Why the lack of healthcare workers cannot be resolved with financial incentives alone
Among the proposals to strengthen the system are better working conditions and hiring additional personnel.
Politicians are using financial incentives to retain or attract personnel as many provinces and states struggle with a lack of healthcare workers and packed emergency rooms.
At least 5 different provinces have announced recruiting incentives or retention bonuses totaling tens of thousands of dollars in the past seven months in an effort to retain or recruit physicians and nurses.
But is money really the best form of hiring incentive?
One-time cash incentives aren't sufficient, according to several experts and recruiters, who base this claim on studies as well as their personal experience.
Monetary incentives have been and always will always be Band-Aid fixes, according to Maria Mathews, senior professor from Western University of London, Ontario's department of family medicine.
Financial incentives are only one component of the jigsaw needed to address the continuous pressure on the health care system, according to nurse unions & national health authorities.
They have stated that issues with the hours worked, the pay, and the working conditions all need to be addressed.
"What matters to these doctors and nurses? Quality of life will be the focus in 2022, according to researcher David Este, senior lecturer of social work at the University of Calgary.
"I don't think that monetary incentives have the capacity to cope with nature of a work place if they are employed in hospitals that seem to be chronically understaffed... and those working circumstances are perpetuated over a long period of time.
Why monetary rewards are preferred
The most recent jurisdictions to offer some kind of financial incentive for existing or new household doctors or nurses include Ontario, Alberta, New foundland, Nova Scotia, and P.E.I.
Mathews notes that this is a strategy that politicians frequently utilize since money can be delivered very rapidly.
"Giving individuals money incentives won't be enough to tackle the issue. We will not be losing nurses if that were the case, "added Este.
Additionally, there are noticeable variations among the recent compensation measures introduced by regional governments and supported by taxpayers.
Bonus pay for nurses were offered in Ontario & Newfoundland and Labrador to maintain current employees. This is distinct from the new funding announced yesterday in Alberta, P.E.I., and Nova Scotia for doctors who open practices in remote areas.
The demand is urgent, according to Dr. Vesta Michelle Warren, head of Alberta Academy Of medicine and just a family physician in Sundre, Alberta. "I believe the governments, either provincially and federally, is seeking a quick response because the need is imminent," she said.
Can monetary rewards be beneficial?
Hospitals are under added pressure for a variety of reasons, which has resulted in closures or long wait times for patients. One of the causes, according to experts, is that patients without even a doctor are prolonging the wait times at hospitals all across nation.
As according Dr. David Rauchwerger, clinical director of the emergency department at Mackenzie Health, nearly 25% of patients who visited the emergency departments of the hospitals in Richmond Hill & Cortellucci Vaughan, north of Toronto, this month did not have family doctor.
According to him, that is a significant increase from the 5% pre-pandemic number.
Albertan and Nova Scotian politicians are hopeful that their recently announced incentives and other recruitment initiatives would persuade physicians and specialist to work in mostly rural or neglected regions. The incentives offered by P.E.I. officials have been expanded to cover family physicians and select specialists who accept positions elsewhere in the province.
Studies conducted in Canada during the 1990s frequently point out that physicians place less importance on recruiting bonuses than they do on other factors, such as job conditions and neighborhood amenities.
Health care professionals ranked monetary incentives as just "slightly important" for hiring and not even important for keeping a physician in a community, according to a 2019 study into retention that involved interviews with 91 Alberta physician, administrators, community members, and spouses.
Community residents, on the other hand, gave incentives a high grade for luring physicians.
This supports a 1999 study's results that, despite "widespread implementation," there isn't much proof that financial-based strategies work exceptionally well.
A refund agreement or grant, which is frequently provided to recent graduates or physicians with overseas training to assist defray several of their training or other expenditures, is another frequent occurrence in very many provinces and territories, according to experts.
According to Mathews, this is frequently the time when someone agrees to relocate and work in an area for one to three years.
She has examined the return-of-service agreement statistics for Newfoundland and Labrador and claims that while these agreements may bring people to underserved areas, they do not "maintain them in those places."
Doctors have occasionally cashed out the of their contract in order to depart the area. Another group of researchers discovered that this occurred in 1999 in other jurisdictions including Saskatchewan and Quebec.
"Monetary incentives will only be effective in attracting and maintaining employees," Mathews said.
Craig Copeland, the mayor of Cold Lake, Alberta, is an expert at keeping physicians and other healthcare professionals in the area.
Northeast metropolitan Edmonton has had a difficult time luring physicians since his election in 2007. He said that the region has had a long-standing demand for five to six doctors.
To entice doctors to Cold Lake, the city is presently offering $20,000 and paying the interest on such a $50,000 credit line in exchange for their services.
Copeland replied, "Unfortunately, you have to pay to play.
Mathews said that as there is a dearth of information on monetary incentives and retention schemes, it should be more widely disseminated among researchers and academics.
Years of experience as a recruiter, Bryan MacLean, who works for Northern Medical at the University of Saskatchewan, said that he and colleagues are attempting to compile that "siloed" data on recruiting and retention initiatives so the data can be more easily accessed.
However, he has seen that doctors may serve in a community, complete their service obligations, and then leave.
"The government has to put greater attention on the retention concerns," he stated.
Bonuses can assist, according to Warren. The chair of Alberta Medical Association, however, claimed that she and her peers frequently place a higher priority on other aspects, such as community fit, whether or not their spouse can find employment, and if they have a positive work environment and team.
"I kept in a center not because of the three-year incentive," Warren said of the return-of-service agreement she signed in 1999. "I kept in a center because it was a very excellent match with my family, with my children, as well as for me on such a professional level."
After the $5,000 salary boost was revealed by the Ford administration earlier this year, nurses across Ontario expressed a similar sentiment. This won't be sufficient to keep workers on the job, according to several nurses and union leaders.
A joint statement submitted at the time by four unions stated, "When you're offering up to [$5,000] as nurses, what they actually want is the assistance to do their tasks properly and to perform them safely."
The other options
To address the issues occurring in hospitals, clinics, and family doctor offices, medical professionals including physicians, nurses, and health officials have urged for particular adjustments.
Many people agreed that it is crucial to hire additional healthcare personnel, including family physicians, nurses, and other professionals.
Warren and MacLean concur that adding more nurse practitioners or physician assistants might improve team-based treatment.
Warren said that another choice is to consider returning Canadian students who received their education at foreign medical institutions.
Governments should also provide retention bonuses to other healthcare employees, according to Mathews, if they are serious about doing so.
"We can't deliver care if we do not have the clerks but if we don't have qualified lab technologists," she added.
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