Canada Training Ground For US physicians

The problem is much less than for third world countries that can ill afford to train physicians in the first place. As the article mentions there are now more coming back to Canada than new ones exiting to the US.
As well as carrots surely sticks could be used to discourage exiting physicians. Medical education is state subsidized. If the physician exits he or she could become liable to pay part or all of this subsidy as a condition of working in another country. This could be made a condition of entrance to medical school.
I wonder how many US trained physicians practice here. I imagine there are actually quite a few.


Canada a training ground for U.S. medical industry: Study
Last Updated: Tuesday, April 10, 2007 | 8:58 AM ET
The Canadian Press
One in nine trained-in-Canada doctors is practising medicine in the United States, says a study published in Tuesday's issue of the Canadian Medical Association Journal.

If Canadian-educated doctors who were born in the U.S. are excluded, the number is one in 12 — and the study suggests that luring back some of these Canadian physicians would go a long way toward solving the country's doctor shortage.

While they admit the exodus has abated a bit in the past couple of years, the authors say the impact is as if two averaged sized medical schools in Canada were doing nothing but training doctors for the United States.

There are only 17 medical schools in this country.

"I must admit that I was sort of knocked over by the numbers. They were a lot bigger than I'd anticipated," said one of the authors, Dr. Walter Rosser, chief of the department of family medicine at Queen's University in Kingston, Ont.

'I must admit that I was sort of knocked over by the numbers. They were a lot bigger than I'd anticipated.'
—Dr. Walter Rosser, Queen's UniversityThere were 8,162 Canadian-educated doctors providing direct patient care in the U.S. in 2006, the study said.

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Nearly half of the Canadian-educated physicians in the U.S. graduated from three medical schools — McGill University (24.7 per cent), the University of Toronto (15.2 per cent) and the University of Manitoba (eight per cent).

Canadian-educated specialists practising in the U.S. in 2006 represented nearly 20 per cent of the Canadian specialist workforce.

Of the Canadian doctors working in the States, 1,023 were in rural practices. Many parts of rural Canada are in dire need of doctors and finding a way to draw some of those people back home would be a major bonus, the study suggested.

Luring doctors home
"I still believe that there's a lot of opportunity to get some of these folks back," said Rosser, who noted he's recently recruited a husband-and-wife team of Canadian doctors from Ohio, where they have been practising.

"Generally, they're very unhappy," he said of Canadians in family practice in the U.S. "In fact, they're much more unhappy than family doctors here."

"And so it seems to me they're ripe for the picking."

And luring back Canadian doctors home from the U.S. doesn't pose the ethical quandaries associated with recruiting doctors from developing countries, a form of medical "poaching" that has been widely criticized but which is still widely done by developed countries.

The president of the Association of Faculties of Medicine of Canada said political authorities have to figure out what's behind the exodus to the U.S. — and do their best to stem the tide.

"We need to further understand the reasons for this ongoing loss and find ways to encourage these physicians to practise in Canada," Nick Busing said in a guest editorial in the journal.

Rosser and his co-authors suggested provincial governments ought to consider offering incentives to attract Canadian-educated doctors back to Canada. The former head of the division of family medicine at the University of Toronto, Rosser had become tired in the 1990s of watching his students head south of the border. In 1997, he recalled, all eight family medicine graduates in one program went to the United States to practise.

It was a time when governments were talking about restricting where new doctors could set up shop and doctors were feeling disenchanted and underappreciated, he said.

In talking with some colleagues in the U.S., Rosser realized with their help he could tap into the American Medical Association's physician masterfile, which lists all doctors living in the U.S. From the data set, they could tell which medical school each doctor graduated from as well as the doctor's nationality.

Looking at patterns from 1995 onward, they could see that the return migration of Canadian doctors outnumbered those leaving for the first time in 2004 — 262 left and 317 returned.

Rosser believes the tide has turned, though he acknowledges Canada will always lose some doctors — in particular specialists looking to work in world-renowned centres of excellence elsewhere. But changes in policies at the provincial level have made practising in Canada more attractive, he said.

"I think we're in a much better position and I think we're going to find the doctor shortage is going to reverse fairly quickly, within three or four years, hopefully."