How a provincial responsibility is being downloaded and you are paying twice – in provincial taxes and again in municipal property taxes.
Ontario has a family-doctor shortage, but it has also developed a second problem that receives far less attention: municipalities are increasingly spending property-tax dollars competing with one another for the same limited supply of physicians.
Prince Edward County is a useful case study because its County Docs program is widely promoted as a recruitment success. The August 2026 headline announcing that “nine new doctors are in the County and a 10th is on the way” certainly sounds like a significant expansion in primary-care capacity. The underlying numbers tell a more complicated story. County Docs itself reported in 2024 that Prince Edward County had 21 physicians in 2022–23, seven departures during that period and only two arrivals. By 2024, the expected physician complement had fallen to 16, with another four departures and four arrivals projected that year. The Prince Edward Family Health Team currently says it has 16 County family physicians against 23 Ministry-allotted positions.
In other words, the recruitment program appears to have performed an important function, but a large portion of that function has been replacement. A local Picton newspaper reported in April that County Docs had recruited 11 family doctors since 2022 but that “many” had taken over the practices of retiring physicians, limiting the number of previously unattached residents who could be brought into care.
That distinction should be central to every physician-recruitment announcement in Ontario.
Recruiting ten doctors does not mean a community gained ten doctors.
If eight doctors retired or left during the same period, the net gain is two.
And if the departing doctors carried larger practices than their replacements, even a one-for-one head-count replacement can leave the community with less patient capacity than it had before.
Prince Edward County: 16 Doctors for 25,704 Residents
Statistics Canada counted 25,704 residents in Prince Edward County in the 2021 Census. The Prince Edward Family Health Team currently lists 16 County family physicians. On a simple head-count basis, that works out to approximately:
0.62 family physicians per 1,000 residents
The Ministry-approved complement of 23 physicians would represent approximately:
0.89 physicians per 1,000 residents
Ontario as a whole had 104 family physicians/general practitioners per 100,000 people in 2023, or approximately:
1.04 per 1,000
The Auditor General of Ontario noted that this was already below the Canadian average of 115 per 100,000.
These measures are not perfectly interchangeable. Prince Edward County’s 16 refers to physicians associated with its Family Health Organization/Family Health Team structure, while the provincial CIHI measure includes family physicians and general practitioners more broadly. Head counts also do not account for whether physicians work full time, spend substantial hours in emergency departments or long-term care, or maintain practices of 750 rather than 1,500 patients.
But even with those caveats, the comparison illustrates the problem.
Prince Edward County is operating with seven of its 23 approved physician positions vacant, and its current family-physician head count per resident is substantially below the provincial physician-to-population benchmark.
This Is Why “Nine Doctors Recruited” Is Not the Number That Matters
County Docs’ own April 2024 presentation is unusually useful because it shows physician flows rather than simply cumulative recruitment announcements.
| Period | Physician complement | Departures | Arrivals |
|---|---|---|---|
| 2022–23 | 21 | 7 | 2 |
| 2024 expected | 16 | 4 | 4 |
| 2025 expected | 16 | 1 listed |
Source: County Docs presentation to Prince Edward County Council, April 2024.
That table tells a very different story from a headline about multiplying doctors.
The community entered the period with 21 physicians and fell to 16. Recruitment helped prevent the situation from becoming considerably worse, but it did not create anything resembling nine or eleven net new physicians.
That does not make County Docs unsuccessful.
It means its success needs to be measured correctly.
A program that recruits enough physicians to prevent a retirement wave from collapsing local primary care may be extremely valuable. But preventing a loss of ten doctors is not the same accomplishment as adding ten doctors, and residents deserve reporting that distinguishes the two.
Even One-for-One Replacement Can Conceal a Loss of Capacity
County Docs has said rural family practices in Prince Edward County can range from approximately 750 to 1,500 patients, because local family physicians may also work at the hospital, in emergency medicine and in long-term care.
That creates another measurement problem.
Suppose a retiring physician has 1,500 rostered patients. A recruited replacement decides on a 900-patient family practice because the physician also works in the emergency department.
The municipality can announce:
One doctor retired. One doctor recruited.
The head count is unchanged.
But primary-care capacity has fallen by 600 patients.
This is why municipal recruitment programs should report patient capacity, not merely names and head counts.
How Does Prince Edward Compare With Other Rural Counties? The Public Data Are Surprisingly Poor
County First attempted to construct a current family-physicians-per-1,000 comparison for Prince Edward, Northumberland, Huron, Norfolk, Hastings and Lennox and Addington.
The exercise exposed another problem: current county-level physician head counts are not consistently published in a standardized form.
Prince Edward County is unusual because its Family Health Team publishes the current figure of 16 physicians and the Ministry complement of 23. Northumberland County publicly reported more than 20 primary-care physician vacancies in 2024 and said in 2026 that more than 8,000 residents were estimated to be without a family doctor, but it does not publish an equivalent current county-wide active physician total in the sources reviewed.
Hastings County says its recruitment program has recruited 29 family physicians since the program began in 2006, but that is a cumulative recruitment figure, not the current number practising in Hastings County.
Comparable, current county-wide active physician counts could not be established from official public sources reviewed for Huron or Norfolk either.
That makes any table purporting to rank those counties by current physicians per 1,000 residents potentially misleading.
Ontario should publish this information centrally.
Every Ontario resident should be able to see, by municipality or health-service area:
- active comprehensive family physicians;
- full-time-equivalent physicians;
- active nurse practitioners;
- patients rostered;
- patients unattached;
- physicians aged 60, 65 and 70-plus;
- projected retirements;
- vacancies;
- arrivals;
- departures; and
- net primary-care capacity per 1,000 residents.
Without those numbers, municipalities can report recruitment successes while residents remain unable to tell whether their community is actually gaining capacity.
Northumberland Shows This Is Not a Prince Edward County Problem
Northumberland County launched a county-wide recruitment initiative in 2025 after reporting a growing shortage. By 2026 it estimated that more than 8,000 residents were without a family doctor.
Northumberland has since recruited physicians through the new program and, like Prince Edward County, has reported progress clearing older Health Care Connect registrations.
These are meaningful improvements, but they illustrate the same provincial contradiction.
Northumberland taxpayers are being asked to finance municipal recruitment because Ontario has not historically operated the kind of centralized physician-recruitment system used elsewhere in Canada.
The result is not really Prince Edward competing against Toronto.
It is Prince Edward competing against Belleville, Kingston, Huntsville, Niagara Falls, Welland, Northumberland and dozens of other communities—using local taxpayers’ money to move a provincially regulated and provincially funded workforce around within Ontario.
Ontario Has Created a Municipal Bidding War
The incentives are now substantial.
Belleville advertises up to $150,000 for a family physician.
Kingston offers eligible family doctors $100,000.
Niagara Falls increased its maximum incentive to $100,000 per physician.
Huntsville authorizes $60,000 for a physician taking over an existing practice and up to $80,000 for a new practice, with authority covering as many as ten physicians.
The Township of Leeds and the Thousand Islands offers a $100,000 signing bonus plus a $5,000 relocation allowance.
Loyalist Township advertises incentives worth as much as $100,000 per physician.
Welland committed $1 million to physician recruitment in 2023 and, after recruiting ten physicians, approved another $1 million to continue the program.
Peterborough approved a physician-recruitment pilot requiring approximately $580,000, while retaining a smaller direct physician incentive.
This is no longer occasional municipal hospitality.
It is a labour-market bidding system financed through property taxes.
The Province-Wide Number: At Least $6.3 Million a Year
The best province-wide figure currently available comes from the Association of Municipalities of Ontario.
A 2025 AMO survey found that responding municipalities—representing approximately 89 per cent of Ontario’s population—were collectively spending more than $6.3 million per year on physician recruitment and incentives. That spending included cash incentives, housing support and other recruitment benefits.
That number deserves much more attention.
More than $6.3 million in municipal money every year
And it is not a complete Ontario total, because the survey did not cover every municipality.
Nor does it necessarily capture every indirect cost such as:
- municipal recruiter salaries;
- travel and recruitment fairs;
- advertising;
- administrative support;
- subsidized clinic space;
- waived municipal fees;
- recreation memberships;
- moving assistance;
- municipal staff time; or
- foregone rent.
The actual province-wide municipal burden may therefore be higher.
County First could not locate an authoritative province-wide aggregate for 2024, 2023 or earlier years. Public municipal records show that many of these programs existed well before 2025—some for decades—but no provincial body appears to have maintained a comprehensive annual accounting of what Ontario property taxpayers were spending on them.
That missing data should itself concern the Province.
Prince Edward County Alone Is Spending Hundreds of Thousands a Year
Prince Edward County Council allocated $150,000 in 2022 to establish the expanded physician-recruitment initiative. The plan included a possible $100,000 physician incentive and recruitment staffing.
By 2024, County Docs reported an ongoing municipal budget composed of:
- $150,000 for the County Docs recruitment program and recruiter;
- $100,000 for physician incentives;
- $100,000 for four Health Care Connect premiums;
- plus a request for another $75,000 for three additional premiums.
That would have brought the 2024 total to $425,000.
The County’s proposed 2026 budget allocated $400,500 to physician recruitment and retention.
County Docs also received an extension through 2029 and a new reserve fund intended to support future return-of-service incentives.
The County is therefore no longer making a token contribution.
It has created a continuing municipal health-recruitment program costing several hundred thousand dollars annually.
Why Is a Property Taxpayer Paying for This?
Even County Docs acknowledges that primary-care recruitment is “technically a provincial responsibility.” Its director made that point explicitly to Council in July 2026.
The Association of Municipalities of Ontario has been even clearer. AMO has stated that municipalities fund physician-recruitment incentives even though they are not required by legislation, describing this as municipal governments filling gaps in provincial health funding. AMO has argued that the property-tax base is already stretched covering core municipal responsibilities and should not be expected to fund provincial health services.
Ontario’s own Minister of Health said in January 2026 that she did not want municipalities offering financial incentives to lure doctors from one underserved community to another.
That raises the obvious question:
Why are municipalities still being put in a position where they believe they have to do it?
Is It Double Taxation? Not Technically—but Residents Are Paying Twice
It is tempting to describe this as “double taxation.”
Legally and technically, that is not quite the correct term. Residents are not being assessed the same tax twice by the same taxing authority for the same transaction.
But the practical complaint behind the phrase is legitimate.
Ontario residents pay provincial taxes to finance a provincial health-care system. They then pay municipal property taxes, some of which are increasingly being used to recruit physicians into that same provincially regulated and provincially funded system.
So while it may not meet a technical definition of double taxation, it is unquestionably a second layer of taxpayer funding for a function municipalities themselves say belongs to the Province.
And the second layer is particularly regressive.
Property taxation is poorly matched to health-system workforce planning. A municipality with a large tax base can offer a $100,000 or $150,000 signing bonus. A poorer rural municipality may not be able to compete.
The physician goes somewhere.
Ontario has not created another physician.
It has changed the physician’s postal code.
That Is the Fatal Flaw in Municipal Incentives
Municipal bonuses can work for an individual community.
That does not mean they work for Ontario.
If Belleville pays $150,000 and attracts a doctor who would otherwise have gone to another Ontario municipality, Belleville benefits. But Ontario still has the same number of family physicians.
The neighbouring community may then respond with a larger bonus.
That is why municipal leaders have described the system as an arms race and why reporting in 2025 called it the physician-recruitment “Hunger Games.”
The incentives may redistribute scarcity rather than solve it.
Ontario’s 2025 Auditor General report found that Ontario had 104 family physicians/general practitioners per 100,000 residents in 2023, below the Canadian average of 115. It also highlighted weaknesses in provincial health-workforce planning.
Ontario has since committed major new provincial funding to primary-care teams, including more than $235 million in 2025–26 for 80 additional or expanded teams intended to attach approximately 300,000 people to primary care.
That is the scale at which the problem ultimately has to be addressed.
Supply.
Training.
Licensing.
Team-based care.
Compensation.
Geographic distribution.
Retention.
Those are provincial system questions.
Prince Edward County Demonstrates Both Sides of the Argument
It would be unfair to say the County Docs money has accomplished nothing.
The program recruited physicians during a period of severe retirement and departure pressure. The Family Health Team reports that older Health Care Connect registrations have been cleared, and a provincially funded nurse practitioner has rostered 801 patients.
Without aggressive recruitment, Prince Edward County could plausibly have ended up with substantially fewer physicians than the 16 it has today.
But that is precisely why the Province should take responsibility.
Prince Edward County should not have to decide whether to spend $400,000 recruiting physicians or put that money into roads, housing, emergency services or another municipal responsibility.
Northumberland should not have to outbid Prince Edward.
Belleville should not have to outbid Kingston.
Huntsville should not have to outbid another northern or rural community.
The provincial government should be managing the distribution of a provincial health workforce.
The Numbers County Docs Should Publish Every Year
The August 2026 County Docs story says nine doctors have joined and a tenth will arrive by year-end. An April story said 11 had been recruited since 2022. Those numbers may be perfectly reconcilable—for example, one may refer to signed recruits while the other counts physicians actually practising—but the difference is not explained in the public reporting.
That is one of several questions County Docs should answer in a public annual report.
1. How many active family physicians are practising in Prince Edward County today?
The Family Health Team currently says 16. County Docs should confirm the figure and explain exactly who is included.
2. How many physicians were practising when County Docs began?
The 2024 County Docs presentation reported 21 in 2022–23.
3. How many have retired or left since the program began?
Publish the annual number without identifying individual physicians where privacy is relevant.
4. How many recruits replaced existing practices?
This is essential. Replacement recruitment and net-new recruitment are not the same outcome.
5. What is the net change in physician capacity?
Not cumulative recruits. Arrivals minus departures.
6. How many patients did departing physicians roster and how many do their replacements roster?
That would reveal whether patient capacity actually increased.
7. How many residents currently have no regular family physician or nurse practitioner?
Health Care Connect alone is not necessarily the total. County Docs acknowledged in 2024 that its HCC figures represented people on the list, not the total number of County residents without a family doctor.
8. What is the denominator behind the reported “80 per cent” clearance figure?
Percentages without the original number can exaggerate apparent progress.
9. How much municipal money has been paid to each category of recruitment activity?
Report separately:
- recruiter salary and benefits;
- advertising;
- travel;
- direct physician incentives;
- Health Care Connect premiums;
- relocation expenses;
- memberships and perks;
- consultant costs; and
- administrative costs.
10. How much money has been committed but not yet paid?
Budgets and signed incentive agreements are different from actual cash expenditures.
11. How many physicians are expected to retire or leave over the next five and ten years?
The names need not be disclosed.
The aggregate forecast is essential for workforce planning.
12. How many recruits are required simply to replace expected departures?
This would show residents the difference between maintaining present service and expanding it.
13. Why did April reporting say 11 doctors had been recruited while August reporting describes nine, with a tenth coming?
There may be a simple explanation. Publish it.
14. How much has each net-new physician cost municipal taxpayers?
Total County Docs expenditures divided by net additional physician capacity, rather than gross recruits, would provide a much more meaningful performance measure.
15. When will the municipality stop paying?
County Docs has now been extended to 2029. What measurable provincial change would allow the municipality to exit physician recruitment altogether?
Ontario Should Publish a Municipal Health-Care Downloading Report
The $6.3-million AMO figure should be the beginning, not the end, of provincial disclosure.
Ontario should publish annually:
| Measure | Province-wide total |
|---|---|
| Municipal physician-recruitment spending | >$6.3M in 2025 among AMO survey respondents |
| Municipal cash signing bonuses | Province should report |
| Municipal recruiter salaries | Province should report |
| Subsidized clinic rent/property | Province should report |
| Municipal housing/relocation incentives | Province should report |
| Hospital capital contributions from municipalities | Province should report |
| Number of municipalities competing for physicians | Province should report |
| Doctors moved between Ontario municipalities | Province should report |
| Net new physicians attracted from outside Ontario | Province should report |
The distinction in the last two lines may prove especially revealing.
If millions of municipal dollars primarily move physicians from one Ontario community to another, taxpayers are financing competition rather than increasing supply.
The Better Model
Municipalities still have a useful role.
They know their communities. They can welcome physicians, help spouses find employment, identify clinic space, explain schools and housing, and make it easier for new residents to settle into the community.
Those are sensible local functions.
What municipalities should not have to do is purchase doctors.
Ontario should provide centralized recruitment and workforce planning, coordinate international recruitment, forecast retirements, expand training and residency capacity, support team-based practices and create province-wide incentives for genuinely underserved regions.
Provincial incentives already exist. Ontario’s Northern and Rural Recruitment and Retention Initiative provides eligible physicians with taxable grants ranging from roughly $84,851 to $124,730 over four years, depending on the community.
That raises another question: why should an eligible doctor potentially receive a provincial recruitment incentive and then a separate municipal incentive financed by the same resident through another tax bill?
One County. One Lesson.
Prince Edward County demonstrates why physician-recruitment headlines need more context.
County Docs has recruited doctors.
That is factual.
Some of those physicians replaced doctors who retired or left.
That is also factual.
The County had 21 physicians in 2022–23 and reported a complement of 16 in 2024. The Family Health Team still reports 16 today against 23 Ministry-approved positions.
That does not describe failure.
It describes a community running hard simply to prevent a provincial workforce shortage from getting worse locally.
And Prince Edward County taxpayers are paying hundreds of thousands of municipal dollars a year to do it.
Ontario municipalities collectively reported spending more than $6.3 million annually in 2025 filling this gap.
The Province now says it does not want municipalities competing with financial incentives. AMO says physician recruitment is not a legislated municipal responsibility. County Docs itself describes primary care as technically a provincial responsibility.
On that, there is remarkable agreement.
So the question for Queen’s Park is becoming difficult to avoid:
If everyone agrees physician recruitment is a provincial responsibility, why are Ontario property taxpayers still paying millions of dollars a year to do the Province’s job?
Source Notes
[1] Prince Edward physician supply. Prince Edward Family Health Team currently reports 16 County family physicians and says the region is regulated for 23.
[2] County Docs physician flows. An April 2024 presentation reported 21 physicians in 2022–23, seven departures and two arrivals, followed by a 2024 complement of 16 with four departures and four arrivals expected.
[3] Recruitment versus replacement. April 2026 report stated that County Docs had recruited 11 family doctors since 2022 but that many replaced retiring physicians.
[4] Population. Statistics Canada counted 25,704 residents in Prince Edward County in 2021.
[5] Ontario benchmark. The Auditor General reported 104 family physicians/general practitioners per 100,000 Ontarians in 2023, compared with 115 nationally.
[6] Prince Edward municipal costs. County Docs reported a 2024 approved program/recruitment/incentive budget of $350,000 and sought $75,000 more, for a potential $425,000 total. Prince Edward County budgeted $400,500 for physician recruitment and retention in 2026.
[7] Ontario municipal spending. AMO’s 2025 survey found responding municipalities representing approximately 89 per cent of Ontario’s population collectively spent more than $6.3 million annually on recruitment and incentives. I found no equivalent authoritative province-wide total for prior years; individual municipal records demonstrate significant spending existed before 2025.
[8] Municipal responsibility. AMO has stated that municipal physician recruitment incentives are not legislatively required and represent municipalities filling provincial health-care gaps using the property-tax base.
[9] Comparable counties. Current standardized physician counts per 1,000 residents were not publicly available across all comparison counties reviewed. Northumberland publicly reports more than 8,000 residents without a family doctor and previously identified more than 20 primary-care physician vacancies; Hastings reports cumulative recruitment rather than a current comprehensive physician head count.
Disclaimer
This article distinguishes physician recruitment from net physician growth. A recruited doctor who replaces a retiring physician represents a genuine retention of health-care capacity but not necessarily an increase in physician supply. Head-count ratios also do not measure full-time equivalents, practice sizes, hospital work or nurse-practitioner capacity.
The term “double taxation” is not used here as a technical legal characterization. Municipal and provincial taxes are distinct levies. The concern is that residents pay provincial taxes to support a provincially administered health-care system while some municipalities also use property-tax revenue to finance physician recruitment for that system.
The $6.3-million figure comes from an AMO survey of responding municipalities representing approximately 89 per cent of Ontario’s population and is therefore not a complete accounting of all 444 municipalities. I did not find a reliable authoritative province-wide aggregate for years before 2025 and have not manufactured one by adding incomparable municipal budgets, multi-year commitments and actual expenditures.