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HomeMy WebLinkAboutFSD-028-23Clarftwn Staff Report If this information is required in an alternate accessible format, please contact the Accessibility Coordinator at 905-623-3379 ext. 2131. Report To: Joint Committees Date of Meeting: June 19, 2023 Report Number: FSD-028-23 Submitted By: Trevor Pinn, Deputy CAO/Treasurer Reviewed By: Mary -Anne Dempster, CAO Resolution#: JC-072-23 File Number: By-law Number: Report Subject: Regional Physician Recruitment Request Recommendations: 1. That Report FSD-028-23, and any related delegations or communication items, be received; 2. That Council approves the use of $20,000 from the Economic Development Reserve Fund, as budgeted in the 2023 budget, to be sent to the Region of Durham for physician recruitment; and 3. That all interested parties listed in Report FSD-028-23, and any delegations be advised of Council's decision. Municipality of Clarington Report FSD-028-23 Report Overview Page 2 Data suggest that approximately 230,000 Durham residents do not have a family physician practicing in Durham Region, with approximately 44,000 without a family physician at all. In recognition of the family physician shortage, Council approved $100,000 in 2023 for Physician Recruitment, pending a report back from Staff on a program prior to releasing funding. Staff at the Region of Durham, local municipalities, Lakeridge Health and Queens University have met to discuss a partnership for physician recruitment leveraging a new family - medicine program that will launch September 2023 at the Queen's Campus at Lakeridge Health. The program will bring 20 new students each year for a six -year family physician program. Staff are proposing a collaborative recruitment approach to retain these students who will spend the next six years of their lives within Durham to become local family physicians. The financial contribution of $20,000 in 2023 is below the approved limit of $100,000 and Staff are supportive of a collaborative approach for this regional issue. 1. Background 1.1 At the January 30, 2023 Special General Government Committee meeting, Committee heard a delegation from Dr. Tony Stone regarding a Clarington Board of Trade request for funding to support local physician recruitment. 1.2 The CBOT request was for $500,000 over a five-year period. At the February 13, 2023, Council meeting, Council passed resolution C-027-23 amending the budget "...to provide $100,000 for Physician Recruitment funded by the Economic Development Reserve Fund; and that Staff report to Council on the framework, goals, objectives and processes for this recruitment prior to any funding being provided." 1.3 Staff from Financial Services and Planning and Infrastructure Services attended a meeting on April 21, 2023, with Dr. Stone and other family medicine leaders from Lakeridge and the Province. At this meeting, staff were made aware of a new program between Queens University and Lakeridge Health to bring in 20 students per year into a family medicine program located at a campus in Durham Region. 1.4 On May 17, 2023, Staff received a request, Attachment #1, from the Region of Durham Economic Development & Tourism Team requesting financial support for a two-part Region -wide physician recruitment strategy. Municipality of Clarington Page 3 Report FSD-028-23 2. Regional Physician Recruitment Request 2.1 The Region has proposed a two-part project for the recruitment of physicians to Durham Region in partnership with the local municipalities, Queens University, Lakeridge Health and a regional group of family physicians. Attachment #2 to this report summarizes the project. 2.2 Part 1 includes the delivery of welcome and settlement services for one year to 38 medical students and family medicine resident trainees enrolled in the Queen's— Lakeridge program. These services are aimed to create lasting bonds and ties with the local community to retain these students after their program in the Durham Region as practicing family physicians. 2.3 Part 2 is a collaboration between the Region, local municipalities and other community partners to draft a comprehensive plan to create a permanent family physician recruitment program. This report will recommend best practices, structures and funding requirements for the future. 2.4 The $215,000 cost for the program is being shared by each municipality in the region as follows: 6 Municipality Region of Durham Ajax, Clarington, Oshawa, Pickering, Whitby Brock, Scugog, Uxbridge 20,000 3,000 2.5 The request from the Region brings all the municipalities together to provide joint recruitment recognizing that family physicians serve patients that cross borders and that the lack of physicians currently impacts all municipalities. The Region is providing 49.3% of the funding for this project. 2.6 This request would utilize the funding approved during the budget, leaving $80,000 available for local recruitment or future recruitment initiatives. By leveraging the partnership with all municipalities, the Municipality is able to reduce its cost. Municipality of Clarington Report FSD-028-23 Page 4 2.7 Staff have been informed that one of the training locations is Bowmanville which provides a built-in recruitment advantage for Clarington as the students will be used to the facilities, local amenities and community from their training. 2.8 In discussion with the Director of Planning and Infrastructure Services, it has been determined that future reports and the carriage of this project will reside in the Economic Development Division. The existing relationship with CBOT and the Region of Durham's Economic Development and Tourism team will be leveraged for the collaboration on this project. 3. Financial Considerations 3.1 Staff have confirmed with CBOT that this request is not in addition to the 2023 Budget request but rather leverages a partnership between the local municipalities for a regional approach. 3.2 Part of the work will facilitate the creation of a funding model for physician recruitment; at that point, funding needs will be brought back to Council to determine ongoing support. 3.3 The funding is available, and this report fulfills the request of Council to report back with a framework/plan prior to providing funding. Additional use of the remaining $80,000 would be subject to a future report to Council indicating the business plan, processes and priorities for the use of the funds. 4. Concurrence This report has been reviewed by the Director of Planning and Infrastructure Services, who concurs with the recommendations. 5. Conclusion It is respectfully recommended that support the work of the Region of Durham for a regional physician recruitment strategy and provide $20,000 to the Region for this project. Staff Contact: Andrew Poray, 905-623-3379 x2424 or aporay@clarington.net. Attachments: Attachment 1 — Letter from CBOT to the Region of Durham dated May 12, 2023 Attachment 2 — PowerPoint presentation regarding the Physician Recruitment Project Municipality of Clarington Report FSD-028-23 Interested Parties: The following interested parties will be notified of Council's decision: - Region of Durham and Area Municipalities - Clarington Board of Trade Page 5 Attachment 1 to Report FSD-028-23 May 12, 2023 Mr. Simon Gill Director, Economic Development, Tourism, Invest Durham Re: Proposal for Durham Physician Recruitment Program Development and services. Executive Summa This proposal responds to a recent request from Lakeridge Health and from regional medical leadership for services related to the retention and attraction of family physicians. Services proposed through this engagement would consist of two distinct scopes of work: 1. Provision of services for a 12-month period to welcome and settle new medical trainees to Durham Region who are enrolled in the Queen's — Lakeridge Health MD Family Physician, training programs, including assistance in finding housing, schools for children, jobs for spouses, welcome dinner(s), and more generally, activities to begin creating bonds between the medical trainees and the Durham community. 2. The creation of a plan to establish a Family Physician Recruitment & Retention Program. This will consist of partner outreach, research, and a final report. Outreach will include engagement and consultation with the academic, business, and municipal sector, and with the physician community. The report will outline a Plan containing: • A jurisdictional scan of recruitment program best practices in Ontario • Regulatory context • Consideration of the various possible objectives, including without limitation: delivery of services to medical trainees to retain them post -graduation; retention of practicing family physicians; attraction of family physicians from outside Durham Region; and a recommendation for objectives. • Consideration of the various services that could be delivered through this initiative, including without limitation: marketing, outreach, and promotion; direct recruitment; settlement services; local industry support (e.g., support for creating comprehensive practices); succession planning support; data analysis and research; financial incentives and inducements; and a recommendation on services. • Recommended governance and structure options; composition of a board or advisory committee • Recommended program resourcing requirements (including staffing, annual operating, and capital) The cost of scope #1 is $175,000 and the cost of scope #2 is $40,000. 1 https:Hmeds.gueensu.ca/academics/queens-lakeridge-health-md-family-medicine-program 1 Durham Region Physician Recruitment - Background "There is a crisis in family medicine and in the delivery of comprehensive primary care which has left over 4.6M Canadians without a family doctor, and with many people unable to access timely care. The evidence is clear that patients who have a family doctor have better health outcomes and live longer. The best health systems in the world are those that invest in primary care as the foundation of the health care system and include family doctors as key members of health care teams."' The Ontario College of Family Physicians notes that "new research from INSPIRE Primary Health Care was conducted to include data between March 2020 and March 2022. The data shows that nearly 15 per cent the population is now without access to a regular family doctor. While the shortage is impacting people across the province, those who are vulnerable, including newcomers, and those with the lowest incomes are even less likely to have a family doctor." 3 Family physicians are often the first point of contact for people seeking healthcare services. It is estimated that well over 2 million encounters occur between Durham residents and their family physicians every year. This includes patient office visits, urgent care clinic visits, and MD visits to long term care, retirement homes, and home visits for palliative care services just to name a few. With the recent and anticipated rapid population growth in Durham, and most of Durham's Family Physicians having full patient rosters, the current supply of family physicians in Durham is unable to meet the primary care needs of this increasing population. Preliminary data in Durham suggests that the family physician shortage is being felt acutely here. There are approximately 366 family physicians in Durham Region who deliver comprehensive primary care services. Based on an average Ontario family physician patient roster of 1,380, and a regional population of 738,710, it may be estimated that there are up to 230,000 Durham residents without a family doctor practicing in Durham, and recent research suggests that an estimated 44,000 of these Durham residents have no regular family physician at a114. It is worth noting that each year, over 1,500 babies born in Durham Region are discharged without a primary care physician (Lakeridge Health data). And in many walk-in clinics across Durham, 50-60% of patient visits are from Durham residents who require care but do not have a local family physician — contributing to long wait times for urgent care. With effective collaboration among members of the sector and community, these issues can begin to be z Canadian Medical Forum July 2022 https://www.afmc.ca/wp-content/uploads/2022/10/220705 CMF-Call-to-Action Comprehensive - Prima ry- Health-Care.pdf 3 Ontario College of Family Physicians February 2023 https://www.ontariofamilyphysicians.ca/news-features/news/^287-More-Than-2-2- Million-Ontarians-Left-Without-a-Family-Doctor 4 Estimated 44K in Durham have no family physician: Report Durhamregion.com May 8, 2023 https://www.durhamregion.com/news/estimated-44k-in-durham-have-no-family-physician-report/article a326c9fd-e290-5248-9f36- afaff9f62254.html 2 addressed and access to care can be improved —particularly for marginalized populations, newer residents of Durham, and those who must travel long distances to see their current family physician. The attraction of Family Physicians is not new to the Durham community. There have been significant efforts and dedicated resources in support of physician recruitment for decades at the area municipal level. However, today we need a dedicated resource person and committee structure to oversee this much needed service focused on the entire Durham Regional geography. The Durham community will be best served taking a regional approach and leveraging the experience and expertise that exists today. The Clarington Board of Trade (CBOT) partnered with local stakeholders to execute a very successful physician recruitment program from 2007 to 2017. Over the duration of this program many partnerships were developed, and key strategies were implemented. Partnering physicians contributed with increased focus on teaching both medical students and medical residents in their practices. The Municipality invested in financial support and the business community supported in many ways from donations to employment support for partners. Although the formal programming was rested in 2017, the CBOT remained engaged and supportive of the efforts to support superior healthcare in our community. As active participants on the Clarington Advisory Panel for Bowmanville Hospital and a member of the Lakeridge Health Master Plan Steering Committee the team at the CBOT remains passionate, engaged, and eager to take this critical initiative to a next level. Most recently Sheila Hall, Executive Director at CBOT actively participated on the Community Advisory Committee for the New Lakeridge/Queens program to bring 20 focused trainees to our front door annually in Durham starting in 2023. This document clearly outlines the urgency of being ready in the next month or so to grasp all opportunities for trainees in our community. CBOT is positioned to jump in with experience and expertise. In addition, with the deep partnerships and understanding of the need to scale to a regional approach, CBOT is eager to assign resources to develop a collaborative plan forward for a sustainable and success program for years to come. Family Physician Recruitment Opportunities - Profile of learners from Queen's University Faculty of Medicine: The existing Queen's — Bowmanville — Oshawa — Lakeridge (QBOL) Family Medicine residency program has been in place in Durham since 2013. These residents are based in Durham for their 2-year training program. It graduates 9 residents every year. The New Queen's - Lakeridge MD Family Medicine training program (medical school plus family medicine residency) will take its first 20 trainees this August. 3 This novel program will select 20 new trainees every year — trainees who will complete 4 years of medical school and then 2 years of family medicine residency. They will be based here at the Queen's Regional Medical Campus in Durham. • New learners in this new program will do their full 6-years of training in the Durham region. • Under this new program, the intention is that the students admitted into this program have a passion and desire to work in family medicine when they are finished their training (medical school + residency) • Note: the 4 years are in medical school where students are provided no funding while learning in the community. Our success will be linked to the community surrounding all our trainees with a supportive environment and help them get established in the community. Academic Year Med Studen t yr. 1 Med Studen t yr. 2 Med student yr. 3 Med student yr. 4 Fam Med resident yr. 1 (both programs) Fam Med resident yr. 2 (both programs) Total Queen's FM trainees in Durham 23-24 20 9 9 38 24-25 20 20 9 9 58 25-26 20 20 20 9 9 78 26-27 20 20 20 20 9 9 98 27-28 20 20 20 20 9 + 20 9 118 28-29 20 20 20 20 9 + 20 9 + 20 138 Note: some of these graduates may choose to do an additional year of training in an area of special interest after residency (e.g., Emergency Medicine, Hospitalist, etc.) Additional sources of new family physicians There are other cohorts for consideration of recruitment efforts: - The Rural Ontario Medical Program (ROMP) for underserviced Rural communities also sends family medicine residents from Queen's and from the University of Toronto to Clarington, Uxbridge and Scugog for 8-week rotations. Port Perry also takes 2 second year residents from University of Toronto every year for a full year of rural family medicine - There are many other family medicine graduates from across Ontario who may be interested in a career in Durham. - There are many Canadians training internationally in family medicine. An important number of these are hoping to return to Canada for a career in medicine. The focus should be on international family medicine graduates from the USA, UK, Ireland, New Zealand, and Australia as they already meet Ontario licensing requirements. 4 Although the profiles are different for these groups, one thing is constant. They are all potential new doctors for our community. With various tracks and continuous inflow of potential, Durham needs to look at immediate and long-term solutions for the attraction of Primary Care Physicians. Physician Attraction Landscape and Options In the past there have been formalized community -focused efforts to attract new Family Physicians in some Durham communities including Clarington, Oshawa, and Whitby. Based on cursory research, at least 10 municipalities across Ontario have staffed and funded programs delivering physician attraction programming, and at least 10 municipalities across Ontario offer some form of financial incentive to attract and/or retain family physicians. These activities occur in all tiers of local government (upper, lower, and single), and in some cases, through agencies external to local government. Based on discussions with local medical leaders, Lakeridge, and the province, it was recommended that the most effective approach for Durham would be a single cohesive approach covering the entire regional geography. The types of services and programming delivered elsewhere in Ontario include marketing, outreach, and promotion; direct recruitment; settlement services; local industry support (e.g., support for creating comprehensive practices); succession planning support; data analysis and research; and financial incentives and inducements. Scope of Work #1: Responding to the Immediate Opportunity In May 2023, 20 medical students that have already identified Primary (Family) medicine as their path will be accepting offers to start and finish their medical training in Durham through the new Lakeridge Health/Queens project. Their learning will begin in August 2023 and therefore will be looking to be settled in Durham mid -Summer 2023. Further, there are already presently nine medical trainees entering their final year (July 2023), and eight medical trainees graduating imminently (June 30th, 2023). The Clarington Board of Trade was a key partner in delivering the Physician Recruitment efforts for the Municipality of Clarington between the years of 2007 to 2017. This program produced great success recruiting what averages out to 2.5 new doctors for Clarington per year. This proposed scope of work responds to the immediate opportunity to create strong first impressions with new medical trainees entering the Region through the new program and retain the medical trainees that are presently graduating from the existing program. 5 The following services will be provided: • Provision of assistance in finding housing, including liaising with the Durham Region Association of Realtors (DRAR), compiling a list of suitable options representing a mix of appropriate housing options for trainees and graduates, and assisting medical trainees in accessing realtor services • Leveraging the settlement resources of Durham Region's LIP (Local Immigration Partnership) to provide settlement services for these new residents, including finding schools for children, services providers such as accountants, etc. • Working with partners to assist the spouses of medical trainees in finding jobs locally. • Organizing and hosting a welcome dinner for all medical trainees (include political leadership, healthcare partners, other emergency medical providers such as paramedics, police, fire), and subsequently, taking medical trainees out for lunch or dinner individually to express that Durham is a welcoming community. • Having one-on-one meetings to identify individual support requirements: overview and education of the Region. • Assignment of a point person that they can count on to help them navigate Durham as their new home, with at minimum - a quarterly check -in to ensure support is appropriate and meeting their needs. • Undertake activities to begin creating strong and lasting bonds between the medical trainees and the community including negotiating with local tourism industries to provide gift certificates or discounts, organizing fun activities for medical trainees such as trail bicycling in Uxbridge or indoor rock climbing in Bowmanville; liaise with Durham Tourism and other municipal tourism teams to provide steady support in creating connections with Durham's quality of place assets. Term: These services will be provided for a period of 12 months beginning on the date of this engagement. Price: $175,000 Breakdown: • 0.6 Full Time Equivalent staff time for 12 months - $81,900 • Welcome Dinner for 39 trainees and 25 dignitaries - $16,000 • Expenses - $5,000 • Settlement & Building Connections to the Community - $72,100 Invoiced Quarterly. 'Settlement & Building Connections to the Community' to be a reimbursement of actual program expenditures up to the maximum indicated above. L Scope of Work #2: Partner Engagement and Creating a Plan for a Physician Retention Recruitment & Incentive Program The shortage of Family doctors in not unique to Durham, and the attraction and retention of family physicians is very competitive across the province and country. Addressing this acute need for family physicians and ensuring the competitiveness of Durham in attracting and retaining doctors, a professional and coordinated effort will be necessary, consisting of dedicated resources, and key objectives and performance indicators. Key Partners • Region of Durham • Local Municipalities • Lakeridge Health • Local family physicians • Local Business • Durham Region Real Estate Board / Association of Realtors • Durham Boards of Trades/Chambers of Commerce • School Boards • Local Post -Secondary Institutions • Queen's University This scope of work includes the research, engagement, and evaluation of best practices and the unique needs of Durham Region, necessary to create a plan for family physician attraction and retention. The services to be delivered under this scope include the following: • Primary research and outreach to the Key Partners listed above regarding the unique needs of Durham Region • A report containing the following information. o Best estimates of actual number of additional family doctors needed in Durham. (Consideration should be given to creating a registry for Durham residents seeking a family doctor.) o A jurisdictional scan of physician attraction / retention practices at the municipal level across Ontario o The Regulatory context o An evaluation (advantages/disadvantages) of the various possible objectives of a program, and recommendation for Durham, including without limitation: ■ delivery of services to medical trainees to retain them post -graduation. ■ retention of practicing family physicians; and ■ attraction of family physicians from outside Durham Region. 7 o An evaluation (advantages/disadvantages) of the various services/programming that could be delivered through this initiative, and a recommendation for Durham, including without limitation: ■ marketing, outreach, and promotion (including a website). ■ direct recruitment. ■ settlement services. ■ local industry support (e.g., support for creating comprehensive practices). ■ succession planning support. ■ data analysis and research; and ■ financial incentives and inducements (if financial incentives are recommended, include a clear process, eligibility criteria, and proposed guidelines for application) o Resourcing requirements (including staffing, annual operating funding, and capital) recommendation, including an indicative one-year program budget. o An evaluation of governance and structure options (including which organization and/or department would be best suited to house this new program); funding sources, composition of a board or advisory committee; recommendation for Durham Region o Program success metrics, target outcomes Term: The final report will be delivered to the Region of Durham by September 22, 2023. Price: $40,000.00 Invoiced 50% upon contract award, and 50% upon project completion. Sheila Hall, Executive Director Clarington Board of Trade On Behalf of the consortium of regional medicine leadership. L Attachment 1 to Report FSD-028-23 \� Invest Durham Physician -• •'tment Proposed Scope for 2023 and Request for One -Time Financial Contributions May 16, 2023 .o � Issue Identification Doctor Shortage • Between 45,000 — 110,000 Durham Residents have no comprehensive -care family doctor • 1,500 newborns are discharged annually without a primary care physician Impacts • Resident health & wellbeing • Emergency and urgent care overload / wait times • Economic: talent attraction, business investment attraction Invest S Durham shortages acros s unique to Ontario. Durham; there are Many Ontario municipalities are actively recruiting doctors and even paying incentives, putting Durham at a competitive disadvantage. Invest S Durham .o � Opportunity Immediate • Queen's—Lakeridge Family Medicine Program: up to 80 post -grad students and 58 trainees in residency in Durham • Building lasting bonds between trainees and the community will improve the likelihood they choose to stay and practice here Long -Term Best practices from other municipalities include: • Staffed family doctor recruitment program • Strengthen local comprehensive care Some other municipalities offer incentives Invest S Durham .o � Immediate Opportunity #1 Support / retain 20 new post -grads and 18 family medicine residents • Assist in securing housing • Provide settlement services (schools for children, service providers, connect to community resources) • Assist is securing jobs for spouses • Welcome dinner / reception • Regular one-on-one meetings for individualized support • Create lasting bonds with the community through activities / tourism industries • $175k for 1 year Invest S Durham .o � Immediate Opportunity #2 Collaborate to Create a Plan for a Family Physician Recruitment Program • Jurisdictional Scan • Create Objectives • Define Activities: o Marketing, outreach, promotion (website) o Direct recruitment o Settlement services o Strengthening local practices o Succession planning o Financial incentives • Staffing / Budget • Governance / Structure / Funding Model • $40k to create the plan y Invest S Durham .o � Recommendation / Request • Jointly fund scopes 1 & 2 of the attached proposal with the following one-time financial contributions: o $106k Region of Durham o $20k ea. Ajax, Clarington, Oshawa, Pickering, Whitby o $3k ea. Brock, Scugog, Uxbridge • Contract Sheila Hall /CBOT (on behalf of the consortium of regional family medicine leadership) to deliver these scopes for the whole Region of Durham. • It is expected that this plan would recommend creating Physician Recruitment Program with a Regional mandc- Through collaboration, we will all inform the mandate, structure, funding model, and governance.