Number of Canadian doctors leaving for U.S. lowest since 1970s

TORONTO | A new study published in BMC Health Services Research has suggested that the number of Canadian-trained physicians leaving the country to practise in the U.S. has reached a 40-year low.Several Washington-based physicians, one researcher, and one current professor at Western University's medical school in London, Ont. conducted an analysis of the 2015 American Medical Association's Masterfile (a database of education and professional certifications of 1.4 million physicians).They found that in the early 1990s, the number of Canadian medical graduates (CMGs) moving south hit an all-time high. This prompted concerns over a "brain drain," although one later study suggested it was responsible for just 3% of the perceived physician shortage.Then, in 1995, the number of CMGs moving south dropped off abruptly and the pattern has been trending downward ever since.By 2004, there were more CMGs returning to practice in Canada than there were leaving. According to the study, in 2015 there were just 6,709 CMGs directly caring for U.S. patients, which is down from 8,162 in 2005.Today, "the current outflow is negligible" the authors wrote."Just 27 CMGs who graduated between 2009 and 2011 appear in the 2015 AMA Masterfile," though this number will increase slightly in the future as U.S. citizens who trained in Canada return to the U.S. to practice (about 10-15% of American doctors complete their residencies in Canada).The authors identified a few factors responsible for the changes. In the early 1990s, for example, provincial governments agreed there was a surplus of physicians so many began cutting medical school enrolment slots and positions for IMGs. During that same time, economic pressures mounted, health funding was cut and discussions over physician fees became more contentious encouraging physicians to seek work in the U.S. where a shift to "managed care" created new openings.But then in the 2000s these "push and pull factors" were reversed again. Canada's surplus came to be seen as a deficit and that led to an infusion of funding and improved physician pay. On the American side, the attacks of 9/11 resulted in a drop in visas and a shrinking number of positions for new medical graduates, even as medical school enrolment increased."It is important however, to recognize that ‘push-pull’ dynamics are fluid," the authors wrote. Today,they suggested the fallout from the 2008 recession is again making fee negotiations in Canadian provinces difficult which may push doctors away.In the U.S., Congress is attempting to correct the mismatch between medical school enrolment and clinical positions. Other legislative changes may create openings for some 52,000 primary care doctors by 2025—occurring while there seems to be declining interest in primary care among would-be American doctors."Decisions about health human resources are important and costly, yet are frequently made in the context of a lack of reliable data," the authors wrote.

Number of Canadian doctors leaving for U.S. lowest since 1970s

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