Why One Family Doctor Took a $250,000 Incentive in Rural Ontario

In 2022, I moved from Manitoba to Sudbury, Ontario, for my medical residency. I was drawn by the pressing need for family doctors in rural communities. During my time in Sudbury, I saw how short-staffed and underfunded rural hospitals and clinics were. Everyone ran double-time to keep things afloat. Family doctors shouldered a huge burden and often fashioned themselves into pseudo-specialists to fill in critical gaps. For example, some patients I saw had advanced, undiagnosed endocarditis—a potentially fatal heart infection that often stems from untreated minor infections like UTIs. Most of these patients didn’t have a family doctor, so their condition went unnoticed until it became severe. By then, they needed a specialist, but they often had to wait for days. Meanwhile, their primary caregiver would scramble to absorb specialized knowledge and devise a treatment plan quickly. Sometimes, it was already too late. Once, a patient asked me what they could have done to detect their endocarditis sooner, and all I could say was, “It’s not your fault. The system is broken.”

My dream was to open my own innovative practice—one that would streamline admin work with new tech, foster strong patient-doctor relationships and give patients tools to monitor their own health. But about a year into my residency, reality hit: I’d need at least $100,000 annually just to cover operating costs. And that would be on top of the $300,000 in student debt I’d racked up over a decade of intense training to become a family physician. The City of Greater Sudbury offers new doctors a $20,000 signing bonus, but that would barely make a dent. Most doctors drawn to these incentives are fresh out of school, eager to get established but often needing great financial support to do so, like me. My only other option in Sudbury would be to work as a hospitalist until I could save enough to open my own practice—if I wasn’t burnt out by that point. 

I started looking for better incentives. Around this time, I also became interested in the business side of running a clinic, especially billing—an essential skill for family doctors that’s never taught in med school. As a result, many of us end up billing incorrectly or inefficiently, wasting time that could go to patients and adding to our financial strain. During my research, I came across Adam Stewart’s website. He’s a doctor who practices in Madoc, Ontario, a small town of 2,200 people halfway between Toronto and Ottawa. I arranged to do an elective in his clinic in September of 2023, and it was a game-changer. The doctors had a refreshing energy I hadn’t seen in a long time, and the staff—many of whom had been there for over a decade—were paid better than in other clinics. Stewart’s electronic medical records were set up impeccably, and every process was streamlined.

I found out Madoc was offering its own $100,000 signing bonus, plus another $150,000 from Hastings County over five years and about $86,000 from the Ministry of Health’s Northern and Rural Recruitment and Retention Initiative, or NRRRI. These incentives would help me cover my startup and operating costs. I couldn’t pass the offer up. In July of 2024, my husband and I sold our Sudbury home and moved to Madoc. 

I didn’t expect the Ministry of Health to throw so many hurdles in my path. Bureaucratic red tape nearly pushed back my practice’s opening date. I’d submitted all the required paperwork in early July, and the ministry assured me it would be processed in time for my September 1 launch. But in August, my office manager received an email demanding yet another form, rehashing all the details I’d already provided and effectively delaying my start by a month. It was only after my office manager sent a strongly worded email to the ministry that they finally agreed to expedite their process.

I was also told by the Ontario Medical Association that I would likely not receive the NRRRI, even though Madoc is listed as an eligible community on their website—all because my clinic sits just 500 meters beyond a municipal boundary, a technicality not clarified anywhere online. When I applied for income stabilization, which helps new doctors get paid while building a patient base, I was again refused the additional $20,000 that rural doctors typically receive. The reason was the same technicality, despite the fact that I clearly work in a rural area and face the same challenges rural doctors do.

Financial pressure has been a constant. Affordable rentals in Madoc are practically non-existent, so my husband and I have been bouncing between Airbnbs for the last few months, trying to save enough for a down payment. Meanwhile, inflation has driven up the price of medical equipment. Exam tables alone can exceed $10,000 apiece now. It’s been hard to juggle these steep costs with the rising cost of living. 

The work is tough but rewarding. Many of my patients have never had a primary physician. Some are grappling with conditions that should’ve been caught years ago. At least now I can help them. In Hastings County, about 25,000 people don’t have access to a primary care physician or nurse practitioner, and I’m determined to shrink that gap. I’m starting from scratch rather than taking over another doctor’s practice, so I’m constantly enrolling patients—a process that will take up most of my first year here. New patients are often more open-minded about what they want from a doctor, which gives me room to bring in new technology and processes.

The broken system feeds into a vicious cycle: fewer family doctors mean fewer early diagnoses of treatable conditions, which piles even more pressure onto hospitals and specialists who are already overwhelmed. That pressure inevitably shifts back to family doctors, which is why municipalities are offering incentives in the first place. But, as my experience shows, these incentives aren’t bonus money. They’re more like startup funds; they only cover the essential costs to move and set up a practice in a new location. They should exceed $100,000, especially since doctors are being asked to relocate, often to areas with limited housing options, outdated equipment and unreliable internet to essentially launch a new business. For more established doctors, the emotional cost is also high. Moving to a new town isn’t just leaving a practice—it also means leaving thousands of patients behind.

On a larger scale, the ministry doesn’t recognize the value of family physicians, which shows in their administrative red tape and our low pay: a family doctor’s expertise is valued at just $39 per patient visit. Investing in family doctors would save the province money in the long run. I want to spend more time on treating patients early, helping them before they need a specialist, an ER visit or face the lasting impact of an advanced illness. I also hope to develop tools that will help doctors save time, like an app to streamline billing or connect family doctors with nearby specialists for quicker referrals. But it’s impossible to invest my time or money into these ideas when I’m just trying to survive. 

Family physicians are in crisis, and ignoring that won’t make it go away. We need to value the backbone of our health-care system by providing family physicians with the resources they need—financial and otherwise. The result will save lives. 

—As told to Marta Anielska