As a travelling physician in northern Ontario, Dannica Switzer is acutely aware of the health-care crisis in underserved communities.
“It's sad to see how much worse things can get,” said Switzer, who works as a locum, filling roles on a temporary basis in rural or remote areas.
Switzer has been in high demand since returning to locum work after quitting her family practice in Wawa, Ont., due to burnout more than two years ago.
Rural and northern Ontario hospitals are competing to recruit locums by offering hefty financial incentives amid a severe shortage of doctors that has plagued the health-care system. The hospitals are vying for doctors from a relatively small pool of locums, often as a way to prevent emergency department closures that have become more common in recent years.
“But the reality is that most people are booked,” Switzer said in a recent interview. “And even if you really want to go help that town out to prevent the closure, you can't because you're already working somewhere else.”
Hospitals' fierce competition for locum recruitment has triggered concerns about equitable access to health care, with some doctors and experts saying it leaves smaller communities and hospitals vulnerable because they may not have the financial resources needed to entice physicians.
While funding mainly comes from provincial programs, some hospitals top up the pay for locum shifts by tapping into their operating budgets or money that's available due to vacant staff positions.
But Mike Cotterill, a physician in Wawa and one of Switzer's former colleagues, said that approach is not ideal.
“If you top up with X dollars, then the next town down the road will top up with X plus, you know, X plus Y," he said in an interview.
“So, it's a competition that is bad for hospitals and bad for towns. It really shouldn't have to happen."
He said the Lady Dunn Health Centre, where he works, has so far avoided having to top up the pay for locums and its "excellent" recruiter has been able to ensure a steady supply of such physicians.
But that's not the case at some other hospitals.
Timmins and District Hospital is currently offering up to $18,500 for hospitalist medicine locums to work there for one week in August, according to an ad posted on the hospital’s social media page. The North Bay Regional Health Centre pays up to $2,700 per eight-hour shift for emergency medicine locums, according to its website.
Manitoulin Health Centre’s Little Current site offers $250 per hour to physicians who take ER shifts in July and August. The hospital receives around $160 per hour from the Health Ministry for night and weekend shifts and tops up that amount so it can stay “competitive," using funds from unfilled positions at the hospital, said lead physician Anne McDonald.
The generous pay, flexible scheduling and less administrative work that comes with being a locum may impede some hospitals' recruitment and retention of full-time doctors, some experts say. The financial incentives for locums, which can also include accommodation, flights, car rentals and other expenses, are unaffordable in the long run, they add.
The goal should be to make permanent positions more appealing so that doctors stay in communities, Switzer said.
"We cannot recruit our way out of a retention crisis," she said.
Still, doctors agree that locums play a vital role in rural and northern areas of the province.
"We absolutely need the locum and the local program," said Dr. Anjali Oberai, who works in Wawa alongside Cotterill, her husband.
“We need to support locums but if the support is such that it de-incentivizes working and living in community, yeah, then we have a problem."
Oberai and Cotterill worked for nearly two years as locum doctors to take advantage of the lifestyle before settling down in Wawa in 1998.
But "the locum landscape was quite different back then,” Oberai said.
They worked mainly during the summer, covering for doctors who were on vacation or other short-term leaves. But locums are now often used to fill vacant positions, and they've helped Wawa keep its hospital and primary care centre operational during a worsening physician shortage in the community in recent years.
McDonald, the lead doctor at Manitoulin Health Centre’s Little Current site, said rural doctors are under a lot of pressure, taking care of patients who are often their neighbours, friends or relatives due to physician shortages. Some cannot handle that workload and become locums instead.
"I really think the locum lifestyle is less about the money exactly and more about the lack of burden of ongoing responsibilities that weighs physicians down," McDonald said.
There are more than 350 physician vacancies in northern communities, according to the Ontario Medical Association. That shortage might get even worse as nearly half of the doctors there are expected to retire in the next five years.
The association always advocates for a system that encourages doctors to provide reliable and continuous care at a specific location, OMA president Zainab Abdurrahman said. But the doctor shortage is so acute that locums have become an essential part of the system.
"It's not that having a locum means you're not hiring and you're not actively trying to recruit,” she said.
Some new medical school graduates want to take time to explore their options as the financial cost and administrative burden of setting up a practice holds them back, she said, while others want to become locums to help underserved communities.
While financial incentives offered by some hospitals do lead to inequities, they are just a symptom of a larger issue, Abdurrahman said.
“The utilization of these kind of extra incentives is really a reflection of the desperation in the health-care system,” she said. “People are making choices to be competitive because they're feeling the constraint.”
The Health Ministry says its Rural Emergency Medicine Coverage Investment Fund, which replaced the Temporary Locum Program in April, is helping hospitals improve access to emergency care throughout the year by offering them the flexibility to hire locums and improve their capacity to recruit permanent doctors.
That commitment came out of negotiations between the government and the OMA for a new Physician Services Agreement.
Ministry spokesperson Ema Popovic also pointed to the province's investments aimed at connecting every Ontarian with a primary care provider by 2029, and efforts to add hundreds of seats in medical schools.
Many doctors say that other incentives, such as improving access to education, more vacation time and less administrative paperwork, are also needed to recruit and retain full-time physicians.
For Switzer, being a locum gives her more control over her schedule but that comes with a cost.
“I have a house, I'm not at it. I have a garden. I'm not there ... I miss a lot of moments with my family," she said.
This report by The Canadian Press was first published July 31, 2025.
Sharif Hassan, The Canadian Press
