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30 - The Oakville Beaver Weekend, Saturday November 24, 2007 www.oakvillebeaver.com Many reasons some doctors fly south By David Lea OAKVILLE BEAVER STAFF fter nearly a decade of working in America a Canadian family doctor has been reclaimed by Oakville, but only by chance. Dr. Ted Jacobson, a graduate of the University of Toronto, had been practicing family medicine in Chattanooga, Tennessee since 1997. He had a thriving practice, a pay cheque the size of which the government of Ontario could not compete with and really no reason to return, except of course for family. "When our youngest daughter graduated from high school she decided she was going to the University of Western Ontario and that meant three of our four kids were back in Canada," said Jacobson. "We had grandchildren in Oakville. It was clearly time to come home." A chance encounter with an Oakville doctor who was contemplating retirement from the Oakville Health Centre Clinic resulted in the setting up of a general practice in 2006 where Jacobson now sees, on average, 25-40 patients each day. While Jacobson's route to Oakville was certainly fortunate for the town it was by no means evidence of the kind of recruitment initiatives needed to return the number of family physicians in Oakville to an appropriate level. A 2006 census put Oakville's population at 165,613, which according to the Ministry of Health means Oakville requires at least 123 full-time family physicians. Oakville only has an estimated 113 family doctors, of whom 35 are parttime. To make matters worse very few of these doctors are accepting new patients. One of the roots of this shortage seems to be the fact that other provinces and even other countries are offering Ontario doctors better opportunities than they can find here in Ontario. "The United States loves our family doctors because they find them very cost efficient," said Dr. Janice Willett, President of the Ontario Medical Association (OMA). " A lot of physicians went there in the '70s and '80s and we'd like to get those physicians back." Jacobson has seen first hand the aggressive recruiting tactics employed by the U.S., as almost immediately after graduation in 1979 he began receiving flyers urging him to move his practice to America. "They are aware of the fact that you are going to be making more money with them so they make that clear that there are generous compensation packages. Often they are offering a sort of lifestyle, pointing out that they are at or near recreation outdoor activities, fishing, skiing that kind of stuff," said Jacobson. "There were times when I would be getting literally four or five flyers a week. `Come down to Virginia, great vacation area,' they'd say and I'd just toss them in the garbage. Then at a point I started putting them in a file folder. I'd get one and I'd say, `Maybe I'll think about this.'" Thought turned to action in 1997 when Jacobson learned about a promising practice in Chattanooga and promptly moved there. It was during this period that the magnitude of the trend he was now part of became obvious to him. "In that group in Chattanooga seven out of the 10 family A DOC+OR IN THE HOUSE? doctors I worked with were Canadian," said Jacobson. These family doctors had not left their homes in Canada for nothing because, as Jacobson noted, despite the high overhead, which comes from having a large number of support staff, the perks of practicing family medicine in America are IS THERE A numerous, including a pay rate which Jacobson estimates to be about 25 per cent higher than what family doctors make in Ontario. "Down in Tennessee it was a win, win, win situation because the bottom line pay was better. The tax rate was far kinder and the cost of living was quite a bit lower too," he said. "There are a lot of problems with the U.S. health care system, but one thing you gotta say for it is that if something needs to be done, it can be done just like that." Dr. Ted Jacobson, who returned to Oakville after working as a family doctor in Chattanooga, Tennessee for 10 years. "Let's face it, in Toronto or Oakville the cost of living is so high that you have to take that into consideration." A large support team who would help with certain tasks like taking a patient's blood pressure, tasks Jacobson has to do himself here in Ontario, was another perk he enjoyed while in America. However, the biggest difference between the two systems Jacobson says is the speed with which a family doctor is able to get help for their patients. "In Ontario it is amazing to me how people have just gotten used to the fact there are such long delays. If I tell someone it will be three months before they can have an x-ray most patients will just say, `Okay,' said Jacobson. "When someone comes in with a shoulder problem, I explain to them that an MRI wouldn't be a bad examination, but unless you are a celebrity or a professional athlete you're not going to get it or you'll get it, but not for quite a while. I always call an ultra-sound a poor man's MRI because we can get that pretty soon and it's a pretty good examination." This experience with the Ontario system contrasted greatly with Jacobson's time in America where an abundance of resources led to speedier care for his patients, no matter what medical equipment was required. "There are a lot of problems with the U.S. health care system, but one thing you gotta say for it is that if something needs to be done, it can be done just like that," said Jacobson, snapping his fingers. "If I felt you needed an MRI scan, filling out the forms and getting the insurance company to approve it, depending on the nature of your insurance, that might take a little time, but in terms of getting the tests done I could probably have it done the next day." With greater pay, teams to tackle the simpler aspects of medicine and a greater accessibility to the more advanced tools to their trade, brought on by the fact that America spends around $2 trillion on health care each year, it is not difficult to see why the challenge of bringing doctors back to Ontario is a difficult one. Still the OMA believes it can be done. "We need to look at how we pay the physicians, but more specifically we need to look at how we are competing on all the other issues. Have we got our system running in an efficient manner so the physician can access the care the patient needs? Are we connecting the physicians with the right resources and are we providing an environment that is less frustrating than other provinces?" said Willett. "Information technology that allows them to get all the tests patients have had, allows them to find those tests easily and access a whole network of care. We're a little behind other jurisdictions in some of that." Willett says some communities are trying to attract more family doctors by accommodating their needs. "They probably need a lifestyle that lets them spend some time with their families. In other words, you can't expect them to be on call every night and think that is going to be a reasonable workload," said Willett. The hunt for family doctors is a task the Halton Region has undertaken with the aid of an active physician recruitment program. Each year officials from the program visit trade shows geared towards informing medical students about physician practice opportunities in the area. They have advertised in various journals and conducted presentations at medical schools all for the express purpose of getting Halton's name in the minds of a new crop of family doctors. Oakville is in the process of increasing its odds of being selected by some of these new physicians by applying for an underserviced designation from the Ministry of Health. An underserviced designation would mean family physicians could apply for incentive grants such as the Free Tuition Program, which offers physician applicants up to $40,000 for a three or four year return-of-service commitment. Oakville's application for an underserviced designation is expected to be issued to the Ministry of Health in the fall.