matthews said.

she looked at These agreements may move people into underserved areas, but the agreements do not “keep people in those communities,” says Newfoundland and Labrador Reservation Agreement data.

In some cases, doctors pushed out of their contracts to leave the community. And that’s what Another team from researchers It found an event in 1999 in other provinces such as Saskatchewan and Quebec.

“The financial incentives are not going to go very far in recruiting and retaining people,” Matthews said.

Persuading doctors and other health care workers to stay in the community is something Mayor Craig Copeland knows all too well in Cold Lake, Alta.

Since his election in 2007, the Northeast Edmonton community has struggled to recruit doctors for the area. He said the area has needed about five to six doctors for several years now.

To connect them to the community, the city is currently offering $20,000 and paying interest on a $50,000 line of credit to doctors if they agree to work at Cold Lake.

“You have to pay to play, unfortunately,” Copeland said.

Matthews said access to data on financial incentives and retention programs should be better shared with academics and those studying the issue, because it is so limited.

Brian MacLean, who has recruited doctors for Northern Medical Services at the University of Saskatchewan and has been a recruiter for years, said he and his colleagues are trying to collect and retain that “isolated” information about recruitment programs so the data can be better accessed.

But based on what he saw, doctors would work in a community, fulfill their obligation to serve and then move on.

“More focus is needed on retention issues by the government,” he said.

Warren said rewards can help. But the president of the Alberta Medical Association said she and her other colleagues often value other factors more — such as community fit, whether a spouse can find a job and whether they have a good work environment and staff.

“I stayed in position not because of that three-year bonus, but because it was really suitable for my family, my children, and for me on a professional basis,” Warren said of the signed re-service contract. in 1999.

Nurses in Ontario echoed a similar statement after the Ford government announced the $5,000 stipend bonus earlier this year. Several nurses and union representatives said it wouldn’t be enough to keep them working.

Overseas-trained nurse offers certification advice to newcomers

Healthcare workers who plan to come to Canada can make better use of pre-arrival services and start the accreditation process before coming to the country, says Queenie Cho, a former nurse trained in the UK who now runs an organization that helps new arrivals.

“While promising [$5,000] For nurses, what they really want is support to do their jobs well and do them safely,” read a joint letter submitted by four unions. in time.

Other solutions

Health leaders, nurses and doctors have called for specific changes to address what is happening in hospitals, clinics, and in family doctors’ offices.

Many said that getting more health care personnel, whether they are family doctors, nurses or other workers, is essential.

McClain and Warren agree that bringing in more physician assistants or nurse practitioners can create more team-based care.

Warren also said looking back at Canadian students who trained at international medical schools is another option.

If governments are serious about retention bonuses, Matthews said, they should offer them to other health care workers as well.

“If we didn’t have scribes and if we didn’t have good lab techniques, we wouldn’t be able to provide care,” she said.