After declining for 5 years, the number of physicians Canada is losing to other countries increased by 68% in 2001, reaching its highest level since 1997 (see Pulse column, page 682).
The statistics, compiled by the Canadian Institute for Health Information (CIHI), indicate that the country suffered a net loss of 275 physicians in 2001, with 609 doctors going abroad and only 334 returning. The data were released in August.
“There is no surprise here,” says Dr. Hugh Scully, who is cochairing a federal task force on physician human resources. “Our physicians' expectations are high and, notwithstanding the problems with managed care in the US, the grass is beginning to look greener there.”
Dr. Mamoru Watanabe, a physician human resources expert at the University of Calgary, says it is too early to say whether a trend is developing. “There is a cycle to these migration patterns. We had a peak around 1978 and another around 1995.
“The peak in '95 related to the climate here — there were new rules, restrictions on where you could practise, and so on — and the US was recruiting heavily, particularly family physicians, at the same time.”
Watanabe thinks a “sense of unrest” among Canadian doctors is gaining strength, particularly because they bear the brunt of patient complaints about the health care system. This may be encouraging some physicians to vote with their feet.
Scully says most doctors leaving Canada depart because of a lack of resources, and most head to the US.
“We are losing the equivalent of 2 or 3 graduating classes in 1 year,” he says of the newly released CIHI data, “so yes, this is serious. These are largely our youngest, brightest and most energetic doctors, so the end result is a horrible balance-of-trade loss. I know that 1 year doesn't tell a story, but I find it worrisome.”
Watanabe agrees. “The net loss may not seem high [given Canada's physician population of 58 500] , but you're looking at the output of 3 or 4 medical schools and at people who tend to leave at the peak of their careers.”
And he says it will become more difficult to find replacements in places like South Africa, which are complaining about “physician poaching” by wealthier countries. “There's an ethical component to that now, and we're being asked to stop that sort of raiding.” — Patrick Sullivan, CMAJ