When Harvey Walker's wife, Joan, died of pancreatic cancer two years ago, he wanted to find a way to honour her memory.

Mr. Walker, a 75-year-old retiree, decided the most fitting tribute would be to donate $100,000 in her name to the Scarborough Hospital, which provided compassion and care to Joan and her family in some difficult moments. Hardly an insignificant amount for a man who, throughout his career, was always "just a working guy," but Mr. Walker believed it was the right thing to do.

"They helped me out when I needed it and I'd like to help them out if I can," he explained in a recent interview.

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Two years later, Mr. Walker has become something of a darling on the mailing lists of hospital foundations across the city. Appeals for money arrive in his mailbox constantly. He's never donated to most of the hospitals asking for his cash and doesn't even know how they got his name.

"The ones that come every week, I don't even open them any more. I just toss them in the garbage," he said. "Some outfits just never stop."

Considering hospitals in the Greater Toronto Area are trying to collectively raise nearly $4-billion over the next five years, it's no wonder people like Mr. Walker are suddenly in demand and feeling the pressure.

The $4-billion figure is unprecedented in the history of hospital fundraising in Toronto and executives, volunteers and high-level donors say it marks the beginning of a new era in which the pressure to raise ever-higher amounts is the new way of life.

"I think the whole scope has changed," said Steve Hoscheit, president and CEO of the Trillium Health Centre Foundation in Mississauga. "There was a time where a million…or $5-million [donation] would hit the headlines, but now it seems you have to at least be at the $10-million mark to gain any attention."

By today's standards, even a hefty cheque like that seems like a paltry sum.

In April, the Princess Margaret Hospital Foundation launched a five-year campaign to raise $1-billion – $500-million in research grants and $500-million from donors – to fund personalized cancer medicine. The Toronto General and Western Hospital Foundation is in the midst of a five-year push to raise $600-million for redevelopment, recruitment and facility upgrades. Mount Sinai Hospital is in the preliminary stages of planning a $500-million drive to pay for redevelopment. After just finishing a $100-million campaign, the Centre for Addiction and Mental Health says it will need to raise an additional $200-million in the next five years. Meanwhile, the Hospital for Sick Children has set $115-million as the target it needs to raise annually. This is the tip of the iceberg; About two dozen other hospitals and health-care centres across the Greater Toronto Area have their own fundraising drives.

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"It's an exciting period," said Mark Gryfe, president and CEO of the Mount Sinai Hospital Foundation. "The bar has been raised so high by the donors that have stepped forward."

But the extraordinary fundraising goals being set assume donors will continue to come through, despite being inundated like never before by competing hospitals across the city. Many foundation executives acknowledge they have deep concerns that donor fatigue, when people simply can't or won't give any more, will be the result of these zealous campaigns. While there is optimism that Toronto's deep pockets, combined with its philanthropic spirit, will rise to the challenge, there's one nagging question in the background of every charity run, event gala and direct mail brochure: Is hospital fundraising going too far?

Medical advances fuel the drive for dollars

About 10 years ago, Emmanuelle Gattuso was told she might have breast cancer. Like thousands of other women, she had to wait weeks for the diagnosis to be confirmed, a time of significant anxiety and uncertainty. When the news finally did come, it wasn't good: Ms. Gattuso did indeed have cancer. She received treatment at Princess Margaret Hospital and recovered.

A few years later, she heard an oncologist at the hospital, David McCready, was spearheading a pilot project to deliver breast cancer diagnoses and treatment plans in a single day.

"I was just blown away by this concept," Ms. Gattuso said. "Why haven't we done it before, frankly?"

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The answer then, as now, was money.

Hospitals have a commitment to deliver the necessary services to patients and Ontario has a reputation for providing high-quality care. But limited public funds and an onslaught of growing demands makes it impossible for every department in every hospital to have the newest and best equipment, staff the brightest minds in the field or provide cutting-edge, experimental therapies.

Enter philanthropy.

In Ms. Gattuso's case, she and her husband, Allan Slaight, decided to donate a total of $13.9-million to fund Princess Margaret's rapid diagnostic centre and personally led a fundraising drive to raise millions more. The Gattuso Rapid Diagnostic Centre has helped hundreds of patients and is continuing to expand.

The impact those donations are having on the lives of patients is at the heart of the pitch hospitals are making.

"The reality of why you're seeing more and more fundraising is because we want our public institutions to be absolutely world class and there is a role for private philanthropy to play in that," said Ted Garrard, president and CEO of the SickKids Foundation. "Were it not for philanthropy, we would not have the kind of worldwide reputation that we do."

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But being a world-class institution isn't getting any cheaper. New equipment, innovative programs and recruitment of top medical minds is an expensive prospect that is driving Toronto's multi-billion-dollar fundraising push. In many ways, the need for money is greater than ever. On the whole, patients are living longer and treatment costs have continued to escalate. And important advances in medicine, hospital design and treatment delivery are quickly dating many institutions. Public money will only take hospitals so far, especially in an era of austerity.

As a result, hospitals have had to adapt their approach. Campaigns have become more aggressive and the sheer number of money-raising walks, rides, tournaments and other activities has exploded.

Fundraisers have also become increasingly adept at targeting existing and potential donors by bringing them for visits to patient wards or laboratories where their money is put to work. They'll even ask donors to introduce them to their social networks.

"I think, in general, the whole sector has become more sophisticated in that regard," Mr. Hoscheit said.

Now foundation executives across the country are looking to crack the latest golden egg: social media.

Although it's a great way to boost awareness or create engagement with the community, translating that communication into donations isn't easy.

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"I think we are all still challenged to find out how we can get people to use online giving and social media as a way to, if you will, invest in our organization," Mr. Garrard said.

But what about the risks? Hospital fundraising campaigns have become an incessant year-long event with appeals coming in the mail, online, on the radio and TV. Yet, as the fundraising pitches become increasingly enormous in size and scope, so too grows the worry that potential donors are beginning to tune out.

Pushing the personal connection

Making the appeal personal is how many fundraisers are trying to cut through the noise of a saturated marketplace.

When Ed Clark, CEO of Toronto-Dominion Bank, makes a fundraising pitch, he does it as a businessman. Mr. Clark, the honorary chair of Women's College Hospital's $70-million capital campaign, doesn't ask potential donors to write a blank cheque; he tells them about the new virtual ward that provides at-home care to patients who are at high risk of hospital readmission, which results in better health outcomes and major cost savings.

"It's not hard to get people excited about that," Mr. Clark said in a recent interview.

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The stories of how philanthropy dollars can make a difference are the key to reaching fundraising goals, Mr. Clark said.

Overcoming so-called donor fatigue requires a similar pitch. As long as the city's wealthy class is advocating for lower taxes or grumbling that governments shouldn't be making cuts to reduce the deficit, there is no excuse for not giving money to make our public institutions better, argues Mr. Clark.

"You can be overwhelmed [by requests for donations] or you can be overwhelmed by how much wealth was created for the top one per cent or five per cent in the last 15 years," Mr. Clark said. "The money is there. What you have to do is aggressively go after it by making people feel they can make a difference."

But it's not a lack of money that many fundraisers fear. The concern is that people are so sick of being asked, they'll stop responding.

"I think people are tuning out because they're asked so much," said Sherri Freedman, chief development officer at the Princess Margaret Hospital Foundation. "And people do talk about that a lot."

"It always seems like people are saying 'When is it going to end? When is enough too much?'" said Mount Sinai's Mr. Gryfe.

Despite this, he remains optimistic that the city's fundraising goals are not exceeding the donor pool's capacity to give.

"I've been in the business for 35 years and as long as I can remember, people thought we had reached the limit, and then someone steps forward and raises the bar. It's remarkable."

For people like Mr. Walker, there are limits to how much he can give. He has enough in the bank to provide for his children and plans to make at least one more donation to a hospital that treated his wife. And try as they might, all of the requests hospital fundraisers send to him each week won't change his mind.

"I'd rather make a large donation to something and feel good about it," Mr. Walker said. "It means something to me."