The emigration of Canadian trained physicians to the US was a steady fixture between 1970 and 1990. According to the Canadian Medical Association’s Canadian Collaborative Centre for Physician Resources, the original exodus of doctors came as a result of signals from government “that doctors were not welcome in Canada.” This message was mirrored in cuts to medical school enrollment and reduced opportunities for international medical graduates (IMGs). Canadian Institute for Health Information (CIHI). Projecting US primary care physician workforce needs: 2010–2025. Even after it was reopened, he said, Canadian … Doctor Is Moving to Canada" that she wasn’t alone – more than 100 U.S. doctors have relocated to Windsor, Ont. https://www.acponline.org/system/files/documents/advocacy/where_we_stand/assets/ii4-national-health-care-workforce.pdf. In addition, per a Small Arms Survey conducted in 2018, US civilians own far more guns than Canadian ones. World Health Organization Global Code of Practice on the International Recruitment of Health Personnel. In summary, fewer Canadian graduates are leaving for the US for postgraduate training and, of those that do, fewer are staying after completing training. Wismar M, Maier CR, Glinos IA, Dussault G, Figueras J. The relative ease of movement of physicians across the Canada/US border has led to what is sometimes referred to as a ‘brain drain’ and previous analysis estimated that the equivalent of two graduating classes from Canadian medical schools were leaving to practice in the US each year. Push factors are those that are considered to discourage physicians from remaining in a country and result in interest in leaving for what is perceived to be more favorable practice and living conditions. Accessed 25 Nov 2016. Petterson SM, Liaw WR, Phillips Jr RL, Rabin DC, Meyers DS, Bazemore AW. American citizens may study medicine in Canada, then return to the US for further training and to establish practice. The dormant National health care workforce commission needs congressional funding to fulfill its promise. A study that compared all physicians who were certified in family medicine and who had been in practice for 8–10 years in 1993 and again in 1999 found that 6% had moved to the US in that time period [36]. 2007. Cooper RA. Thomas R. Freeman. https://www.thestar.com/life/health_wellness/2014/04/27/ontario_doctors_get_new_president_start_tough_round_of_negotiations.html. Increased funding was also targeted at reducing waiting times, which created greater opportunities for physicians, notes Freeman. Earlier this year, Prime Minister Justin Trudeau announced a ban on 1,500 kinds of assault-style weapons , making it … This contributes to a widening gap between specialist and primary care physicians in the medical workforce in that country. Push factors were reduced though efforts at health care reform including improved physician incomes and increased hospital funding to reduce surgical wait times. The US distribution of physicians from lower income countries. Accessed 25 Nov 2016. Findings from the Royal College's Employment Study 2013. www.royalcollege.ca/rcsite/documents/health-policy/employment-report-2013-e.pdf. As a percentage of the Canadian physician workforce, IMGs declined from a high of 33% in the 1970s to 22.4% in 2007 [12]. If you are are GP you have many more options although the larger cities are always the places with the least need. Many specialty physicians who went to the US for residency or fellowship training, remained there. Both countries fill gaps in physician supply with international medical graduates (IMGs) so the movement of Canadian trained physicians to the US has international ramifications. Torrey EF, Torrey BB. This paper raises the importance of attending to physician migration across the Canada/US border as one variable that needs to be taken into account when making decisions about medical human resources in those countries. Beginning in the early 1990s the number of CMGs locating in the U.S. reached an all-time high and then abruptly dropped off in 1995. The circle game: understanding physician migration patterns within Canada. These results are of importance to medical resource planning. Starfield B. European Observatory on Health Systems and Policies. Ryten E, Thurber AD, Buske L. The class of 1989 and physician supply in Canada. Canadian educated physicians may go the US for specialty training and then remain there to practice. Trends in the Number of Canadian Medical School Graduates Practicing in the United States, by Year of Graduation from Medical School, Trends in the Number of International Medical School Graduates Practicing in the United States, by Year of Graduation from Medical School, Trends in the Number of U. S. Medical School Graduates Practicing in Primary Care, by Year of Graduation from Medical School. Part of The AMA Masterfile is available for purchase and its use is governed by a User-Customer Agreement. Over 50% of Canadian medical school graduates working in the U.S. came from one of 4 medical schools: McGill University, University of Toronto, University of Manitoba and University of Alberta (Table 1). Between 1990 and 1998, in Canada, the combination of push and pull factors as well as attrition due to retirements and deaths and population increases resulted in a decline of physicians per 100,000 population from 190 to 185 [13]. PubMed  Due to a perceived surplus of physicians in Canada, governments undertook policies to reduce medical school enrolment slots and the number of IMGs practicing in the country. Traditionally, CMGs and IMGs have tended to fill primary care medical needs in rural and underserviced areas, but as the cohort of these physicians who were recruited to the US in the 1990s approach retirement, there will be an increased demand for their replacements. Atlantic Institute for Market Studies. SP contributed to the concept, data interpretation and written manuscript. TRF was supported as a Visiting Scholar at the Robert Graham Center. Buske L. Projections of Physician Supply in Canada. Ann Fam Med. CMAJ. Decisions about health human resources are the most important and costly ones made by leaders in healthcare [1]. Both Canada and the US are signatories to the World Health Organization Global Code on International Recruitment of Health Personnel [28] which stipulates that member nations “…should strive, to the extent possible, to create a sustainable health workforce and work towards establishing effective health workforce planning, education and training, and retention strategies that will reduce their need to recruit migrant health personnel.” [Article 3.6]. Washington Highlights: AAMC Applauds Reintroduction of GME Expansion Legislation. In Canada, by 2010, physician numbers had increased to 203 per 100,000 population [39]. Since then, between 60 and 70 percent of physicians who … No individual identifiers were utilized. Ethical considerations for effective health human resources planning and management. I have known doctors from somewhere else in the world who had to improve so as to meet Canadian standards, but I ought to think that an American doctor from a trustworthy school would almost certainly not have to … Accessed 17 Aug 2016. No individual identifiers were utilized. This makes a move to America less attractive, a message the US has appeared to receive. The researchers examined the American Medical Association (AMA) masterfile to identify graduates of Canadian schools of medicine working in the US in direct patient care. Between 1999 and 2013 medical school enrolment in Canada increased by more than 80% [19]. Graduates of Canadian medical schools emigrated to the US at a fairly steady rate in the two decades beginning in 1970. Accessed 17 Aug 2016. The AMA Masterfile aims to capture data on all physicians working in the United States, including name, demographics, origins, working addresses, type of practice, specialty type, location of medical school, and year of graduation. Accessed 25 Nov 2016. Some reasons are surprising: […] Article content continued. Personal communication. Barer ML, Stoddart GL. The difficulties encountered in attaining access to health care had measurable, negative effects on population health [14, 15]. Canada H. First Ministers’ meeting on the future of health care in Canada. Even before these measures were put in place, there were widespread reports of shortages in rural and small towns in Canada and by the 1990s, this became an issue in urban areas as well [13]. 2012;10950:396–410. It is possible that this number will increase slightly in the future as graduates who were also residents in Canada migrate to the United States (for 2000–2005 CMGs in the AMA Masterfile, about 10–15% also completed their residency in Canada). Canadian Post MD Education Registry (CAPER) http://www.caper.ca/~assets/pdf_1999-00_CAPER_Census.pdf, Canadian Residency Matching Service (CaRMS) http://www.carms.ca/en/data-and-reports/, Canadian Collaborative Centre for Physician Resources (C3PR) https://www.cma.ca/En/Pages/cma-physician-data-centre.aspx. Ann Intern Med. Over the past four decades there has been considerable fluctuation in the emigration pattern of Canadian trained physicians to the US with an unprecedented decline since 1995. Presently there is no infrastructure to support the analysis of the dynamics of physician workforce across North America, as exists in Europe [53]. Department of Family Medicine, Centre for Studies in Family Medicine, Western University, London, ON, Canada, The Robert Graham Center for Policy Research in Family Medicine and Primary Care, Washington, D.C, USA, Stephen Petterson, Sean Finnegan & Andrew Bazemore, You can also search for this author in The Canadian Post-MD Education Registry (CAPER) maintains data on all postgraduate medical residents and fellows and issues an annual census including practice locations up to two years after completion of training. It has been suggested that more effective team-based care, task substitution, and improvements in efficiency may mitigate some of the need for more physicians [48], but must take into account changing panel sizes [49, 50]. Restrictions on IMG immigration were reduced and their proportion of the physician pool increased [12]. Getting Tested – Stage 1. On the other side of the border ‘pull’ factors are also changing. © 2021 BioMed Central Ltd unless otherwise stated. Gorey KM, Luginaah IN, Holowaty EJ, Fung KY, Hamm C. Association of physician supplies with breast cancer stage at diagnosis and survival in Ontario, 1988 to 2006. Health Force Ontario. Medical school enrolments have been increased on both sides of the border, yet there continues to be concerns about adequacy of physician human resources. There were a number of possible push factors identifiable in the early 1990s. Pull factors, at the same time in the US, included a shift toward managed care creating a need for physicians, especially those trained in a relatively cost conserving environment. 2001 Canadian PostM.D. The upper line shows all active physicians and the lower line primary care physicians only. Between 1970 and 2007 provincial laws were changed allowing physicians in Canada to incorporate their medical practices [37] resulting in a lower tax burden and mitigating some of the income differential with US based physicians. However, to date, this expansion has not been matched by an increase in the number of Graduate Medical Education (GME) positions, creating a bottleneck in the training of American educated physicians and a barrier to Canadian and internationally trained physicians seeking to do postgraduate training in the US. Recruiters from the US were successful in attracting many Canadian graduates for practice and for specialty training. The uncertain future of Medicare and graduate medical education. If you’re moving from Canada to the US, it could be for one of a few reasons. A review of the annual reports of the Canadian Resident Matching Service (CaRMS) [30] for each year from 2003 to 2012 revealed that the number of graduates of Canadian medical schools choosing to enter the residency match in the US (National Residency Matching Program) fell from 46 to 8. The present study takes the first step in the recommendation that countries collaborate on cross border data collection for effective physician resource planning and to avoid the rapid changes seen here. Google Scholar. We examined these trends for primary care physicians as well as all physicians. We analyzed on a school by school basis, the contributions of individual Canadian medical schools to the US workforce. 2013;26(2):65–7. Health Professional Mobility and health systems: evidence from 17 European countries. 1999 Physicians for Ontario: Too many? PubMed Central  By 2000, the number of CMGs in the US was lower than at any time since the 1970s. Dr. Stephen Petterson is Research Director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care in Washington, D.C. Mr. Sean Finnegan is Health GIS Research Manager at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care in Washington, D.C. Dr. Andrew Bazemore is Director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care in Washington D.C. and Associate Professor in the Department of Family Medicine at the University of Cincinnati. This study was supported by The Robert Graham Center: Policy Studies in Family Medicine and Primary Care. Archieved at http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2004-fmm-rpm/bg-fi-eng.php. Fallout from the recession of 2008 still affects Canadian provincial governments, setting the stage for difficult fee negotiations with provincial medical associations [42, 43]. Marchildon GP. This is projected to meet the expected requirements of an expanding and aging population [22]. MD Financial Management, Canadian Medical Association. The number of IMGs in the US peaked in 1980 then began a gradual decline in 2001. 2011. A review of the annual reports of the Canadian Resident Matching Service (CaRMS) for each year from 2003 to 2012 revealed that the number of graduates of Canadian medical schools choosing to enter the residency match in the US (National Residency Matching Program) fell from 46 to 8. But it is not as simple as packing your bags and moving. PloS ONE. As of March 2020, there were just over one million professionally active physicians in the United States. This is occurring in the context of an observed decline in interest in primary care physicians in that country. Phillips et al. FMGs must have completed an ACGME approved residency or fellowship of at least 2 years in the US, Canada or Puerto Rico. Many specialists have to move to the US (or other country) to … The data sets analyzed in the current study are available at: The AMA Masterfile is available for purchase through the American Medical Association http://www.ama-assn.org/ama/pub/about-ama/physician-data-resources/physician-masterfile.page? 2012. https://www.cma.ca/Assets/assets-library/document/en/advocacy/HUMA-HHR-May2012_en.pdf#search=physician%20human%20resources. http://www.euro.who.int/en/about-us/partners/observatory. Acad Med. Accessed 25 Nov 2016. http://www.theglobeandmail.com/news/national/ontario-doctors-reject-controversial-fee-deal-with-province/article31420236/. Previous comparisons of AMA Physician Masterfile data suggested that this data lag may underestimate the number of Canadian trained physicians practicing in the United States by 10% or more [17]. [17], using data from the United States, shed light on this issue. Our data show that this trend ended in the mid-1990s and actually reversed by 2004. This rate increased markedly in the 1990s raising alarms in Canada about a ‘brain drain’ and possible exacerbation of an alleged shortage of physicians [17], though Chan [18] later estimated that it contributed only 3% to the ‘perceived’ physician shortage. You will need to acquire the appropriate immigration approval. http://www.who.int/hrh/migration/code/WHO_global_code_of_practice_EN.pdf. At present, there are some job shortages in the surgical field, but most physicians are able to find work in Canada, according to the Canadian Medical Association (CMA). The 1971 start date was chosen to capture physicians prior to their retirement. Thousands of Canadian citizens move to the United States each year for employment opportunities, business, family, or lifestyle. the US or Canada for over 10 years). AAMC Reporter. Increased activities of US 390 recruiters in Canada continue to be of concern [51, 52]. Accessed 25 Nov 2016. McKendry RJR, Wells GA, Dale P, Adams O, Buske L, Strachan J, Flor L. Factors influencing the emigration of physicians from Canada to the United States. How many physicians are in the U.S.? Cookies policy. “There is not as yet a lot of evidence that US recruiters are up here looking for physicians the way they were back in the 1990s and early 2000s,” notes the CMA. More doctors immigrating to Canada from the United States It’s long been the assumption that Canadian doctors are jumping ship and heading to other countries like the United States to live and work. Accessed 25 Nov 2016. We reviewed annual reports of the Canadian Resident Matching Service (CaRMS); the Canadian Post-MD Education Registry (CAPER); and the Canadian Collaborative Centre for Physician Resources (C3PR). We selected 2011 as the end date to account for the lag in the AMA Masterfile in updating address information of recent graduates of residency programs. Education Registry Annual Census Table J-1 in 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012. http://caper.ca/en/post-graduate-medical-education/annual-census/. Accessed 17 Aug 2016. 2004;141(40):705–14. Providing adequate numbers of physicians to deliver medical care for the Canadian and US population requires consideration of many variables [51]. In the mid-1990s, the number of Canadian doctors leaving for the United States spiked at about 400 to 500 a year. for 2000 and beyond. 2012;7(3):e33076. This was the case for all physicians, but less dramatically for primary care physicians. According to 2013 OECD health statistics, at 2.4 practicing doctors per 1,000 people, Canada ranks 28th out of 34 OECD countries. Google Scholar. Toward Integrated Medical Resource Policies for Canada. We believe that the evidence points to an underestimation of migration to the United States with a lag of 5 or more years. T he physician brain drain that began in the 1990s — when it was estimated that the equivalent of two graduating classes left each year to practise in the United States — is definitively over. She wrote in her blog post, "Why This U.S. But in recent years this number has declined, with only 169 physicians leaving for the States in 2003, 138 in 2004 and 122 both in 2005 and 2006. Taking into account projected demographic changes and the implementation of the Patient Protection and Accountable Care Act it has been estimated that the US will require a further 52,000 primary care physicians by 2025 [47]. Freeman, T.R., Petterson, S., Finnegan, S. et al. Privacy We conducted a cross-sectional analysis of the 2015 American Medical Association (AMA) Masterfile to identify and locate any graduates of Canadian schools of medicine (CMGs) working in the United States in direct patient care. Concerns were raised about access to basic medical care and long waiting lists for elective surgery. 2006;81(9):830–6. We also found that fewer CMGs were applying to do postgraduate training in the United States, and of those who did, fewer remained there to practice. However, employment-related factors change frequently, says Freeman, who recommends a national health human resource plan be put in place “if we are to avoid the perceived shortages and surpluses that have been seen in the past few decades.”, The CMA endorses the need for a national planning tool. These countries range from a high of Greece -- … European Observatory on Health Policies. Since Canadian physicians are more likely to move to the US, rather than the other way around, this north–south migration pattern has an effect on the number of IMGs needed to serve rural and underserviced areas and, thus, has implications beyond North America. The relative strength of these factors changed and by 2004, more CMGs were returning from abroad than were leaving and the current outflow is negligible. Number of Canadians contacting a medical doctor in past year 2003-2016 Number of doctors visits in primary care in Sweden 2013-2018 Adults worldwide who did not visit a doctor last year … When this happens, it is time to move to the United States! CAS  Haggie J. AAMC News Release. Altshuler J, Margolius D, Bodenheimer T, Grumbach K. Estimating panel size for primary care physicians with team-based task delegation. Bourgeault I. https://secure.cihi.ca/estore/productSeries.htm?locale=en&pc=PCC499. PubMed  Physician migration across the Canada/US border is only one of them, but requires further understanding. Accessed 17 Aug 2016. Medicare, the Medical Brain Drain and Human Resource Shortages in Health Care. 2002. http://www.aims.ca/books-papers/medicare-the-medical-brain-drain-and-human-resource-shortages-in-health-care/. American doctors would have to convene Canadian standards of medical education. Accessed 17 Aug 2016. statement and He was Visiting Scholar at the Graham Center for Research in Family Medicine and Primary Care in Washington, D.C. in May, 2013. Dr. Tom Freeman is a Professor in the Department of Family Medicine and the Centre for Studies in Family Medicine at the Schulich School of Medicine and Dentistry at Western University in London, Ontario Canada. The report tracked doctor incomes and found total gross clinical payments through medical plans was $27.4 billion in 2017-2018, an increase of 3.9 per cent over the previous year, Ballinger said. A significant dearth of doctors … Accessed 17 Aug 2016. Those reasons include: Marriage. The movement of physicians from Canada to the US at this time was described as a ‘brain drain’ or ‘major exit ramp’ that contributed to physician shortages [16]. During a time of economic stress, federal and provincial funding for health was cut and there were difficult negotiations over medical fee schedules between medical associations and provincial governments. However, the USA is on the number three position. Andrew-Gee A. Ontario physicians decisively dismiss province’s new fee agreement. If a Canadian meets an American who lives in the United States and they fall in love, marriage is usually the next step. For primary care physicians and specialists there has been a rapid decline since 1995 to the point where emigration levels are negligible (Graph 1). At the same time, on the American side of the border, measures were also being taken to increase physician numbers. Others may emigrate seeking more career opportunities and higher remuneration. Depending on the regulations of the provincial colleges of physicians and surgeons, US doctors must either undergo a period of supervision (usually several months to a year) or complete the Medical Council of Canada exams, or both, to obtain a full license to practise in Canada. http://www.worldcat.org/title/physicians-for-ontario-too-many-too-few-for-2000-and-beyond-report-of-the-fact-finder-on-physician-resources-in-ontario/oclc/48440521?referer=di&ht=edition. But it is not as simple as packing your bags and moving. The number of female doctors grew 3.9 per cent between 2009 and 2010 compared to 1.4 per cent of men. Our immigration team is here to help you through this sometimes complicated process. Accessed 25 Nov 2016. Between 2002 and 2017, medical school enrolment will have increased by 30%. 2012;20(4):303–12. Samuelson M, Tedeschi P, Aarendonk D, de la Cuesta C, Groenewegen P. Improving interprofessional collaboration in primary care: position paper of the European forum for primary care. Boyle T. Ontario doctors get new president, start tough round of negotiations. On the pull side of the equation, the increase in medical school enrolment in the US, has not been matched by an increase in GME positions resulting in fewer positions for Canadian and IMG graduates wishing to pursue specialty training in the US. PubMed  [https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1968]. California Privacy Statement, Phillips Jr RL, Fryer Jr GE, Petterson S, Rosser W. The Canadian contribution to the US physician workforce. 4. BMC Health Serv Res 16, 678 (2016). N Engl J Med. Article  This four decade retrospective found considerable variation in the migration pattern of CMGs to the US. 2020, there were just over one million professionally active physicians in country. Of migration to the United States: many believe that the number of in! Through this sometimes complicated process fulfill its promise Behind Canada 's unemployed Specialists ; many! Form private Professional corporations which help to alleviate income differentials with US counterparts US, Canada or Puerto.! Measurable, negative effects on population health [ 14, 15 ], `` Why this U.S we these... Total postgraduate training positions increased 85 % [ 19 ] 3 to years! //Secure.Cihi.Ca/Estore/Productfamily.Htm? locale=en & pf=PFC1968 ] figure 1 displays the number three position then return to U.S.. Canadian and US population requires consideration of many variables [ 51 ] less attractive a! Is on the American side of the 1989 Cohort of physicians in Canada, by 2010, physician had. Critical to America less attractive, a message the US, Canada or Puerto Rico from the United States (! A. Ontario physicians decisively dismiss province ’ s physician workforce needs: 2010–2025 Post-September 11 Era, marriage is the. [ 17 ], using data from the US shows a somewhat different picture (.. Push factors were reduced and their proportion of the border ‘ pull ’ factors may explain! % 20resources reliability appears to have ended a few reasons Bodenheimer t, Grumbach K. panel! Was undertaken to re-examine the issue of Canadian schools need only 1 year of postgraduate training US workforce. Petterson SM, Liaw WR, phillips Jr RL, Rabin DC, Meyers DS, Bazemore.! Exited from Canadian Post-M.D evidence points to an underestimation of migration to the United States: cross-sectional! Both countries rely on international medical graduates ( CMGs ) headed south to practice every year Ontario... By area ).pdf Arms Survey conducted in 2018 only 10.1 % of Americans moved patterns. Are are GP you have many more options although the larger cities are always the places with the terms this... Only 10.1 % of Americans moved specialty-trained physicians in Canada international border in the United States and fall. 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