Myth: Canadian doctors are leaving for the United States in droves

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Myth Busted June 2001
Busted Again! September 2005
Yet Again! March 2008

Higher incomes, newer equipment and more opportunities - for some Canadian physicians, the United States seems to have it all. i Some critics have long alleged that because of the "exploitative nature of medicare," Canadian doctors cannot resist heading south. ii More recently, some argue that this brain drain is a "major contributor to physician shortages in Canada," iii prompting physician associations and ministries of health to launch campaigns to lure expatriate, Canadian-trained physicians back home. iv Fears of physician losses are further fuelled by reports that the U.S. - renowned for luring more physicians than any other country v - could be short 85,000 doctors by 2020. vi

There's no doubt that Canada - like other wealthy nations - is losing some of its physicians, particularly to the U.S., vii and that this emigration represents a loss for Canadians. However, when it comes to the brain drain, it's nowhere near a mass exodus. At worst, it's more a trickle than a flood.

Entry and exit

Physicians enter and leave the country for a number of reasons. For instance, some Canadian doctors go overseas for medical training, then return home to practise. Foreign medical school graduates may arrive with temporary work visas or as landed immigrants, practise in Canada for awhile, leave, and even decide to return eventually. viii

The Canadian Institute for Health Information charts migration patterns for practising physicians. The data exclude interns, residents and doctors who leave Canada right after graduation without ever working here, but they still provide important information on trends. According to the Institute's data, the gross number of doctors leaving the country hit two peaks in the last 35 years: one in the late 1970s, when we lost between 500 to 600 doctors a year, and another in the mid-1990s, when we lost around 600 to 700 a year. When assessing the brain drain, it's important to consider not only the number of doctors who are leaving, but also the number returning to Canada. This number has been holding fairly steady since 1980, with around 250 to 350 returning per year. Thus, our net loss of physicians is fairly small - since 1980, our annual net loss has never been more than one percent (and averages closer to one quarter of a percent) of all practising physicians. ix, x

In recent years, not only has the brain drain trend slowed, it has actually reversed. In 2004, there was a net brain gain of 85 doctors. Although this gain has decreased as of late - a net gain of 61 doctors in 2005 and 31 in 2006 ix, x - the data still counter popular perceptions that Canadian doctors are leaving in droves.

The data also disprove claims that the brain drain is responsible for Canada's doctor shortage. In 2006, there were 62,307 active physicians in Canada - the highest number ever, largely attributable to a more than five percent increase in Canadian-trained physicians over the last five years. ix The 2006 data also show a five percent increase in physicians between 2002 and 2006, which is just over parity with population growth over the same time. ix

An important issue in all of this is where our doctors are coming from. In 2006, of the 238 returning physicians, about 190 had received training in Canada, while the rest were trained mostly in the UK and Ireland, but also South Africa, India and elsewhere. ix In the same year, international medical graduates accounted for 22 percent (13,715 doctors) of the total physician supply in Canada. ix If this means Canada is "poaching" doctors from countries that have a much more limited ability to train physicians and handle internal crises in population health, then this is a serious public policy problem. xi

Destination U.S.

Of the doctors who are leaving Canada, more than half choose to go to the U.S. ix The Canadian Institute for Health Information has been tracking doctors' destinations only since 1992. Since then, between 60 and 70 percent of physicians who emigrate have headed south of the border. In the mid-1990s, the number leaving for the U.S. spiked at about 400 to 500 a year. However, in recent years, this number has declined, with only 169 physicians leaving for the States in 2003; 138 in 2004; and 122 in each of 2005 and 2006. These numbers represent less than half a percent of all doctors working in Canada.

PHYSICIAN MIGRATION, 1970-2006 IX, X

Popular culture's obsession with the "mass exodus" of Canadian-trained physicians to the U.S. has meant little attention is given to the movement of physicians from one Canadian jurisdiction to another. In particular, physicians appear to be moving "from less prosperous to more prosperous provinces and from rural to urban areas," xii which likely exacerbates real shortages in rural, remote and economically disadvantaged areas.

Conclusion

Over time, annual losses of physicians can add up - if we lose even a handful of physicians each year, in 25 years we will have lost a stock of Canadian-trained doctors. This point merits our attention, for educating our physicians is a costly, time-intensive investment - it costs about $1.5 million to train a doctor, much of which is paid for through taxes. xiii There is also the real concern of physician retention in rural and remote areas. vii To address these problems and ensure Canadian taxpayers are able to benefit from their investment, provincial and federal policy makers should focus on co-ordinated national recruitment and retention strategies to retain and sustain our physician supply in all regions of the country. i

References:

i.Buske L. Canadian Centre for Physician Resources, and Canadian Medical Association. 2007. Analysis of the survey of Canadian graduates practicing in the United States.

ii. Skinner BJ. 2002. Medicare, the medical brain drain and human resource shortages in health care. Atlantic Institute for Market Studies. http://www.aims.ca/library/BrainDrain.pdf

iii. Phillips RL. Jr. et al. 2007. "The Canadian contribution to the US physician workforce." Canadian Medical Association Journal; 176(8): 1083-1087.

iv. The Medical Post. 2007, April 17. "As the Ontario government launches a campaign to bring doctors home, the Medical Post explores what they really want." www.medicalpost.com

v. Mullan F. 2005. "The metrics of the physician brain drain." The New England Journal of Medicine; 353(17): 1810-1818.

vi. Council on Graduate Medical Education. Physician workforce policy guidelines for the U.S. for 2000-2020. Rockville, MD: U.S. Department of Health and Human Services: 2005.

vii. Arah OA, Ogbu UC and Okeke CE. 2008. Too poor to leave, too rich to stay; developmental and global health correlates of physician migration to the United States, Canada, Australia, and the United Kingdom. American Journal of Public Health; 98(1): 148-154.

viii. Barer ML and Webber WA. 1999. Immigration and Emigration of Physicians to/from Canada. University of British Columbia; Centre for Health Services and Policy Research: Health Human Resources Unit paper 99:6. http://www.chspr.ubc.ca/files/publications/1999/hhru99-06.pdf

ix. Canadian Institute for Health Information. Scott's Medical Database (SMDB). 2000-2007. Supply, Distribution and Migration of Canadian Physicians, 1999-2006. http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_14_E

x. Canadian Institute for Health Information. 2008. Aggregate data request.*

xi. Labonte R et al. 2004. Fatal indifference: The G8, Africa, and Global Health. University of Cape Town Press/International Development Research Centre. www.idrc.ca

xii. Dauphinee W and Dale MD. 2006. The circle game: Understanding physician migration patterns within Canada. Academic Medicine. Impact of International Medical Graduates on U.S. and Global Health Care: Proceedings of the 50th Anniversary Invitational Conference of the Educational Commission for Foreign Medical Graduates. 81(12) Supplement: 49-54.

xiii. Valberg LS et al. 1994. "Planning the Future Academic Medical Centre." Canadian Medical Association Journal; 151(11): 1581-1587.

* Part of this document is based on data and information provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions and statements expressed herein are those of the Canadian Health Services Research Foundation, and not necessarily those of the Institute.

Disclaimer:

Mythbusters are prepared by staff at the Canadian Health Services Research Foundation and published only after review by experts on the topic. The Foundation is an independent, not-for-profit corporation. Interests and views expressed by those who distribute this document may not reflect those of the Foundation.