Health care was looking grimmer by the day back in 2023 in a rural corner of western Canada.
Family doctors had retired or moved, starting a chain reaction that cut in half the number serving the 12,000 residents of the Alberta town of Stettler and its surrounding county, also called Stettler.
People with preventable problems, but without family doctors, sought help in the town hospital’s emergency room. Then the emergency room began shutting down on some days because of a doctor shortage, forcing the unlucky to drive 50 miles to the nearest city.
About 450 people came to a hastily called meeting at the hockey arena.
“It was summertime, so there was no ice in there,” recalled Dean Lovell, who was leading the local effort to recruit physicians. “We had the meeting to let everyone know that we were a community in crisis.”
Since then, Stettler has attracted seven new physicians, restoring the number of family doctors to its previous level. Anybody there can now get a family doctor.
The story of how Stettler went from famine to plenty is an outlier. But it shines a spotlight on a fundamental weakness of a health care system that had once been Canada’s source of pride — an acute shortage of family physicians, and the extraordinary efforts communities must undertake to attract them.
One in four Canadian adults said they lacked a family doctor in 2025, according to a survey by OurCare, a research group. Other respondents said they were overseen by a nurse practitioner or at a community health center, bringing down those without basic primary care to one in five. Depending on the province, Canadians can wait months or several years before getting a family doctor.
Dr. Tara Kiran, who led the survey, said, “Canada’s primary care system is in a crisis when one in five people don’t have access to the front door of the very foundation of health care.”
“That’s a huge issue, especially in a country where the values are such that everybody feels that people should have access to health care based on need and not ability to pay,” Dr. Kiran said.
What is happening is that richer communities are outbidding others for doctors.
The town and the county of Stettler spent nearly 400,000 Canadian dollars, or $300,000, to get the seven new physicians. The bulk went to signing bonuses — 50,000 to 70,000 Canadian dollars ($37,000 and $51,000) to each physician.
“It’s like being a hockey player,” said Gord Lawlor, the town mayor.
But there are different leagues. At the last minute, Stettler lost two physicians that “if you were dating, you were almost ready to engage with,” said Larry Clarke, the county government leader. One, a family physician with experience in anesthesia, went to British Columbia on a package worth seven times what Stettler could offer.
“We won’t compete at that level,” Mr. Lawlor said.
These campaigns pit town against town, province against province, in a zero-sum battle. The competition even reverberates internationally, especially in developing nations that are the source of many of Canada’s new physicians. Stettler’s seven new arrivals all are from West Africa.
Last fall, Canada’s two most populous provinces got into a public skirmish when Ontario tried to woo physicians in Quebec who were locked in negotiations over compensation.
Ontario’s premier, Doug Ford, promised to “roll out the red carpet,” inviting prospective transplants to call him on his cellphone. Quebec’s premier, François Legault, called the offer “totally unacceptable” and said “it wasn’t time for the provinces to shoot each other in the back.”
The pandemic fueled the early retirement of many family doctors, but the shortage has longstanding causes. The problems facing primary care — increasing administrative burdens, the complexities of treating an aging population, lower pay compared with specialists — made it less attractive.
At the same time, for years Canada’s provinces have tried to rein in overall health care costs by limiting the number of medical students, whose education and residency training are publicly financed. Canada has essentially relied on foreign-trained doctors to fill gaps. Twenty-seven percent of physicians in Canada were educated outside the country; the share among family doctors is even higher, 32 percent. Canada has lower access to primary care than many other wealthy nations, including the United States.
In what some have called a “Hunger Games” among communities fighting for family physicians, some Ontario municipalities try to outdo one another, with richer ones offering signing bonuses of 100,000 Canadian dollars, or $73,000, with perks like a free car for a year and golf club membership.
A two-and-a-half hour drive northeast of Calgary, Stettler spreads out across central Alberta’s flat landscape, with residents working mostly in farming, oil and manufacturing.
In 2023, when Stettler lost seven of its 14 doctors, many people experienced for the first time what millions of other Canadians have for years.
For Gail and Brian Peterson, now both 72, not having a family physician for two years was upsetting. When Mr. Peterson developed knee problems, he had to turn to a physiotherapist, and the lack of a family doctor complicated his diagnosis and treatment.
“Not having a family doctor was always in the back of my mind,” he said. “What would I do?”
The couple’s new physician, Dr. Sunday Asuke, started working in Stettler last year after practicing in Nigeria for 15 years.
“If you don’t have a family doctor, you can’t get certain tests done,” Dr. Asuke, 52, said during a lunch break at the Heartland Medical Clinic.
Before the new doctors’ arrival, the emergency room at the town hospital — like countless other emergency rooms nationwide — was drawing patients with problems directly tied to a lack of family medicine.
“The unattached diabetic was not getting a follow-up on his results, so he ended up in the emergency room; your ischemic heart disease people showed up and had serious events or strokes,” Dr. Francois du Toit, a family physician in Stettler since 2005, said of patients without family doctors.
“I experienced moments of almost desperation,” Dr. du Toit said, recalling people he wanted to take as patients but could not because of an already overloaded schedule.
Stettler’s remaining family doctors faced burnout with increasing demands, especially at the emergency room, where they work on rotations. The emergency room, once open around the clock, began closing for extended periods.
Worried community leaders went to work.
Mr. Lovell, who spearheaded the recruitment of new physicians, established Stettler Needs Doctors, a group that sold hundreds of lawn signs to raise money for the campaign.
The town and the council increased the signing bonuses significantly. But knowing they could not compete against wealthier communities, they tried something else: concierge service.
An employee at the local chamber of commerce, Byron Geddes, worked full time wooing prospective doctors, and catering to their needs and those of their families after their arrival.
“The doctors call me because I’m the answer guy,” Mr. Geddes said. “‘What churches do you have in the community?’ ‘I have a flat tire at midnight on the highway, who do I call?’”
Mr. Geddes and others led prospective doctors and their families on tours of Stettler — introducing them to store owners on the main street, taking them to schools and churches, leading their children to a skate park and water slides, and organizing a lunch attended by community leaders.
Dr. Ewura Kankam-Yeboah, 37, a physician from Ghana who began working in Stettler last year, said during her family’s first visit to Stettler, her two young children were cranky and acting up.
“But I never felt like I had to apologize for being a mom,” Dr. Kankam-Yeboah said. “Byron took my first kid for ice cream and then to the library where they were having a book sale, and he got him a book.”
Another new physician, Dr. Godwin Agbonkhese, 42, said he received offers from five different communities in Alberta but chose Stettler because of the warm welcome.
“One of the major deciding factors was the recruitment team,” said Dr. Agbonkhese, who came from Nigeria with his wife, a nurse, and their four children.
Word about Stettler had spread among Nigerian doctors relocating to Canada. Of the seven new physicians, six are from Nigeria.
While Mr. Lovell was pleased, he said Canada should produce more medical school graduates and family doctors so it need not rely on international physicians, especially from developing nations.
“It does leave Nigeria in a terrible situation,” Mr. Lovell said. “They’re training all these doctors that are phenomenal doctors and that are leaving to go to other places in the world.”
Norimitsu Onishi reports on life, society and culture in Canada. He is based in Montreal.
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