HomeMy WebLinkAboutECD 02-24Report to
Executive Committee
Report Number: ECD 02-24 Date: June 10, 2024
From: Fiaz Jadoon Director, Economic Development & Strategic Projects
Subject: Family Physician Recruitment Program - File: D-1600-002
Recommendation:
1. That Council approve the Memorandum of Understanding (Attachment 2) among the City of Pickering, the Regional Municipality of Durham and all Durham local area municipalities to fund, create, and deliver a family physician recruitment program in Durham, dated May 2024;
2. That the Mayor and the City Clerk be authorized to execute the Memorandum of Understanding; and,
3. That the appropriate City of Pickering officials be authorized to take the necessary actions as indicated in this report.
Executive Summary: The purpose of this report is to seek Council’s approval of the City’s participation in the Durham Family Physician Recruitment Program.
The Durham Family Physician Recruitment Strategy (Attachment 1) was endorsed by Regional
Council in January of 2024 (Region of Durham Report 2024-COW-3). It identifies a shortage of approximately 145 family physicians, impacting nearly 180,000 Durham residents. The Strategy recommends the creation of a program to attract and retain family medicine trainees and family physicians to Durham, and the hiring of a full-time permanent family physician recruiter by the Durham Ontario Health Team (DOHT).
The annual funding for the program will be $225,000.00 beginning in 2025, with escalation annually at a rate equal to the Consumer Price Index plus two per cent. The cost will be shared among the Region of Durham and all local area municipalities in three-year increments. The cost for each municipality is proportionate to its population in Durham, with the Region of Durham absorbing 50 per cent of the total cost.
City of Pickering’s share for the remainder of 2024 will be $3,913.00, which will be paid from the existing budget in the Consulting & Professional Fees account under Economic Development & Strategic Projects’ cost centre (502230.10050). The annual cost starting in 2025 will be $16,008.00 and will increase to $17,481.00 in 2027. The funding will be proposed as a line item under Consulting & Professional Fees in the 2025 Budget and subsequent years.
ECD 02-24 June 10, 2024
Subject: Family Physician Recruitment Program Page 2
In order for Pickering to participate in the Durham Family Physician Recruitment Program, City staff recommend that the Memorandum of Understanding (MOU) contained in Attachment 2 to this Report be approved and executed.
Relationship to the Pickering Strategic Plan: The recommendations in this report
responds to the Pickering Strategic Plan Priorities of Champion Economic Leadership &
Innovation; Advocate for an Inclusive, Welcoming, Safe & Healthy Community; and Strengthen Existing & Build New Partnerships. ______________________________________________________________________________
Financial Implications: City of Pickering’s share of the cost of the MOU will be $3,913.00
(HST included) in 2024 and will be funded from the Consulting and Professional Fees (502230.0000) G/L account in Economic Development & Strategic Projects (10050) cost centre. The agreement cost in 2025 is estimated to be $16,008.00 (HST included). The program will be indexed to inflation plus two per cent in 2026 and 2027.
Discussion: The purpose of this report is to seek endorsement for the City of Pickering’s
participation in the Durham Family Physician Recruitment Program. On January 31, 2024,
Durham Regional Council endorsed the recommendations in Report 2024-COW-3 to create a Region-wide Family Physician Recruitment Program to attract and retain family medicine trainees and family physicians to Durham and to fund the Durham Ontario Health Team (DOHT) to hire a full-time permanent family physician recruiter, with core funding expenses shared among the
Region and local municipalities, and to report on that arrangement to Durham Regional Council.
That recommendation was based on the Durham Family Physician Recruitment Strategy, which identified a shortage of family physicians impacting nearly 180,000 Durham residents. Furthermore, each year over 1,500 babies born in Durham Region are discharged without a primary care physician. Simultaneously, approximately 27 per cent of Durham’s family physicians
are over the age of 60 and nearing retirement from clinical practice. With the recent and
anticipated growth in Durham, the supply of family physicians is unable to keep up with the current and future demand. Without planning for replacements, the number of patients in the Region without a family doctor will rise by nearly 14,000. The Strategy identifies that, specifically in the City of Pickering, that 26,025 patients, equivalent to 25.2 per cent, are currently without a family
physician. This represents approximately a shortage of 19 family physicians in Pickering.
The success of this program will be monitored by staff in collaboration with the Durham Physician Recruitment Team and the Durham OHT. The first year will consist of program development and the establishment of regular monitoring and reporting functions. KPIs will be established to track outreach, retention of learners, retention of existing physicians, and satisfaction with the
recruitment process. Over time, changes in the number of family doctors to population will be
tracked, with granularity by community. Beginning in January 2025, the funding will be used to hire one FTE professional regional physician recruiter housed within the Durham Ontario Health Team for a 10-year term. Contribution will include attraction and retention programming and will be reviewed in three year increments to ensure the program meets established performance metrics.
ECD 02-24 June 10, 2024
Subject: Family Physician Recruitment Program Page 3
The Durham Ontario Health Team is a collaborative group of organizations and patient, family and care partner advisors working in partnership to improve access and delivery of coordinated health services. The group is comprised of partners from across the care continuum, including primary
care providers, hospitals, mental health and addiction services, social support services, home and
community care support services, and long-term care.
The shortage of family physicians is not unique to Durham. Competition for recruitment is growing across the Province, with many other communities establishing or enhancing dedicated family
physician recruitment programs. As a municipal service, such a program can serve to improve
long-term health and wellness of the community, reduce the overloading of urgent care services, and address inequalities across diverse populations.
An assessment of 12 communities revealed varying incentive packages to attract new physicians, with benefits ranging from housing benefits to relocation expenses. On average, these incentives
equate to about $19,875.00 annually in exchange for an average five-year commitment by the
physician. These types of incentives were considered for Durham; however, it was determined that Durham’s geographic location, vibrant communities, and quality of life, are sufficiently competitive and that financial incentives are not called for. Instead, the program will carry out concerted marketing and recruitment activities.
The proposed funding model for the program between July 1, 2024, and December 31, 2027,
provides for a total maximum cost of $55,000.00 in 2024, increasing to $225,000.00 in 2025 and indexed to inflation plus two per cent in 2026 and 2027. The budget of $225,000.00 per year will be allocated to salaries, operational expenses, marketing, settlement/ local activities, travel and events, and professional stipends. Approximately 50 per cent will be shared by all local area
municipalities based on their proportion of population. The remaining 50 per cent will be covered
by the Region of Durham. Based on City of Pickering’s population of 106,505, 14 per cent of Durham Region’s total population, Pickering will be responsible for 7.1 per cent of the total funding. This results in estimated costs of $3,913.00 in 2024, $16,008.00 in 2025, $16,728.00 in 2026, and $17,481.00 in 2027.
The Strategy also recommends the creation of an administrative body responsible for overseeing
the physician recruitment program. The body will include representatives from healthcare organizations, local government, and community stakeholders. It is recommended that the body be established consisting of three Regional Councillors nominated by the Regional Council and representing north Durham, west Durham, and east Durham alongside seven professionals and
experts from the health sciences and community sectors to be chosen by staff based on skill set,
system and community knowledge. The program will be regularly assessed for effectiveness and necessary adjustments will be made based on data and feedback.
In the Council endorsed Corporate Strategic Plan, under priority two, the City is called upon to advocate for and work with partners to increase access to health care facilities and medical
practitioners. As the City of Pickering continues to grow in population, the shortfall in health care
will continue to grow, impacting the quality of life for residents. The opening of Jerry Coughlan Health & Wellness Centre marked an important milestone for the community as the only health care facility in the City of Pickering. Regrettably, however, given the growing demand and
ECD 02-24 June 10, 2024
Subject: Family Physician Recruitment Program Page 4
declining supply of family physicians, the Centre will not be sufficient to meet the growing demand for health care services.
Staff recommend that the MOU be approved by Council, and that the Mayor and City Clerk be
authorized to execute it.
Attachments:
1. Durham Family Physician Recruitment Strategy2. Memorandum of Understanding3. Proposed Cost Sharing Funding Model
Prepared By: Approved/Endorsed By:
Laraib Arshad, MBA Fiaz Jadoon, Ec.D., CEcD, MPM, B.COMM Manager, Economic Development & Director, Economic Development & Marketing Strategic Projects
FJ:la
Recommended for the consideration of Pickering City Council
Marisa Carpino, M.A. Chief Administrative Officer
Original Signed By:Original Signed By:
Original Signed By:
1
Durham Family Physician
Recruitment Strategy
December 2023
Attachment 1 to Report ECD 02-24
2
Contents
Executive Summary: Physician Recruitment Strategy for Durham Region ................................................... 4
1. Introduction .......................................................................................................................................... 6
2. Background ........................................................................................................................................... 7
2.1 Unique Needs and Challenges in Durham Region .......................................................................... 8
2.2. Family Physician Recruitment and Retention in Durham Region .................................................. 9
2.2.1. Physician Recruitment Initiatives and Medical Trainees in Durham ........................................... 9
2.3 Medical Training in Durham Region ................................................................................................ 9
3. Where We Are Today .......................................................................................................................... 11
4. Future Needs Assessment .................................................................................................................. 11
4.1. Population Growth ...................................................................................................................... 11
4.2. Aging Population ......................................................................................................................... 12
4.3. Physician Retirement ................................................................................................................... 12
4.4 Jurisdictional Competition ............................................................................................................ 12
4.5. Estimating the Additional Number of Family Physicians Required .............................................. 14
5. Physician Recruitment Strategies ....................................................................................................... 14
5.1. Marketing and Promotion ........................................................................................................... 15
5.2. Incentives and Support ................................................................................................................ 15
5.3. Community Engagement ............................................................................................................. 16
5.4. Data-Driven Approach ................................................................................................................. 16
6. Governance Framework ..................................................................................................................... 16
6.1. Regulatory Compliance ................................................................................................................ 16
6.2. Ethical Standards ......................................................................................................................... 17
6.3. Administrative Structure ............................................................................................................. 17
6.4. Resource Allocation ..................................................................................................................... 19
7. Monitoring and Evaluation ................................................................................................................. 21
7.1. Key Performance Indicators (KPIs) ............................................................................................... 21
7.2. Data Collection and Analysis ........................................................................................................ 21
7.3. Stakeholder Feedback ................................................................................................................. 21
7.4. Regular Reporting ........................................................................................................................ 21
7.5. Continuous Improvement ............................................................................................................ 21
8. Conclusion .......................................................................................................................................... 21
3
Appendix 1. Durham Physician Engagement Team Activity Report ............................................................ 22
Introduction ........................................................................................................................................ 22
Support and Engagement ................................................................................................................... 22
Information Hub ................................................................................................................................. 22
Community Engagement .................................................................................................................... 22
Short-Term Objectives (End of 2024) .................................................................................................. 22
Long-Term Goals ................................................................................................................................. 23
Appendix 2: Governance Framework and Timeline for 2024-2025 Work Plan ......................................... 24
2024-2025 Workplan .......................................................................................................................... 24
Appendix 3. Understanding Regional Needs and Competition .................................................................. 26
Appendix 4. Primary Care, Primary Health Care and Comprehensive Care Definitions ............................. 28
Primary Care ........................................................................................................................................... 28
Primary Health Care ............................................................................................................................... 28
Description of Comprehensive Care / Services ...................................................................................... 29
Appendix 5. Governance Model Evaluation ............................................................................................... 31
Abbreviations ............................................................................................................................................. 33
4
Executive Summary: Physician Recruitment Strategy for Durham Region
Background and Urgent Need
Durham Region is currently facing a significant challenge: a substantial gap in primary care access
attributed to a shortage of approximately 145 family physicians (Table 1). This deficit affects nearly
180,000 Durham residents (Table 1). This shortfall not only undermines community health but also
threatens the region's economic stability as accessible healthcare becomes increasingly important for
individuals and businesses. Similar challenges are faced by many communities across Ontario and many
Ontario communities are actively developing or enhancing strategies to recruit and retain family
physicians, intensifying the competition for these professionals across the province.
The Region of Durham and its area municipalities of Ajax, Brock, Clarington, Oshawa, Pickering, Scugog,
Uxbridge and Whitby, are now exploring the development of its own long-term strategy for recruiting and
retaining family physicians who will practice in, and serve, communities across the Region. This work is
being led by a group called the Durham Physician Engagement Team (DPET). This team has developed
the following recommendations for the Region to consider and implement, to achieve these goals.
Key Recommendations and Cost:
1.That the current leadership and structure of the Durham Physician Engagement Team (DPET) team
remain in place to December 31, 2024, with the purpose of program and logistic development. Oversight
will remain at the Clarington Board of Trade and that bridge funding be provided for the months of August
through December 2024. Cost of Recommendation 1 is $55,000 one-time funding.
2.That the region contributes to the hiring of one (1) FTE professional regional physician recruiter housed
with the Durham Ontario Health Team (DOHT) for a 10-year term, beginning in January 2025.
Contribution will include attraction and retention programming and should be reviewed in 3-year
increments to ensure the program meets established performance metrics. Cost of Recommendation 2
is $225,000 per year with an annual escalation of cost at CPI +2%.
The Governance
Governance is designed to leverage the unique capabilities of a wide range of stakeholders. An oversight
Taskforce (the Durham Physician Recruitment Oversite Taskforce or “Taskforce”), which works in
harmony but remains functionally distinct from the Durham OHT, will guide program initiatives, and
evaluate success through key performance indicators. It is carefully curated to ensure a rich blend of
perspectives and expertise. This Taskforce will consist of 10 members: 3 Regional Councillors nominated
by the Regional Council and representing north Durham (Brock, Uxbridge, Scugog), west Durham
(Pickering, Ajax, Whitby) and east Durham (Oshawa, Clarington) alongside 7 professionals and experts
from the health sciences and community sectors to be chosen by staff based on skill set, health system
and community knowledge.
Conclusion
The Durham Physician Recruitment Program, designed to be adaptable, hinges on hiring a regional
physician recruiter and involves a triennial review of attraction and retention strategies, with input from
key regional partners, ensuring customization to Durham’s needs. The immediate launch is critical to build
upon the establishment of the new Queens Lakeridge Campus ensuring an uninterrupted focus on filling
the physician gap through 2024 and beyond. Equally important is developing strong programing to
repatriate Canadian Physicians being trained abroad. The recommendations offer Durham a responsive,
collaborative approach, merging local and external resources to make primary care accessible and holistic,
enhancing the community’s health and economic prosperity.
5
Durham Family Physician
Recruitment Strategy
6
Physician Recruitment Strategy for Durham Region
1. Introduction
Access to primary care is the cornerstone of an effective healthcare system. Comprehensive care provided
by family physicians plays a vital role in this system. Primary care providers are often the initial point of
contact between patients and the healthcare system, encompassing illness prevention, health promotion,
diagnosis, treatment, rehabilitation, and counseling. Extensive evidence demonstrates that access to
primary care physicians improves health outcomes and reduces overall healthcare costs. Unfortunately,
as previously mentioned, recent data indicates that approximately 2.2 million1 Ontarians, and over 6
million Canadians, lack a family physician, and the situation is expected to worsen2 in the coming years.
While the healthcare portfolio is the primary role and responsibility of Ontario Health and the Province of
Ontario, there is a critical role for local communities to contribute to the success of physician retention
and attraction. We can work with provincial officials in support of our shared objectives (i.e. recruiting
and/or graduating sufficient family doctors to meet the needs of Ontario and all its residents). At the same
time, we need to focus on the health care needs of Durham’s residents.
Durham Region is experiencing rapid growth, and most family physicians in the region already have full
patient rosters. Consequently, an increasing number of Durham residents are searching for family
physicians. It is imperative for the community to collaborate and address the growing shortage of family
physicians in Durham. A successful regional physician recruitment program will ensure that Durham's
residents, including our most vulnerable populations, have proper access to primary healthcare services.
In Ontario, each family physician has an average patient load of 1,3803 patients. There are approximately
377 family physicians providing comprehensive care to residents in Durham. Data from the Ministry of
Health suggests that up to 180,000 Durham residents lack access to a family physician, while others have
physicians located at a distance, making access challenging. Furthermore, approximately 100 of Durham’s
family physicians are over the age of 60 and nearing retirement from clinical practice. The situation with
access to family medicine is, indeed, cause for concern. Nonetheless, there are opportunities to grow the
family physician complement in Durham, even in this highly challenging environment.
There is an opportunity to foster relationships with family medicine trainees who are already in Durham.
The Queen’s University satellite medical campus in Durham Region continues to grow in size and stature.
Partnerships between Queen’s University Faculty of Health Sciences, Lakeridge Health, and local
physicians were established in 2012 with the 2-year family medicine training program called QBOL
(Queen’s – Bowmanville – Oshawa – Lakeridge Health)4.
In addition to this, Queen’s and Lakeridge Health have developed a first-in-Canada, innovative medical
education program5 for training family medicine trainees in our region which combines undergraduate
and postgraduate training into a continuous program. Distinct features of this program include a
specialized admission process tailored to identify students committed to pursuing comprehensive Family
Medicine from the onset of their medical education. They benefit from an integrated, purpose-built
1 More than 2.2 million Ontarians Left without a Family Doctor ontariofamilyphysicans.ca February 9, 2023
2 One in four Ontarians may be without a family doctor by 2026, analysis says Globe and Mail, October 26, 2023
3 Family Physician Supply Plan Update, City of Kingston, December 1, 2020
4 Queen's-Bowmanville-Oshawa-Lakeridge (QBOL) Family Medicine Residency Program, Queen’s University, 2023
5 Queen’s-Lakeridge Health MD Family Medicine Program, Queen’s University 2023
7
curriculum and early exposure to diverse family medicine environments, starting in their first year.
Collaborative engagements with communities are integral, facilitating immersive learning experiences.
This ground-breaking cooperative initiative is setting a precedent for other provinces and medical schools
to follow in addressing the scarcity of family physicians6. The first cohort in this new Queen’s-Lakeridge
Health program started in September 2023, and will be graduating in 2029.
Additionally, a few family physician groups in Durham have strong ties with the Faculty of Medicine at the
University of Toronto, and Lakeridge Health has affiliation agreements with all medical schools in Ontario.
Durham Region is uniquely positioned to become a leader in training family physicians within our own
community.
Emphasizing engagement and support of locally trained family physicians will be crucial for successful
recruitment in Durham. These trainees are already familiar with our region and its physicians, and a
unified and coordinated community-led recruitment strategy can leverage these valuable partnerships.
However, we must not overlook the recruitment potential of family medicine trainees from across Canada
and Canadian trainees studying abroad who may also be interested in joining our Durham communities.
Finally, we cannot overlook the opportunity to recruit beyond our community, ensuring we work to attract
family physicians from across Ontario, and those family medicine graduates from across Canada and
internationally who are from Ontario and would like to return.
In this document, we will identify the unique needs of Durham and its municipal partners. Using available
data and local insights, we will estimate the additional number of family doctors required in Durham. We
will review strategies employed by other communities to attract physicians and identify best practices
that Durham can adopt. Furthermore, we will examine the regulatory and governance frameworks
necessary for a long-term recruitment plan. Recommendations will be developed to enhance the delivery
of services for attracting and retaining family physicians, along with community healthcare delivery
models. The document will also evaluate the structure needed to support marketing, research, direct
recruitment, settlement services, succession planning support, and data management and analysis.
Finally, we will compare incentive packages across similar communities and provide recommendations for
financial resources required for the program.
2. Background
In March 20227, the Ontario Government unveiled an ambitious plan for educational expansion,
earmarking the addition of 160 undergraduate seats and 295 postgraduate positions over the next five
years—a milestone representing the most significant growth in undergraduate and postgraduate medical
education in over a decade. Queen's University's School of Medicine partnered with Lakeridge Health to
create a regional campus in Oshawa, focusing on training comprehensive care family physicians8.
A Joint Steering Committee formed four Working Groups: Admission, Curriculum, Community
Engagement, and Faculty Engagement. The Admission Working Group devised recommendations to
identify distinctive traits for selecting future family physicians, while the Curriculum Working Group
6 New SFU medical school will include dedicated family doctor program: minister, Vancouver Sun, September 20, 2023
7 Ontario Training More Doctors as it Builds a More Resilient Health Care System, Government of Ontario, March 15, 2022
8 Queen’s University and Lakeridge Health Establish Collaboration to Address Physician Shortage, Lakeridge Health, May 2, 2022
8
innovated curricular models tailored to comprehensive care family physician training. In parallel, the
Community Engagement Working Group crafted strategies to actively involve Durham Communities and
provide crucial support to learners during their training years. Lastly, the Faculty Engagement Working
Group established recommendations to engage Durham-based physicians in recruitment as faculty for the
new medical school, complemented by plans for robust local faculty development. This collaborative
endeavor is poised to shape the future of medical education and improve healthcare delivery in the
region.
The inauguration of the Queen's Lakeridge Health Campus prompted the formation of the Durham
Physician Engagement Team, dedicated to supporting learners at this innovative medical campus.
Through the Durham Economic Development Partnership, the Region of Durham, Municipality of
Clarington, City of Oshawa, Town of Whitby, Town of Ajax, City of Pickering, Township of Uxbridge, Brock
Township, and the Town of Scugog, came together to collaboratively provide financial support to ensure
the initial need of the first cohort were met and that resources were available to develop a long-term
solution to this important initiative.
Initially, the team focused on addressing the immediate needs of the incoming 2023 cohort of family
medicine students and residents. However, it is now imperative to develop a comprehensive medium-
and long-term physician recruitment strategy to address physician retirements, population growth, and
the needs of an aging population and other vulnerable groups, ensuring sustainable access to medical
care. This strategy is also essential for the successful development and operation of the new tertiary care
hospital in the Durham Region over the next decade.
The shortage of family physicians is not unique to Durham; competition for recruitment is growing across
the province, with many other communities establishing or enhancing9 dedicated family physician
recruitment programs. Niagara Region10 has had a successful physician recruitment program in place for
over a decade. Durham cannot rely solely on ad hoc efforts to address this Health Human resource
challenge. A coordinated, professional effort involving resources from across Durham Region is required,
with readiness to welcome the nine postgraduate family medicine trainees completing their training in
May 2024 and entering family practice.
2.1 Unique Needs and Challenges in Durham Region
Durham Region encompasses eight diverse municipalities; several unique needs and factors must be
considered to effectively recruit family physicians:
1.Diverse Community Needs: Each municipality in Durham Region has its own unique demographic,
socio-economic, and cultural characteristics. Understanding these varied community needs is
crucial for matching the right physicians with the right areas.
2.Urban vs. Rural Requirements: The region includes both urban and rural areas. Rural areas might
face more significant challenges in attracting physicians due to perceived remoteness and limited
resources. Tailoring recruitment strategies to address these differences is essential.
3.Indigenous Health Needs: In order to meet the specific needs of Indigenous communities within
the region, it's important to recruit and educate physicians who are knowledgeable and sensitive
to specific health needs and cultural contexts.
9 Brantford Council looking to solve physician shortage, Brant Beacon November 17, 2023
10 Niagara Physician Recruitment Program, 2023
9
4.Cultural Competence and Diversity: With a diverse population, it's important to recruit physicians
who are culturally competent and can cater to the health needs of various ethnic, racial, and
cultural groups.
5.Infrastructure and Facility Variations: Different municipalities may have varying levels of
healthcare infrastructure. Recruiters need to be aware of the facilities available in each area,
including hospitals, clinics, and specialized healthcare services.
6.Work-Life Balance Opportunities: Prospective physicians often seek a balance between their
professional and personal lives. Understanding and promoting the lifestyle benefits of each area,
such as recreational activities, educational opportunities, and community involvement, can be
attractive.
7.Professional Development Opportunities: Highlighting opportunities for continuous learning,
professional growth, and career development within the region can be a key factor in attracting
and retaining physicians.
8.Collaborative Environment: Promoting a collaborative and supportive professional work
environment, including relationships with local healthcare networks and community
organizations, can be appealing to potential recruits.
9.Family Considerations: Understanding and addressing the needs of physicians' families, such as
access to quality education and spousal employment opportunities, can be crucial in their decision
to relocate.
10.Support for International Graduates: If recruiting internationally trained physicians, support in
navigating the licensing process in Ontario and adapting to the Canadian healthcare system would
be important.
2.2. Family Physician Recruitment and Retention in Durham Region
2.2.1. Physician Recruitment Initiatives and Medical Trainees in Durham
In the past, some Durham communities, including Clarington, Oshawa, and Whitby, have made formalized
community-focused efforts to attract new family physicians and enjoyed some success in doing so.
Currently, family physicians in Durham Region participate in training family medicine residents and
already have familiarity with our region, patient population, physicians, and other affiliated healthcare
professionals through Queen's University and the University of Toronto.
Additionally, all six of Ontario's medical schools collaborate with the Rural Ontario Medical Program11
(ROMP), and directly with Lakeridge Health, to organize medical trainee placements in underserviced rural
communities, including Clarington, Port Perry, and Uxbridge.
2.3 Medical Training in Durham Region
2.3.1. Undergraduate Medical Trainees (Medical Students)
Undergraduate medical trainees on the path to earning their Doctor of Medicine (MD) degree undergo
placements in hospital and community settings during their pre-clinical (years 1 & 2) and clinical clerkship
or rotation (years 3 & 4) years in Durham Region. These trainees are not compensated during their training
and typically graduate with substantial debt.
11 Rural Ontario Medical Program (ROMP), 2023
10
2.3.2. Postgraduate Medical Trainees (Medical Residents)
Upon graduating with a MD degree, postgraduate medical trainees from all six Ontario universities receive
specialty training in community and hospital settings. The training environment can significantly influence
these trainees' eventual practice locations. Postgraduate trainees typically earn modest incomes during
their residency period.
2.3.2.1. Queen's University School of Medicine
The Queen's University Family Medicine Training Programs in Durham Region, including the Queen's-
Bowmanville-Oshawa-Lakeridge Health (QBOL) Family Medicine Program, have been training family
physicians in Durham since 201212. Initially, the program graduated 8 residents per year, but it now
graduates nine 2nd-year Family Medicine Residents annually. It is expected that this program will continue
to grow.
The newly opened Queen's-Lakeridge Health MD Family Medicine Program13 (QLEP) is a progressive
medical education model specifically designed to address the family physician shortage. This program
aims to graduate practice-ready, community-focused, family physicians capable of providing
comprehensive care in southeastern Ontario. The program has experienced rapid development and is
based at the Queen's satellite medical campus at Lakeridge Health in Durham Region. It is anticipated that
this program will graduate 20 medical trainees each year, with the first batch of 20 trainees having begun
their training in September 2023.
The Queen’s Lakeridge Health MD Family Medicine Program will grow exponentially over the next 6 years,
to a capacity of 120 dedicated Family Medicine trainees in the program by 2028. Extensive collaboration
and research efforts have gone into the development of these programs and partnerships.
Figure 1: Number of Family Medicine Trainees related to Queen’s University’s Undergraduate and Postgraduate programs.
2.3.2.2. Other Family Medicine Trainees
The University of Toronto’s School of Medicine also trains some family medicine residents in Durham,
primarily in Uxbridge and Port Perry. Additionally, there are Family Medicine trainees from other
12 Residency program sought to allay family doctor shortage, The Sarnia Observer, December 31, 2018
13 Family doctor shortage: Medical education reform can help address critical gaps, starting with a specialized program, The Conversation,
October 2, 2023
38
58
89
120 120 120 120
9 9 9 9 20 20 20
0
20
40
60
80
100
120
140
2023 2024 2025 2026 2027 2028 2029
Queen's Satellite Campus Growth Practice Ready Family Medicine Graduates
11
universities who participate in 8-week placements through Ontario's ROMP program. These trainees
represent potential new family physicians for the Durham community.
It is important to note that there is a significant number of Canadian family medicine trainees studying
medicine abroad, many of whom hope to return to Ontario to practice. In 2011, almost 3,600 Canadians
were studying medicine at schools in the United Kingdom, Australia, Poland, the Caribbean and elsewhere,
in addition to the approximate 10,500 medical learners in Canada14. Ontario’s physician regulator, the
College of Physicians and Surgeons of Ontario (CPSO), recently made it easier for doctors who were
trained in the U.S., Ireland, Australia, and Britain to get licensed in Ontario as jurisdictions around the
country compete to remove licensing barriers to address chronic shortages in health care15. This presents
an opportunity that should not be overlooked.
3. Where We Are Today
In summary, we are in a transitional phase with several medical training programs in place and significant
growth expected in the coming years in our region. Immediate needs include supporting the current
cohort of medical trainees and developing a comprehensive physician recruitment and retention program
for Durham. The existing medical training programs and partnerships provide a unique opportunity to
create a synergistic approach to recruitment, training, and retention of family physicians in Durham
Region. Helping our medical trainees feel at home here in Durham is critical to our ability to recruit and
retain these physicians for the long term.
4. Future Needs Assessment
A key component of developing an effective recruitment strategy is determining how many family
physicians are needed to meet the current and future healthcare needs of Durham Region. Estimating the
number of family physicians required involves considering various factors, including population growth,
the aging demographic, and the number of physicians retiring from practice.
Table 1 Health Force Ontario Data 2023
Census Sub
Division (CSD)
Name
POPULATION
(Health Card
Holders)
Number of patients
not rostered
% of patients
without a
family physician
Shortage of
Family
Physicians
Roster Ratio
Ajax 139,742 37,126 26.6% 27 1380 pts/Dr
Brock 9,852 3,499 35.5% 3 1380 pts/Dr
Clarington 103,709 21,829 21.0% 16 1380 pts/Dr
Oshawa 184,960 47,452 25.7% 34 1380 pts/Dr
Pickering 103,334 26,025 25.2% 19 1380 pts/Dr
Scugog 26,593 4,155 15.6% 3 1380 pts/Dr
Whitby 142,426 34,257 24.1% 25 1380 pts/Dr
Uxbridge 22,660 3,740 16.5% 18 793 pts/Dr
Durham Region 733,276 178,083 24.3% 144.34 -
Population = # Health Card Holders.
Rostered = Health Card Holders Rostered to a Physician Engagement Model (PEM) Family Physician somewhere in Ontario
Not Rostered = Population – Rostered
The average roster size of the PEM physicians is 793 patients/physician although provincial standards are about 1380
patients/physician.
14 Too many Canadians studying medicine overseas, CBC News, February 22, 2011
15 CPSO Removes Barriers for Internationally Educated Physicians, College of Physicians and Surgeons of Ontario, April 4, 2023
12
4.1. Population Growth
One of the significant drivers of the need for more family physicians in Durham Region is population
growth. Durham Region has been experiencing steady population growth over the past several years,
driven by a combination of natural population growth (births minus deaths) and net migration (people
moving into the region). According to 2022 census data, the population of Durham Region is estimated to
be approximately 751,50016 residents. This population is projected to continue growing in the coming
years, driven by factors such as new residential developments, economic opportunities, and the overall
attractiveness of the region.
4.2. Aging Population
Another critical factor to consider is the aging demographic within Durham Region17. As the population
ages, there is an increased demand for healthcare services, including primary care provided by family
physicians. The proportion of adults aged 65 and older within Durham ranges from 13.1% to 24.1%. Older
adults often have more complex healthcare needs and require ongoing management of chronic
conditions. Additionally, the retirement of older family physicians can further exacerbate the shortage of
primary care providers, as younger physicians may need to take on a larger patient load.
4.3. Physician Retirement
The impending retirement of a significant number of family physicians in Durham Region is a pressing
concern. About 100 of Durham's family doctors are aged 60 and above, nearing retirement, and their
departure from clinical practice will create a larger gap in primary care services. If we do not plan for the
replacement of these retiring physicians to ensure uninterrupted access to healthcare for patients, the
number of patients without a family doctor will rise by nearly 14,000.
4.4 Jurisdictional Competition
The Region of Durham, amidst a province-wide competition for family physicians, must address shortages
affecting its two-tier municipality structure spanning eight communities. The competition is intensified by
well-established recruitment programs in many other Ontario communities.
An assessment of 12 communities revealed varying incentive packages to attract new physicians, with
perks ranging from housing benefits to relocation expenses. On average, these incentives equate to about
$19,875 annually in exchange for an average 5-year commitment by the physician (Appendix 2).
Furthermore, several communities have dedicated recruitment initiatives with varying budgets, staff
structures, and organizational frameworks.
Strategies Employed by Various Municipalities for Physician Recruitment:
1.Recruitment Staff:
●Woodstock, Hamilton, Niagara Region, Haliburton, Peterborough, City Kawartha
Lakes: Employ a full-time physician recruiter.
●Saugeen, Kincardine (Bruce Power): Employs a 0.6 FTE Physician Recruitment
Manager.
2.Program Budget & Structure:
16 Durham Monitoring of Growth Trends, File: D01-02-01 December 2, 2022
17 2021 Census of Population – Regional Municipality of Durham Information Report, September 16, 2022
13
●Prince Edward: $150,000 budget, integrated in Family Health Team, supported by the
county.
●Hamilton: $180,000 budget, a collaboration involving the city, Hamilton Academy,
and Chamber of Commerce, employs a full-time physician recruiter.
●Windsor: $25,000 contribution to a medical program aiming to retain graduating
doctors.
●Saugeen, Kincardine (Bruce Power): $105,000 budget, employs a 0.6 FTE Physician
Recruitment Manager.
●Peterborough: $36,200 budget, operates a not-for-profit family health team, employs
a full-time staff.
●City Kawartha Lakes: Operates through a separate charity organization, employs a
full-time physician recruiter.
3.Financial Incentives:
●Quinte West: $100,000 over 5 years, includes 100% rent coverage and a boat slip.
●Hastings: $150,000 over 4 years, includes $75,000 for relocation expenses.
●Kingston, Belleville, North Grenville, Prince Edward: $100,000 - $150,000 over 5-6
years.
●St. Thomas: $33,000 over 4 years, includes moving expenses.
●Niagara Falls: $50,000 over 5 years, includes $5,000 for moving expenses.
●Haliburton: $150,000 over 6 years.
●Wasaga Beach: $65,000 over 5 years.
●Woodstock, Southern Georgian Bay: Offers moving expenses of $4,000 - $5,000.
4.Collaborative Efforts:
●Prince Edward: Program integrated within the Family Health Team and supported by
the county.
●Hamilton: A collaborative effort of the city, Hamilton Academy, and the Chamber of
Commerce.
●City Kawartha Lakes: Recruitment managed by a separate charity organization.
●Saugeen, Kincardine (Bruce Power): Recruitment managed possibly by the
Municipality of Kincardine.
It is worth noting that these collaborative efforts precede the advent of Ontario Health Teams.
5.Tailored Approaches:
●Strategies tailored to the unique needs and resources of each community, with a mix
of financial incentives, collaborative structures, and dedicated staffing to optimize
physician recruitment and retention efforts.
Each municipality is employing a mix of dedicated staff to optimize their physician recruitment and
retention efforts, financial incentives, and structural collaborations, tailored to their unique
community needs and resources.
The first step in successful recruitment programs is the establishment of dedicated staff and resources to
develop, manage and implement competitive programming.
14
The importance of place for this work has been evaluated based on Readiness, Finance, Administration,
Management, and Connection to Medical Learners and existing physicians.
The value of connection to Medical Learners cannot be overlooked. Strong engagement and support in
navigating the community and healthcare systems will strongly influence decisions on where they will
settle upon graduation. This said, medical learners are not the only audience. We also need to keep focus
on repatriating Canadians training abroad and interest within the communities through medical clinics
and hospital work.
The Canadian Association of Physician Recruiters18 is a national membership organization for physician
recruitment professionals. With membership spanning across the country, this resource provides a broad
view for structure. Most recruiters are stationed within hospitals or medical organizations. With the
development of Ontario Health Teams, there is a growing trend to place recruitment efforts within these
organizations as well.
For Durham to effectively attract and retain family physicians, it's imperative to collaboratively craft a
competitive strategy leveraging recent unique opportunities in the region. This strategy tailored for
Durham should integrate industry best practices and distinctly define roles for both the Region and lower-
tiered municipalities.
4.5. Estimating the Additional Number of Family Physicians Required
To estimate the additional number of family physicians required in Durham Region, a detailed analysis of
the current physician workforce, population demographics, and projected retirements is necessary. This
analysis should consider factors such as the average patient load per physician, the distribution of
physicians across different communities within Durham Region, and the expected growth in the number
of residents.
Team-based collaborative care models involve interdisciplinary healthcare providers working together to
deliver comprehensive and personalized patient care. In this approach, a diverse group of healthcare
professionals, including doctors, nurses, nurse practitioners, pharmacists, social workers, and specialists,
collaborate and share their expertise to address the unique needs of each patient. They communicate
regularly and make collective decisions to ensure that care is coordinated, evidence-based, and patient-
centered. This model fosters a culture of respect and shared responsibility among team members, which
enhances the quality of care, improves health outcomes, and increases patient satisfaction. Through the
integration of varied skills and knowledge, the team ensures that the patient’s physical, mental, and social
needs are met in a holistic manner. Team-based collaborative care models that involve multiple
healthcare providers can help address the demand for primary care services more efficiently.
5. Physician Recruitment Strategies
Recruiting family physicians to practice in Durham Region requires a multifaceted approach that leverages
various strategies and resources. Taking a dyad approach to this work will prove most effective pairing
leadership from the Department of Family Medicine and the community of Durham. Successful
recruitment efforts should be proactive, targeted, and tailored to the specific needs and preferences of
physicians. Below are key physician recruitment strategies employed in other communities across Canada
that can be successfully implemented in Durham Region:
18 Canadian Association of Physician Recruiters, caspr.ca 2023
15
5.1. Marketing and Promotion
5.1.1. Develop a Strong Brand and Identity: Create a compelling and unique brand for Durham Region's
physician recruitment program. This brand should highlight the region's attractions, quality of life, and the
supportive academic and medical community. Note that Invest Durham, Durham Region’s Economic
Development Department and Tourism Department, has been building strong brand identities to promote
the region’s quality of place and creativity for the attraction of tourists and a talented workforce. This
work could be leveraged.
5.1.2. Online Presence: Establish a comprehensive online presence, including a dedicated website that
provides information about practicing in Durham Region. The website should feature testimonials from
current physicians, opportunities at the academic institutions (Ontario Tech, Durham College, Queen’s
University, Trent University) and other healthcare training programs, details about local healthcare
facilities, and resources for newcomers.
5.1.3. Social Media: Utilize social media platforms to showcase the region, share success stories of
recruited physicians, and engage with potential candidates.
5.1.4. Targeted Marketing: Identify key recruitment markets and tailor marketing efforts to reach medical
trainees, recent graduates, and practicing physicians in those markets. Consider attending medical
conferences and events to connect with potential candidates in Ontario, Canada, and the UK to ensure
community recognition through awareness generation activities.
5.2. Incentives and Support
5.2.1 Competitive Compensation: In Canada, community-specific attraction incentives19 are widely used,
each presenting unique risks and opportunities20. It's essential for these incentives to be strategically
considered at a regional level, particularly in the Region of Durham. This approach aims to create
uniformity in primary care access across Durham, minimizing internal competition. Key incentives to
deliberate include salary enhancements, signing bonuses, office setup reimbursements, and student loan
repayment schemes.
5.2.2. Relocation Assistance: Provide relocation assistance to help physicians and their families transition
to Durham Region seamlessly. This may include support with housing, childcare, spousal employment
support and other logistical aspects of moving. It will be important to develop strong relationships and
leverage expertise with local resources in real estate, workforce, social supports, and immigration. Note
that the Durham Local Immigration Partnership has developed strong, fundamental resources and
community connections, in this regard, which could be leveraged.
5.2.3. Mentorship and Support Programs: Establish mentorship programs that pair new physicians with
experienced practitioners in the region. This can help newcomers navigate the local healthcare system
and integrate into the community.
19 HealthForceOntario Northern and Rural Recruitment and Retention Initiative Guidelines, Ministry of Health and Long-Term Care, 2023
20 City of Welland offers $1 million in physician recruitment incentives to triage doctor shortage, myniagaraonline.com, June 28, 2023
16
5.2.4. Continuing Medical Education: Highlight opportunities for professional development and
continuing medical education in Durham Region. Support physicians in pursuing additional certifications
or specializations. Durham's esteemed academic institutions, including the ground-breaking Queen's
Lakeridge Health Campus, specializing in Family Medicine, represent invaluable educational assets in our
region.
5.3. Community Engagement
5.3.1. Physician-Led Recruitment: The involvement of local physicians in the recruitment process cannot
be underestimated. When prospective physicians explore potential practice locations, it is important to
provide insight into the lived experience of practice in community. Current practitioners can serve as
ambassadors for the region and help foster connections and build meaningful relationships with potential
recruits.
5.3.2. Community Integration: Promote the benefits of living and working in Durham Region. Proactively
assist and provide settlement assistance including amenities, recreational opportunities, schools, post-
secondary institutions, and cultural attractions that make the area an attractive place to settle down.
Durham Tourism, the Chambers and Boards, and the local area municipalities’ tourism groups will be
valuable partners for this critical activity.
5.3.3. Partner with Educational Institutions: Strengthen partnerships with local medical schools,
including Queen's University and the University of Toronto, to facilitate the transition of medical trainees
into practicing physicians within Durham Region.
5.4. Data-Driven Approach
5.4.1. Data Collection: Establish a robust data collection and analysis system to track physician
recruitment efforts, including the number of recruited physicians, retention rates, and demographic
information.
5.4.2. Feedback Mechanism: Implement a feedback mechanism that allows recruited physicians to
provide input on their experiences in Durham Region. Use this feedback to make continuous
improvements to the recruitment program.
5.4.3. Market Research: Continuously conduct market research to identify trends in physician preferences
and recruitment challenges. Stay updated on changes in the healthcare landscape.
6. Governance Framework
A well-defined governance framework is essential for the effective operation of the physician recruitment
program in Durham Region. This framework should address ethical and administrative aspects of physician
recruitment and retention. Key components of the framework include:
6.1. Regulatory Compliance
17
6.1.1. Incentives Contracts: Ensure that incentive contracts for recruited physicians comply with all
relevant laws and regulations, including those related to compensation, working conditions, and
professional standards, as well as the Ontario Municipal Act, 2001.
6.1.2. Immigration and Work Authorization: Address immigration and work authorization requirements
for physicians recruited from outside Canada, including necessary permits or licensing requirements.
6.2. Ethical Standards
6.2.1. Fair Recruitment Practices: Establish guidelines for fair and equitable, inclusive, and ethical
recruitment practices, including focusing on various community (including equity-deserving and
marginalized communities) needs, transparency in the recruitment process, avoidance of conflicts of
interest, and adherence to professional codes of conduct.
The integration of equity, diversity, inclusion, indigeneity, and accessibility in Durham Region's physician
recruitment program is vital for fostering a healthcare system that truly reflects and serves its diverse
community. Emphasizing these values ensures that the recruitment process not only attracts a wide range
of talent but also resonates with the varied cultural and individual needs of the population. The
development of this program will leverage the resources of Durham Region’s Diversity, Equity, and
Inclusion Division.
By prioritizing indigeneity, the program acknowledges and respects the unique health needs and
perspectives of Indigenous communities, contributing to more culturally sensitive healthcare. Accessibility
is crucial in removing barriers and creating an inclusive environment for both practitioners and patients
with disabilities.
Overall, embracing these principles in physician recruitment leads to a more inclusive, competent, and
effective healthcare workforce that can better address the multifaceted health concerns of the Durham
region, ultimately leading to improved patient care and community well-being.
6.2.2. Patient Care Standards: Maintain high standards of patient care and ethical conduct among
recruited physicians, emphasizing patient safety and quality of care.
6.3. Administrative Structure
6.3.1 Program Oversight: Create an administrative body or Taskforce responsible for overseeing the
physician recruitment program. This body should include representatives from healthcare organizations,
local government, and community stakeholders. It is recommended that a Taskforce be established
consisting of 10 members: 3 Regional Councillors nominated by the Regional Council and representing
north Durham (Brock, Uxbridge, Scugog), west Durham (Pickering, Ajax, Whitby) and east Durham
(Oshawa, Clarington) alongside 7 professionals and experts from the health sciences and community
sectors to be chosen by staff based on skill set, system and community knowledge.
Complimentary work is currently underway with common goals on building and sustaining a robust
Primary Care/Family Medical community in the Region of Durham. The new Department of Community
and Family Medicine at Lakeridge Health is building bridges for our Healthcare system, residents, and
Family Physicians to collaborate and work together for strengthened community healthcare.
18
Ontario Health has recently prioritized primary care in its healthcare delivery planning. The Durham
Ontario Health Team has been approved for the one of the 12 accelerated programs21 development and
is composed of representation across the regional municipalities, healthcare agencies and the Primary
care community in Durham Region. While the Durham Ontario Health Team is in its initial stages, an
independent body should oversee the program on behalf of the Durham Region municipalities for the
next few years.
The Durham Physician Engagement Team (DPET) has been established and focused on integrating the
inaugural cohort of 20 students from the Queens Lakeridge Health MD Family Medicine Program into the
community, fostering strong local connections. Moreover, the DPET team is also developing both short-
term and long-term strategies aimed at enhancing physician recruitment in the Region of Durham. This
initiative includes, but is not limited to, leveraging the Queens Lakeridge Health MD Family Medicine
(QLEP) and Queen’s Bowmanville Oshawa Lakeridge (QBOL) Family Medicine residency programs to build
a robust physician recruitment framework. The DPET consists of a strategic mix of community, academia
and healthcare including:
•Queens MD Campus in Oshawa: Arun Bala
•Lakeridge Health Academic Affairs: Heidi McHattie
•Chief of Family Medicine: Dr. Joel Kennedy
•Community Family Physician: Dr. Tony Stone
•Community Representative: Sheila Hall
•Ontario Health Representative: Jill Cappa
•Durham Region Liasson: Simon Gill
These collaborative efforts of the Durham Physician Engagement Team are likely to significantly enhance
the recruitment of new family doctors in Durham. However, at present, there isn't a definitive immediate
placement for these recruits. The DPET team developed, and currently maintains, robust connections with
key stakeholders, including the Durham OHT, the Department of Community and Family Medicine at
Lakeridge Health, the Queens Lakeridge Health Medical Campus, and a committed and passionate group
of existing family physician leaders in Durham. These relationships are instrumental in supporting and
advancing our recruitment objectives.
The Durham Ontario Health Team (OHT)22 is a collaborative group of organizations and patient, family and
care partner advisors working in partnership to improve access and delivery of coordinated health
services. The group is comprised of partners from across the care continuum, including primary care
providers, hospitals, mental health and addiction services, social support services, home and community
care support services, and long-term care.
To enhance the effectiveness of physician recruitment in Durham, the initial focus will be on strengthening
the connection between the community and physicians. This will be further supported as a professional
physician recruiter is hired and recruitment efforts intensify. It's crucial that the community recruiter and
a physician-lead representative from the community collaborate closely in this process.
21 Minister's Update: Accelerating Ontario Health Teams (OHTs), RISE September 27, 2023
22 Durham Ontario Health Team doht.ca 2023
19
For optimal structuring of these efforts, a phased approach is advised. Presently, the Clarington Board of
Trade has the resources to oversee the Physician Engagement Team until July 2024. The eventual goal is
to integrate this initiative within the Durham Ontario Health Team in collaboration with Durham Primary
Care Network structure. However, an immediate transition could present challenges as Durham OHT is
yet to be incorporated and define its relationship with Primary Care Network Durham23 (PCND) through a
governance structure. Maintaining the current momentum and preserving the knowledge and
background of ongoing work is essential, necessitating a phased collaborative and strategic approach.
Stage 1: The Clarington Board of Trade will continue as the administrative body until the end of 2024 or
until the Durham Ontario Health Team completes steps to establish Primary Care Network Durham.
During this time, work will be structured to ensure proximity to all medical learners with a focus on
developing primary care partnerships and long-term strategies for collaborating with the community and
physicians and enhancing family physician recruitment efforts.
Stage 2: The administration and oversight of Family Physician Recruitment efforts will transition to the
Durham Ontario Health Team in collaboration with Primary Care Network Durham. This phase will ensure
continued independent oversight and involve stakeholders from Family Medicine and the Durham
community. The Durham OHT maintains strong relationships within community agencies, physician
networks, healthcare institutions and government leadership in healthcare. This structure will allow for
a balanced and independent approach to recruitment and retention for the Region of Durham community.
6.3.2. Accountability: Accountability for roles, financial management, and reporting will be with the
administrative body in collaboration with the Durham Physician Engagement Team.
6.3.3. Evaluation and Reporting: Establish mechanisms for program evaluation and reporting to track
progress, assess outcomes, and make data-driven decisions.
6.4. Resource Allocation
6.4.1. Budgeting: Implementing a Regional Physician Recruitment program will require both financial and
in-kind resources. There will be a role for both regional and lower tier governments in Durham. With a
23 Primary Care Network Durham primarycarenetworkdurham.ca 2023
20
budget of $225,000.00 per year funded by Durham Region, this program can be delivered with budget
allocations as follows:
Salaries $120,000.00
Operational expenses $ 5,000.00
Marketing $ 15,000.00
Settlement/Local Activities $ 40,000.00
Travel and Events $ 20,000.00
Professional Stipend (Physician) $ 25,000.00
$225,000.00
In-kind contributions will be realized through location costs, general supplies and access to related
programs and efforts across the Region.
It has been noted that recruitment of Family Physicians is extremely competitive and that most
communities are offering significant signing incentives in return for a 5-year commitment to family
practice. In our research, we recognized that many two-tier communities are offering incentives in very
different ways, however we want to highlight the Niagara model. The regional programming for attraction
and retention is supported at the regional level and, each municipality in the region is responsible for any
attraction incentives.
Although there are no clear guidelines, there seems to be a standard practice to not out-bid or poach from
each other. Durham Municipalities should be respectful and clear on this topic and share common
parameters around incentives being offered. A crucial step is crafting a strategy that fosters mutual
support, rather than competition, between these communities. If area municipal incentives are
contemplated, it is recommended that there be a resolution of Regional Council stipulating the acceptable
parameters for these incentives, to prevent inter-municipal competition.
6.4.2. Funding Sources:
Considering the critical need for family physician recruitment and retention in Durham Region, it is
essential to emphasize the vital role of local governments’ investment in this initiative. The delivery of key
objectives outlined in Durham Region's Strategic Plan, particularly those concerning community health
and wellness, hinges on the access to healthcare in the region. Therefore, the investment by local
government is not just a matter of resource allocation; it is imperative to ensure that residents have access
to essential primary healthcare services. This is increasingly important as the region faces a significant
shortage of family physicians, impacting the health and economic stability of the community.
Furthermore, it is recommended that the funding for this crucial initiative be a shared responsibility
between the Regional and area municipal governments. Such a collaborative financial approach
underscores the collective commitment to enhancing community health and well-being. By pooling
resources and efforts, both tiers of government can effectively address the challenges of physician
shortages and ensure the availability of comprehensive healthcare services across Durham Region. This
joint funding strategy also reflects a unified response to a common challenge, demonstrating a strong
partnership in prioritizing the health needs of our community.
21
7. Monitoring and Evaluation
Continuous monitoring and evaluation are essential components of a successful physician recruitment
program. Regularly assess the effectiveness of the program's strategies and initiatives, and make
necessary adjustments based on data and feedback. Monitoring of Key Performance Indicators (KPIs) as
outlined below, serve as the foundational metrics through which the effectiveness and impact of the
project or initiative are gauged. Beyond these performance metrics, an insightful evaluation also considers
the projected needs related to space and staffing. By anticipating these future requirements, this family
physician recruitment program can better align its resources and planning to ensure the sustained success
of goals and objectives.
7.1. Key Performance Indicators (KPIs)
Establish KPIs to measure the success of physician recruitment efforts. Examples of relevant KPIs include:
1.Number of recruited family physicians
2.Retention of family medicine learners in Durham
3.Retention rates of recruited family physicians
4.Physician satisfaction with the recruitment process
5.Patient attachment to and satisfaction with primary care services.
7.2. Data Collection and Analysis
Implement data collection mechanisms to gather information on physician recruitment, retention, and
patient outcomes. Use this data to identify trends, strengths, weaknesses, and areas for improvement.
7.3. Stakeholder Feedback
Seek feedback from various stakeholders, including recruited physicians, patients, healthcare
organizations, and the community. Use this feedback to make informed decisions and enhance the
recruitment program.
7.4. Regular Reporting
Provide regular reports on the status and impact of physician recruitment efforts to relevant stakeholders,
including local government authorities, healthcare organizations, and funding partners.
7.5. Continuous Improvement
Based on the findings from monitoring and evaluation, continually refine recruitment strategies,
incentives, and support programs to optimize outcomes.
8. Conclusion
Developing an effective physician recruitment and retention strategy for Durham Region involves a
comprehensive and collaborative approach that addresses the unique needs and challenges of the region.
By conducting a thorough needs assessment, implementing targeted recruitment strategies, establishing
a robust regulatory framework, and continuously monitoring and evaluating the program's effectiveness,
Durham Region can attract and retain the family physicians needed to provide high-quality primary care
services to its growing and diverse population. Additionally, forging partnerships with medical schools and
other stakeholders will be instrumental in ensuring the long-term success of the recruitment program.
22
Appendix 1. Durham Physician Engagement Team Activity Report
Introduction
In July 2023, the Region of Durham, in collaboration with the Clarington Board of Trade (acting as the
oversight organization), initiated a pivotal agreement to advance physician recruitment and bolster
support for Medical Trainees in Durham. The result of this collaboration was the successful establishment
of the New Queens Lakeridge Medical Campus, which opened its doors on August 28, 2023, ready to
welcome its inaugural cohort of 20 students. This pioneering group has provided valuable insights,
fortifying our preparedness for the 2024 cohort.
Support and Engagement
•To ensure a comprehensive understanding of our trainees' needs, we conducted surveys to
emphasize the significance of their role within the Durham community.
•The Durham Physician Engagement Team orchestrated a dynamic and welcoming Orientation
week, fostering connections among students and their future mentors in residency training.
•Our support initiative has been aptly branded as the "Durham Physician Engagement Team," and
we maintain an unwavering commitment to consistent outreach to cater to trainees' evolving
needs.
Information Hub
•Recognizing the importance of accessible information, we are diligently developing a centralized
website to serve as a one-stop resource hub. This platform will provide doctors and trainees with
comprehensive insights into the educational and community opportunities available within
Durham.
Community Engagement
•Our efforts extend beyond the confines of the medical campus, as we have actively engaged with
various local communities to share the mission of this initiative, underscore the benefits for the
community, and garner local insights that will shape our future endeavors.
Short-Term Objectives (End of 2024)
1.Manage and provide support to the Medical Trainees in the 2023 QLEP and QBOL programs.
2.Create and secure funding for a family physician recruitment and retention program tailored to
Durham region communities.
3.Establish resources and partnerships to facilitate the attraction and settlement of Family
Physicians.
4.Strengthen partnerships with organizations such as ROMP and explore additional avenues for
attracting medical talent.
5.Identify the optimal structure for housing Physician Recruitment initiatives.
6.Develop and allocate resources for support and incentives aimed at attracting and retaining
physicians.
7.Define the roles and responsibilities of Regional and Local governments in the physician
recruitment process.
8.Develop impactful marketing collateral to promote Durham as a preferred destination.
9.Maintain a comprehensive family physician database specific to the Durham region.
23
Long-Term Goals
1.Sustain and enhance our collaboration with the Queen’s University Medical Education Programs,
such as QLEP and QBOL programs.
2.Expand outreach efforts to internationally trained family physicians.
3.Initiate outreach to repatriate Canadian Family Physicians.
4.Cultivate strategic partnerships to fortify our recruitment and support efforts.
5.Advocate for healthcare workforce needs, particularly within the realm of Health Human
Resources.
This strategic healthcare plan is emblematic of our unwavering commitment to fostering a robust
healthcare ecosystem within Durham and ensuring it remains a welcoming and prosperous destination
for medical professionals and trainees alike.
24
Appendix 2: Governance Framework and Timeline for 2024-2025 Work Plan
The physician recruitment program in Durham is governed through a multi-tiered structure. This
Taskforce will consist of 10 members: 3 Regional Councillors nominated by the Regional Council and
representing north Durham (Brock, Uxbridge, Scugog), west Durham (Pickering, Ajax, Whitby) and east
Durham (Oshawa, Clarington) alongside 7 professionals and experts from the health sciences and
community sectors to be chosen by staff based on skill set, health system and community knowledge and
will provide overarching oversight. In the interim, the Durham Physician Engagement Team (DPET), known
for effectively integrating medical students into the community and shaping physician recruitment
strategies, will lead the program. This arrangement will continue until the Durham Ontario Health Team's
(OHT) Primary Care Networks are operational. The immediate goal is to enhance the ties between the
community and physicians, under the guidance of a professional recruiter and a physician leader.
Currently, the Clarington Board of Trade oversees the Durham Physician Engagement Team (DPET) and
will continue to do so until 2025. Post-2025, management responsibility will shift to the Durham Primary
Care Network, operating under the Durham Ontario Health Team. This stepwise transition is designed to
maintain momentum and consistency and foster active stakeholder participation, aligning with Durham's
wider objectives of enhancing primary care and promoting collaborative.
2024-2025 Workplan
Year Quarter Primary Tasks Subtasks
2024 Q1 Council Approval for Physician
Recruitment Initiatives
Finalize the governance structure
2024 Q2 Launch Durham Physician
Recruitment Initiative
Website Launch and Online Presence
Establishment
Physician lead and physician Recruiter,
Job posting, candidate screening, and
interviews, Orientation, onboarding.
Brand development and marketing
strategy
25
Year Quarter Primary Tasks Subtasks
Website Content development and
technical setup
2024 Q3 Governance and Administrative
Structure
Establish Administrative Infrastructure
and Information System
Data Collection and Data Coordination
Community practice outreach
2024 Q4 Physician recruitment Targeted Marketing
Social media Campaign
Development of Educational
Opportunities
2025 Q1 Governance and Administrative
Structure Review
Implement a monitoring system
Alignment with Durham Ontario
Health Team (OHT)’s Primary Care
Initiatives
Regular reporting, stakeholder
feedback, and continuous
improvement initiatives
2025 Q2 National and international campaign Initiate national and international
campaign to attract prospective
candidates
2025 Q3 Transition Planning to Durham OHT Development of transition roadmap
and resource allocation Coordinated
Physician Recruitment Strategy
2025 Q4 Finalize the transfer of responsibilities
to Durham Primary Care Networks
Implement a monitoring system to
assess the transition effectiveness
Ensure operational readiness, staff
training, and system integration.
Regular reporting, stakeholder
feedback, and continuous
improvement initiatives
26
Appendix 3. Understanding Regional Needs and Competition
The challenge of attracting family physicians isn't solely a concern for Durham and its affiliated
communities. Given its structure as a two-tier municipality, Durham Region must address distinct
challenges across all eight of its communities. A crucial step is crafting a strategy that fosters mutual
support, rather than competition, between these communities.
Ontario is a very competitive ground, with numerous communities already having implemented well-
established physician recruitment programs. Yet, recent unique opportunities such as Queen’s Lakeridge
Health Campus present Durham with an advantageous position. Collaborating with community partners
now offers a golden opportunity to build an effective recruitment program that stands out and achieves
optimal results in attracting and retaining family physicians.
To inform our approach, we've surveyed 12 Ontario communities to understand the incentive packages
they extend to new physicians.
County/Municipality Tier Incentive
Commitm
ent Term
(Years)
Per Year
Equiv. Housing Other
Quinte West Single $100,000 5 $20,000
Rent
(100%) Boat Slip
Hastings Upper $150,000 4 $37,500
$75,000
Relocation
Expenses
Kingston Single $100,000 5 $20,000
Belleville Single $150,000 6 $25,000
North Grenville Lower $100,000 5 $20,000
Prince Edward Single $100,000 5 $20,000
Woodstock Lower
$5,000 moving
expenses
St. Thomas Lower $33,000 4 $8,250 moving expenses
Niagara Falls Lower $50,000 5 $10,000
$5,000 moving
expenses
Haliburton Upper $150,000 6 $25,000
Wasaga Beach Lower $65,000 5 $13,000
Southern Georgian Bay Lower
$4,000 moving
expenses
Average $19,875
27
In addition, we have started to gather insights for where dedicated and formal programs are
established.
County/
Municipality Tier
Program
Budget Staff Structure
Prince Edward Single $150,000
Integrated in Family Health
Team, supported by County
Woodstock 1 FTE (Physician Recruiter) Further research needed
Hamilton Single $180,000 1 FTE (Physician Recruiter)
Recently moved from City of
Hamilton to local OHT,
Niagara Region Upper 1 FTE (Physician Recruiter) Niagara Region Public Health
Haliburton Upper 1 FTE (Physician Recruiter) Further research needed
Windsor $25,000
Contribution to medical
program with aim to keep
doctors after grad Further research needed
Saugeen, Kincardine
(Bruce Power) Lower $105,000
0.6 FTE (Physician
Recruitment Manager) Municipality of Kincardine
Blue Mountain,
Collingwood, et al Lower Further research needed
Peterborough Single $36,200 1 FTE Not for profit family health team
City Kawartha Lakes Single 1 FTE (Physician Recruiter) Separate Charity organization
28
Appendix 4. Primary Care, Primary Health Care and Comprehensive Care
Definitions
Primary Care
Primary Care is the cornerstone of healthcare in Canada, with family medicine as its principal medical
specialty. Family physicians (referring to both family physicians and general practitioners) offer
comprehensive healthcare services that span across all age groups, genders, and medical conditions.
Public opinion consistently underscores the invaluable role family doctors play in patient care.
While family medicine may appear to be a broad field, it is, in reality, a meticulously honed discipline that
integrates a unique blend of biomedical, behavioral, and social sciences. Family physicians employ a
diverse range of cognitive and procedural skills to provide a system of front-line healthcare that is
accessible, high-quality, comprehensive, and continuous. They individually assume responsibility for
overseeing proactive medical care, ensuring patient follow-up, facilitating care transitions, and making
referrals when necessary. More than just a set of tasks, the essence of their work lies in establishing
relational continuity and upholding a commitment to a broad scope of practice. Through these efforts,
family physicians meaningfully address the complexities of healthcare, ultimately contributing to the
overall health improvement of the population.
Primary Health Care
The fundamental premise of primary health care (PHC) is that every individual, regardless of location or
circumstance, has the right to attain the highest possible level of health. PHC represents a holistic societal
approach aimed at effectively organizing and strengthening national health systems, bringing health and
well-being services closer to communities. It comprises three core components:
1.Integrated Health Services: PHC ensures the provision of integrated health services that meets
people's health needs throughout their entire life journey.
2.Addressing Determinants of Health: It involves addressing the broader determinants of health
through cross-sectoral policies and actions, acknowledging that health is influenced by various
factors beyond healthcare.
3.Empowerment: PHC empowers individuals, families, and communities to actively manage their
own health, fostering a sense of control and responsibility.
PHC empowers health systems to cater to a person's comprehensive health requirements, spanning from
health promotion and disease prevention, to treatment, rehabilitation, palliative care, and more. This
approach also ensures that healthcare is person-centered, respecting individual preferences.
PHC is widely recognized as the most inclusive, equitable, and cost-effective means to achieve universal
health coverage. It plays a pivotal role in strengthening health systems, making them more resilient in the
face of shocks and crises.
Every day, thousands of Canadians receive primary health care (PHC) services, primarily from nurse
practitioners, general practitioners, or family physicians. Additionally, nurses, dietitians, physiotherapists,
and social workers may contribute to PHC. These services encompass routine care, addressing minor or
common health concerns, mental health support, maternal and child healthcare, psychosocial services,
29
coordination with home care, health promotion, disease prevention, nutrition counseling, and end-of-life
care. Moreover, PHC is a vital resource for preventing and managing chronic diseases. Many of these
services can now be provided virtually through email, telephone, messaging, and other technologies,
expanding accessibility and convenience for patients. Explore comprehensive information on primary
care, including indicators, data tables, reports, and other essential resources.
Description of Comprehensive Care / Services24
Health Assessments
1.When necessary, take a full history, including presenting complaint if any, past illnesses, social
history, family history, review of systems and perform a complete physical examination.
2.Periodically take a specific history and perform a physical examination as required to screen
patients for disease.
3.Regularly take a specific history and perform physical examination as required to respond to
patient complaints and/or to manage chronic problems.
Diagnosis and Treatment
Assess and plan for patients’ care based on the outcome of a history and physical examination aided by
investigations and consultations as determined to be appropriate according to the results of complete,
periodic, or regular health assessments. Care for and monitor episodic and chronic illness or injury. In the
case of acute illness or injury, offer early access to assessment, diagnostic, primary medical treatment and
advice on self-care and prevention.
Primary Reproductive Care
Provide primary reproductive care, including counselling patients on birth control and family planning,
and educating about, screening for, and treating sexually transmitted diseases.
Primary Mental Health Care
Offer treatment of emotional and psychiatric problems, to the extent that the physicians are comfortably
able to provide such treatment. Where appropriate, refer patients to and collaborate with psychiatrists
and appropriate mental health care providers.
Primary Palliative Care
Provide palliative care or offer to provide support to the team responsible for providing palliative care, to
terminally ill patients. Palliative care shall include offering office-based services, referrals to Community
Care Access Centres or to such other support services as are required, and making home visits, where
appropriate.
Support for Hospital, Home and, Where Applicable, Long-Term Care Facilities
Where applicable and where possible, assist with discharge planning, rehabilitation services, out-patient
follow-up, and home care services.
24 Description of Comprehensive Care / Service, Ontario Ministry of Health, 2023
30
In northern and rural areas, physicians must have active or associate in-patient hospital privileges and
involvement, with discharge planning, rehabilitation services, out-patient follow-up, and home care
services, unless otherwise agreed to by the community, hospital, and the ministry.
Service Co-ordination and Referral
Co-ordinate referrals to other health care providers and agencies, including specialists, rehabilitation and
physiotherapy services, home care and hospice programs, and diagnostic services, as appropriate. Co-
ordinate referrals for secondary and tertiary care, where and when required. Monitor the status of
patients who have been referred for additional care and collaborate on the medical treatment of such
patients.
Patient Education and Preventive Care
Use evidence-based guidelines to screen patients at risk for disease, to attempt early detection and
institute early intervention and counselling to reduce risk or development of harm from disease, including
appropriate immunizations and periodic health assessments. Where disease is detected, institute early
intervention and counselling, including appropriate immunizations and periodic health assessments, to
reduce risk or development of harm.
Access to Pre-Natal, Obstetrical, Post-Natal, and In-Hospital Newborn Care
Provide maternal services, including antenatal care to term, labour and delivery, and immediate maternal
and newborn care. If the physicians do not offer full maternal care, they shall make best efforts to arrange
for patients to receive these services.
Arrangements for 24/7 Response
Provide service to patients through a combination of regular office hours, extended office hours, and the
THAS which allows twenty-four hours a day, seven days a week response to patient health concerns.
31
Appendix 5. Governance Model Evaluation
Across the Province of Ontario communities are promoting their locations as unique and exciting places
for doctors to set up their family practice. Population, demographics, geography, and financial
incentives are as unique as they are common. Durham has a great deal to offer through our healthcare
sector and hospital system. Our expanding educational opportunities, clinic research and engaged
community provide opportunities for growth and diversity in work for our medical professionals and
learners.
The importance of place for this work has been evaluated based on Readiness, Finance/Admin,
Management, and Connection to Medical Learners and existing physicians.
The importance of connection to Medical Learners cannot be overlooked. Strong engagement and
support in navigating the community and healthcare systems will strongly influence decisions on where
they will settle upon graduation. This said, medical learners are not the only audience. We need to keep
focus on repatriating Canadians training abroad and interest within the communities through medical
clinics and hospital work. (Locums etc.)
The Canadian Association of Physician Recruiters is a national membership organization for physician
recruitment professions. With membership spanning across the country, this resource provides a broad
view for structure. Most recruiters are situated within hospitals or medical organizations. In Ontario,
with the development of Ontario Health Teams, there is a growing trend to place recruitment efforts
within these organizations as well. Hamilton Recruitment has moved into the OHT and Caledon is
working towards this as well.
Durham Ontario Health Team
The Durham Ontario Health Team is one of 12 teams to be part of the OHT Acceleration Program. They
are an established entity with 18 signatory partners in the healthcare community and are currently
working on a Primary Care Action Plan in the Region of Durham.
Pros
-Proposed that there will be primary care network across the OHT that will engage with all
primary care practitioners, staff will have direct access to primary care physicians.
-Proposed that primary care planning will be a responsibility of the OHT.
-Would specialist recruitment be a responsibility of the OHT across multiple hospital sites?
-Existing relationship
Cons
-Newer organization, structure and governance details need to be identified and confirmed.
-Very early in the development stage.
-Availability to house not until 2025.
Reporting: OHT would have to provide reports to the Region of program deliverable
32
Region of Durham
The Region of Durham will be the main funder for Physician Recruitment and have structure in place to
easily inject a new position either in the department of Economic Development or Strategic Initiatives.
Pros
-They are the funder and have direct oversight over staff and work.
-Will be able to utilize their connections with the municipalities.
-Existing marketing experience for Regional and community assets.
-Will be able to access internal resources of staff, office space, etc. of the Region.
-Ease of office setup.
Cons
-Loss of local and medical specific oversight
-Loss of proximity to learners
-Distant from existing family doctors
-Higher potential for distracted focus
-Need to build relationships.
Reporting: easy reporting to funder
how would work be reported to medical community?
Lakeridge Health – Department of Family Medicine
Lakeridge Health has connection to the entire health system in Durham Region. The new Queens
Lakeridge Medical Campus is currently located in the Oshawa Hospital Site with strong connections with
Department of Family Medicine, Queens University, Lakeridge Academic Affairs and Health Human
Resources.
Pros
-Staff will have direct access to learners – medical students and residents.
-Staff will have direct access to the chief of family medicine, medical and academic affairs, office,
chief of staff office.
-Will be able to access internal resources of staff, office space, mature administrative
infrastructure etc. of Lakeridge Health.
Cons
-Limited community access and knowledge
-Perception of Hospital recruitment vs. community recruitment
Reporting: hospital would have to provide reports to the Region of program deliverables
33
Abbreviations
CBOT Clarington Board of Trade
CPSO College of Physicians and Surgeons of Ontario
CSD Census Subdivision
DOHT Durham Ontario Health Team
DPET Durham Physician Engagement Team
FTE Full Time Equivalent
QBOL Queen’s University’s postgraduate Family Medicine Residency program in Durham Region
(Queen’s-Bowmanville-Oshawa-Lakeridge)
QLEP Queen’s Lakeridge Health Medical Education Expansion Program that created the innovative
Queen’s Lakeridge Health MD Family Medicine Program.
OHT Ontario Health Team
PCN Primary Care Network
PCND Primary Care Network, Durham
1
Family Physician Recruitment Program: Memorandum of Understanding
This purpose of this memorandum of understanding, dated 24 May 2024, is to guide discussions to
fund, create and deliver a family physician recruitment program in Durham, with costs shared
between the following municipalities:
The Regional Municipality of Durham (the “Region”);
The Corporation of the Town of Ajax (“Ajax”);
The Corporation of the Township of Brock (“Brock”);
The Corporation of the Municipality of Clarington (“Clarington”);
The Corporation of the City of Oshawa (“Oshawa”);
The Corporation of the City of Pickering (“Pickering”);
The Corporation of the Township of Scugog (“Scugog”);
The Corporation of the Township of Uxbridge (“Uxbridge”); and
The Corporation of the Town of Whitby (“Whitby”).
At its meeting on 31 January 2024, Durham Regional Council endorsed the recommendations in
Report #2024-COW-3 to create a Region-wide Family Physician Recruitment Program to attract and
retain family medicine trainees and family physicians to Durham and to fund the Durham Ontario
Health Team to hire a full-time permanent family physician recruiter (the “Program”),with core
funding expenses shared between the Region and local municipalities, and to report on that
arrangement to Durham Regional Council.
The proposed funding model for the Program between 1 July 2024 and 31 December 2027 provides
for a maximum cost of $55,000 in 2024, increasing to $225,000 in 2025 and indexed to inflation
plus 2 per cent in 2026 and 2027.
Each municipality recognizes that its council approval may be required to take part in such a cost-
sharing arrangement, and that any arrangement that results from these discussions might take the
form of a binding agreement between one or more parties and the Durham Ontario Health Team.
1.The parties acknowledge that the discussions and their respective plans are preliminary.
Each party’s participation in this cost-sharing arrangement is subject to the condition that
that party receives its council’s approval or delegated authority for
(a)this memorandum of understanding;
(b)a funding agreement with the Durham Ontario Health Team, and
(c)budget approval in each of 2024, 2025, 2026 and 2027 for any funds disbursed or
scheduled to be disbursed.
2.The parties intend to fund the Program costs according to the table attached to this
memorandum of understanding (attachment 1). The Program cost on which each party’s
proportionate share is based will be adjusted as of 1 January 2026 and as of 1 January
2027, calculated according to this formula:
N = (1+ (I + 2 %)) × 225,000
Attachment 2 to Report ECD 02-24
2
In this formula, the following applies:
N = the total Program cost, in dollars
I = the average year-over-year percentage growth in the all-items Consumer Price Index for
Ontario published by Statistics Canada for the then most recent year
3.The parties intend to discuss, among other things, how that Program’s success will be
measured, the contents of a binding agreement with the Durham Ontario Health Team,
and oversight of that Program and that binding agreement.
4.The parties intend that any discussions will take place in good faith. Each party shall make
reasonable efforts to engage in the discussions competently and promptly.
5.The parties are not prohibited from negotiating with from anyone else or from engaging in
their own family physician recruitment strategies, whether existing or new.
6.The parties may share that a partnership is being explored related to the Program as part
of community engagement and public presentations.
7.Each party will be responsible for its own expenses related to this memorandum of
understanding.
8.No party will be liable to any other party for any loss that other party suffers because of
this memorandum of understanding or any failure to enter a binding agreement with the
Durham Ontario Health Team.
9.This memorandum of understanding will become effective for each party when that party
has signed it. Each party may sign this memorandum using an electronic or handwritten
signature, which are of equal effect. If the parties sign this memorandum of understanding
in several counterparts, each will be deemed an original but all counterparts together will
constitute one instrument.
10.If a party signs this memorandum of understanding but fails to date their signature, the
date the Region receives the signing party’s signature will be deemed to be the date the
signing party signed this memorandum of understanding.
11.This memorandum of understanding will continue to apply to a party until the earlier of (1)
the date that party notifies the other parties that it no longer wishes to proceed with the
Program, (2) that party enters a binding agreement for the Program, and (3) 31 December
2027.
Signature pages follow.
3
The Regional Municipality of Durham
Date: ________________________, 2024 By: __________________________
Nancy Taylor
Commissioner of Finance
Authorized by: #2024-COW-3
The Corporation of the Township of Ajax
Date: ________________________, 2024 By: __________________________
Name:
Title:
Authorized by:
The Corporation of the Township of Brock
Date: ________________________, 2024 By: __________________________
Name:
Title:
Authorized by:
The Corporation of the Municipality of Clarington
Date: ________________________, 2024 By: __________________________
Name:
Title:
Authorized by:
The Corporation of the City of Oshawa
Date: ________________________, 2024 By: __________________________
Name:
Title:
Authorized by:
4
The Corporation of the City of Pickering
Date: ________________________, 2024 By: __________________________
Name:
Title:
Authorized by:
The Corporation of the Township of Scugog
Date: ________________________, 2024 By: __________________________
Name:
Title:
Authorized by:
The Corporation of the Township of Uxbridge
Date: ________________________, 2024 By: __________________________
Name:
Title:
Authorized by:
The Corporation of the Town of Whitby
Date: ________________________, 2024 By: __________________________
Name:
Title:
Authorized by:
5
Attachment 1: Proposed Funding Model
Proposed Funding Model
Municipality Population1
Pop.
%
Funding
% 2H 2024 ($) 2025 ($) 2026 ($) 2027 ($)
Total Program Cost $ 55,000 $ 225,000 225,000 × (CPI + 2%) Prior Yr × (CPI + 2%)
Durham 748,495 100% 50.0% 27,500 112,500
Ajax 135,930 18% 9.1% 4,994 20,430
Brock 13,760 2% 0.9% 506 2,068
Clarington 107,770 14% 7.2% 3,960 16,198
Oshawa 187,080 25% 12.5% 6,873 28,118
Pickering 106,505 14% 7.1% 3,913 16,008
Scugog 22,505 3% 1.5% 827 3,383
Uxbridge 22,605 3% 1.5% 831 3,398
Whitby 152,340 20% 10.2% 5,597 22,897
1 Source: #2023-INFO-102, Monitoring of Growth Trends, File: D01-02-01, as of May 2023
Municipality Population Pop. %Funding %2H 2024 2025 2026 2027
Total Program Cost 55,000$ 225,000$ 225,000 x (CPI+2%)Prior Yr x (CPI+2%)
Durham 748,495 100%50.0%27,500$ 112,500$ 117,563$ 122,853$ Ajax 135,930 18%9.1%4,994$ 20,430$ 21,350$ 22,311$
Brock 13,760 2%0.9%506$ 2,068$ 2,161$ 2,258$
Clarington 107,770 14%7.2%3,960$ 16,198$ 16,927$ 17,689$
Oshawa 187,080 25%12.5%6,873$ 28,118$ 29,384$ 30,706$
Pickering 106,505 14%7.1%3,913$ 16,008$ 16,728$ 17,481$ Scugog 22,505 3%1.5%827$ 3,383$ 3,535$ 3,694$
Uxbridge 22,605 3%1.5%831$ 3,398$ 3,550$ 3,710$
Whitby 152,340 20%10.2%5,597$ 22,897$ 23,927$ 25,004$
Assumption of Annual CPI:2.5%
Contract Escalation:4.5%(to be calculated end of each funding year based on actual CPI)
Proposed Funding Model
Attachment 3 to Report ECD 02-24