It takes more than financial incentives to attract doctors to remote areas

It was reported in the media that the 3,000 residents of Percé had lost their CLSC’s only GP. A lack of access to appropriate and timely care can lead to serious health problems, particularly amongst vulnerable people.

Research carried out at CIRANO provides insights into the pressing issue of attracting and retaining doctors in remote areas. The authors had access to unpublished data on all new family doctors who began practising between 1975 and 2024.

What has Quebec done to tackle the problem?

Various incentive and coercive measures were introduced from 1975 onwards.

One example is the policy of regionally differentiated remuneration for new doctors during their first three years of practice. For instance, a general practitioner practising in Rimouski receives 120 per cent of the RAMQ rate if she works in a healthcare facility. The same general practitioner practising in Montreal, Quebec City or Sherbrooke receives the basic rate.

Under the regional medical workforce plans, called Plans régionaux d’effectifs médicaux (PREM), any newly licensed general practitioner hoping to set up a practice in a particular region would have to first obtain a compliance notice from the regional authority to work in that region, failing which a very severe penalty will be imposed, such as a 30 per cent reduction in remuneration in the university region. The PREM schemes were made more stringent in 2015.

The findings of the CIRANO study?

These measures have helped to attract more GPs to rural areas. But simply attracting them is not enough. We must also retain them.

Differential remuneration appears to be consistently associated with a longer length of stay in remote or isolated regions, whilst the PREMs are associated with a lower frequency of certain moves to the most attractive regions.

Quebec’s policies have therefore helped to improve retention in remote or isolated regions over the past few decades, but the problem is far from being resolved.

In university or peripheral regions, half of all doctors will have left their region after 23 years. This period is 16 years in intermediate regions, such as Saguenay-Lac-Saint-Jean, and only 6 years in remote regions such as the Gaspé Peninsula.

What lessons do the authors draw from their analyses?

Policies to attract and retain doctors in remote areas must not be limited to financial incentives. They must also address working conditions, professional support and the development of a supportive community environment.

The long-term presence of general practitioners in regional areas is key to ensuring access to primary care, continuity of services and the reduction of health inequalities.

Read the CIRANO report