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160803 Physician Recruitment MIN= Attendance Chair and Deputy Mayor Dave Beres, Mayor Stephen Molnar, Dr. Gerry Rowland, Dr. Howard Lamb, Crystal Houze, David Calder, Lance Scott, Lana White Regrets: Councillor Penny Esseltine 1. Call to Order The meeting was called to order at 12:05 p.m. 2. Adoption of Agenda Moved By: Dr. Rowland Seconded By: Dr. Lamb Resolution THAT the Agenda as prepared for the Committee meeting of July 6, 2016, be adopted. ‘Carried’ 3. Disclosures of Pecuniary Interest and the General Nature Thereof There were no disclosures of pecuniary interest declared. 4. Adoption of Minutes of Previous Meetings – June 20, 2016 Moved By: Mayor Molnar Seconded By: Dr. Rowland Resolution THAT the Minutes of the June 20, 2016 meeting of the Physician Recruitment and Retention Committee, be adopted. ‘Carried’ 5. Delegations and Presentations The Corporation of the Town of Tillsonburg PHYSICIAN RECRUITMENT & RETENTION July 6, 2016 12:00noon Council Chambers 200 Broadway, 2nd Floor, Tillsonburg, ON N4G 5A7 MINUTES Physician Recruitment and Retention Committee July 6, 2016 – Minutes - 2 - 6. General Business & Reports 6.1. Follow-up - Health Recruiter Coordinator Position The draft work plan was circulated, noting the content is from what the Committee discussed at the last meeting The document was reviewed and the following changes noted: - k) spell out Recruitment and Retention Committee. - remove word ‘monthly’. Leave it was required. - works in cooperation with the local medical community to define the health care requirements/needs of the municipality and area - under Relationships, clarify that CEO is TDMH. Moved By: Mayor Molnar Seconded By: Dr. Lamb Resolution THAT the Terms of Reference of the Physician Recruitment and Retention Coordinator, as amended, be adopted. ‘Carried’ 6.2. Funding for Position D.Calder and C.Houze have discussed the funding. The Town has budgeted $10,000 and will share 50/50 with the Hospital. ($14,000 - $7,000 each/year). The Hospital is providing this person and the position reports to the Hospital’s CEO, but the CEO and the Town’s CAO will converse. With respect to recruitment activity, will be looking at other partnerships and resources. Moved By: Mayor Molnar Seconded By: Lance Scott Resolution THAT the Physician Recruitment and Retention Committee authorize the placement of an individual to fill the role of the Physician Recruitment and Retention Coordinator for a 12-month period. ‘Carried’ Physician Recruitment and Retention Committee July 6, 2016 – Minutes - 3 - Dr. Rowland suggested that the Coordinator work with him regarding events and timing of activities. With respect to fee for service, once Dr. Rowland has the information, he will work with the Coordinator on that. For the next meeting he hopes to be able to bring back a thorough review regarding income stability as well as fee for service. Relative to Budget, it was noted that we need to bring in other parties to be successful. We need to look at various models and determine resources available. 7. Correspondence 8. Other Business To be added to the Work Plan – Pilot Program/Project 9. Next Meeting – August 3, 2016 Meetings to be scheduled for the first Wednesday each month at 12:00noon. 10. Adjournment – 12:53pm DRAFT #2 FOR DISCUSSION Physician Recruitment & Retention Coordinator Work Plan 2016/2017  August / September 2016  Planning meeting Crystal Houze and David Calder  Finalize 2016/17 Work Plan  Investigate stimulus pilot program (incentive package)  Meet with Jane Tillmann, Health Force Ontario – develop business plan for high needs designation November 2016  Recruitment Coordinator organizes a physician and community representative to attend at least 2 or 3 career fairs offered by various Universities. Historically, UWO (Grand Bend), McMaster and Toronto etc.  Development of a comprehensive brochure detailing the Town and TDMH. Include contact information, inviting residents to “Spend a day in Tillsonburg” at their convenience. May 2017  Prepare for Discovery Week. Host 4 1st year medical students to job shadow family physicians and specialists and other allied health care providers. Ongoing Activities/ Administration  Monitor Websites, Emails, SWOMEN, HealthForce Ontario, CASPR activities  Develop a list of residents or new grads wishing to provide locum coverage  Membership with CASPR Locums. This association provides an annual conference, online networking opportunities and job postings (already a member)  Monthly meetings of the Town of Tillsonburg and TDMH Physician Recruitment Committee  Maintain a database of residents, students and physicians  Regular meetings with the CAO and CEO and Chief of Staff September 2017  Proposed- Organize a two to three hour session with the Committee, new Family Physician recruits and key stakeholders to meet and discuss “what’s new, what’s working well” and discuss new and creative ways to assist with recruitment and retention. Provide feedback from events and create an action plan for the upcoming year. October 2016  Proposed- Develop a Scholarship Program for $1,000 (x 3 Students) scholarship awards to Tillsonburg residents who are enrolled in a Medical School. Supported by TDMH and the Town. December 2016/ January 2017  Proposed- Host “Home for the Holidays Program”. Invite any Tillsonburg or Oxford County residents that are enrolled in a Medical School to meet with the committee, other physicians, stakeholders and dignitaries. Could present scholarships if approved. January/February/March  Continue to monitor “Spend a Day in Tillsonburg” , Follow-up with residents that visited Tillsonburg’s booth at the recruitment fairs that expressed an interest who have not been in contact. PHYSICIAN RECRUITMENT AND RETENTION COMMITTEE DISCUSSION MODEL Incentive Models Research with other peer hospitals has led me to conclude that in the short term, financial incentives can help to attract physicians, however the long-term efficacy of financial incentives may be limited (after contractual arrangement, physician may chose to leave). Physicians select current work location based on availability of practice opportunity, appealing location, spousal support, family support (i.e. schools – French Emersion and Montessori). It should be noted that newly graduated GPs are somewhat attracted to financial incentives but of equal importance to this is what they refer to as “work life balance”. #1: (HISTORICAL MODEL) Shared Physician Recruitment Contract Support Model (50% Town/ 50% TDMH):  $64,000 subsidy for a recruit (up to a maximum of $64,000). This financial support is intended to assist physician practices mitigate the financial impact of a new physician on other members of the FHO while the new physician is waiting to be approved from income stabilization (not applicable in 2016). Contribute up to $5,000.00 in moving expenses with receipts for the physician recruit. The recruit would be encouraged to live in the community or very close by, in order for the moving stipend to apply.  Upfront stipend of $5,000 to offset moving expenses and an additional $5,000 to the Clinic that will employ the recruit to offset the cost of setting the recruit up in their office.  During the first six months of practice, the physician will not be required to pay any of the usual overhead expenses. Physician will receive all of the billings rendered. These expenses ($6,000 per month) will be paid to the clinic group employing the physician on a monthly basis by the community  During months six to nine, physician will pay one-third of the office expenses ($2,000/month) and the community will pay one-third ($2,000)  During months nine to twelve, physician will pay two-thirds of office expenses ($4,000 per month) and the community will be one-third ($2,000).  After the first year, the physician, as negotiated between him/herself and the office will pay all office expenses.  The new recruit’s obligations will include:  The intent to practice in Tillsonburg for the long-term  Work a minimum of four (4) full days of office practice; and  Take share of hospital on-call and ED work Total cost = $10,000 + 36,000 + 12,000 + 6,000 = $64,000 #2: Grant + Tangible Support  $5,000 to $10,000 grant for moving expenses  Assistance to find suitable temporary rental accommodation (paid for by the Town and TDMH for 6 months) #3: Grant  XX per physician funding used for practice improvements only (i.e. purchase of new equipment, EMR, etc.) to enhance the medical practice site #4: Support  Pay for moving expenses with receipts  Reimbursement for expenses for candidate and spouse for visit to Tillsonburg  Subsidy for office expenses paid to the clinic group employing the physician on a monthly basis (decrease over a 6 month period) #5 LOCUM Recruitment  Trial interested Locums for 1 month in the three offices in the town  Government would pay “shadow billing” (15%)  Locums would see patients and physicians would be “clawed back to pay the locum”  Cost $800-1250 per day  To reimburse the physicians for the claw back costs per day(85%):  Each Physician Office would pay one-third  Town would pay one-third  TDMH would pay one-third  Free accommodation for the locum provided by TDMH  $12.000-20,000  Process should be developed through this Committee Other Ontario Communities: Hamilton – Program designed to recruitment family physicians  Signing bonuses of $10,000 to 40,000, funded by private dollars, depending on the length of commitment and hours worked Kingston – offers a 3 year program with financial incentives offered to two groups: 1. Established physicians – Receive one-time payment of $25,000; and 2. Un-established physicians – Receive 75,000 over five years Physicians can use the money as they see appropriate whether it is for moving expenses, office overhead, equipment or debt repayment. If the physician leaves, they must pay back the funds plus interest at punitive rates. St. Thomas – Offers an incentive package  $30,000 per physician to be used for practice improvements only. Hanover No recruitment incentives offered. Incentives aside, working in a beautiful town like Hanover with excellent education and recreational opportunities, makes it hart to put a price tag on Hanover. St. Catherines City of St. Catherines offers a relocation package to offset some of your relation costs. A $5,000 grant from the City is available. They also provide suitable temporary rental accommodation for 6 months (free).