One only has to look to Canada for the answer. They're having a hard time keeping Canadian-trained doctors in the country, so are forced to import doctors from India, Pakistan, and many other countries. These doctors are a mix between excellent and dubious in terms of their training and ability.
Canadian Press
August 26, 2005
TORONTO (CP) - When Dr. Kellie Leitch returned to Canada from the United States a few years ago, she joined a growing number of Canadian physicians choosing to come back home to practise. And now, the country's medical brain-drain has been reversed for the first time in 30 years.
For decades, Canada experienced more drain than gain when it came to doctors departing for so-called greener pastures in the United States or countries overseas. But last year, that trend was reversed for the first time, with more doctors returning home than waving bon voyage to the country's shores, a new report shows.
The report by the Canadian Institute for Health Information (CIHI), released Wednesday, shows that 317 physicians returned to Canada last year compared to 262 who left.
The net surplus is the first since the institute began collecting this data in 1969, and is "a continuation in the trend we have seen since the mid-1990s of a decreasing number of doctors leaving Canada for opportunities in other countries," said Steve Slade, co-author of the report.
"That's not happened once on record with our database, and it's a first, a historical year for Canada," he said from Ottawa.
The number of doctors who left Canada stood at 420 in 2000; and in 1994, a whopping 771 physicians crossed the border south or left the country's shores.
Meanwhile, a 24 per cent rise in the number of doctors returning home in 2004, compared with five years earlier, gave Canada's physician workforce the net gain.
Leitch, who attended the University of Toronto's medical school, went to California in 2001 to complete her training in pediatric orthopedic surgery.
There were lots of opportunities in the United States, but Leitch said she jumped at an offer from the University of Western Ontario and returned to Canada in late 2002. Since then, she has been named chair chief of pediatric surgery at the Children's Hospital of Western Ontario.
"The primary reason I returned to Canada . . . is that the Canadian taxpayers paid for my education," Leitch, 34, said from London. Ont. "There is a huge investment in educating, in particular specialist physicians . . . and it only made sense to me that the people who had made that huge investment should benefit from that specialty they've invested in."
Leitch said there are only about 60 orthopedic surgeons for children in Canada, and even one leaving would have a huge impact on patient care.
But she doesn't think returning home makes her unique.
"I think there are a lot of Canadian physicians who were trained in Canada who've gone to the United States and are looking for a reason to come home. I think it's because we have a better quality of life in Canada, I think they see there are opportunities here that weren't available to them in the United States or elsewhere abroad, and that we are a well-supported community."
The report by the Canadian Institute for Health Information (CIHI), released Wednesday, shows that 317 physicians returned to Canada last year compared to 262 who left.
The net surplus is the first since the institute began collecting this data in 1969, and is "a continuation in the trend we have seen since the mid-1990s of a decreasing number of doctors leaving Canada for opportunities in other countries," said Steve Slade, co-author of the report.
"That's not happened once on record with our database, and it's a first, a historical year for Canada," he said from Ottawa.
The number of doctors who left Canada stood at 420 in 2000; and in 1994, a whopping 771 physicians crossed the border south or left the country's shores.
Meanwhile, a 24 per cent rise in the number of doctors returning home in 2004, compared with five years earlier, gave Canada's physician workforce the net gain.
Dr. Ruth Collins-Nakai, president of the Canadian Medical Association, said the return of some physicians may be related to Canada luring back doctors to head or staff high-profile research institutes at universities across the country.
"I guess we're somewhat relieved to see there's a net increase in physicians coming into Canada, although it doesn't really help us in overall numbers," lamented Collins-Nakai. "We are more or less treading water in terms of our overall physician supply."
The CIHI report shows that the number of doctors across the country rose by five per cent between 2000 and 2004 - to 60,612 from 57,803.
But growth in the country's population kept pace during that period, leaving the number of doctors per 100,000 residents relatively stable - a status quo that has not made it easier for Canadians to find a family physician or get access to a specialist.
Collins-Nakai said hundreds more medical school entry positions are needed - and professors to replace those retiring to teach them - if Canada is to even approach self-sufficiency in achieving a physician workforce large enough to serve all Canadians in a timely fashion.
"In order to accomplish that, the medical schools, which are currently bursting at their seams, are going to need increased resources," the cardiologist said from Edmonton.
Complicating efforts to ramp up the number of doctors to meet an aging population's growing demand for both family practitioners and specialists is the concurrent greying of health-care services.
Baldly put, Canada's doctors are getting older. In 2000-2004, the average age of physicians increased by one year, to 49 from 48. During the same period, the proportion of physicians under age 40 dropped by 13 per cent.
"That's like our window into the future, where we see a decrease in the number of really quite recent graduates in Canada," said Slade.
The report also shows that the doctor supply is made up increasingly by women: in 2004, females accounted for almost one-third of physicians, a 10 per cent increase since 2000. Among doctors 40 and under, women made up nearly half in 2004.
But with more female doctors working shorter hours, access to care is not improving for patients, but declining, experts says.
Making matters worse for patients is the expected retirement of more than six per cent of physicians in the next two years, said Collins-Nakai. "And we expect up to one-third of all physicians to be decreasing hours of work.
"Many physicians over the past half or (full) decade have been doing excessive hours of work to provide access to patients," she said. "And we know we've got increased burnout levels among physicians."
- Here are some highlights from the CIHI report on doctors:
-In 2000, 420 Canadian physicians moved abroad compared to 262 in 2004, a 38 per cent decrease.
-In 2000, 256 physicians returned to Canada compared to 317 in 2004, a 24 per cent increase.
-For the first time since 1969, when statistics were first compiled, more physicians returned to Canada than left the country.
-Between 2000 and 2004, the number of doctors in Canada grew by five per cent, a rate that kept pace with population growth.
-Among the provinces, Alberta and P.E.I. had the largest percentage increase in the number of physicians in the five-year period - up by 19 per cent and 18 per cent, respectively.
-In 2000, there were 188 physicians per 100,000 population; in 2004, there were 189 per 100,000.
-The proportion of family physicians to population rose slightly, while the proportion of specialists dropped between 2000 and 2004.
-During 2000-2004, the number of international medical graduates in family medicine in Canada rose 12 per cent, while specialist graduates numbers fell 9.4 per cent.
-The average age of physicians increased by one year from 2000-2004, to 49.
