Canadians seek treatment abroad The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in … However, only about 170,000 new nurses were licensed in the United States in 2018, the latest year for which data is available. [17], using data from the United States, shed light on this issue. A Doctor for Every Canadian-Better Planning for Canada’s Health Human Resources: The Canadian Medical Association’s brief to the House of Commons Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities-Addressing Existing Labour Shortages in High-Demand Occupations. 1999 Physicians for Ontario: Too many? The emigration of Canadian trained physicians to the US was a steady fixture between 1970 and 1990. Difficulty finding suitable employment for recently trained specialists, in part due to reduced hospital funding, all contribute to a potential increase in ‘push’ factors. This pattern peaked in 1995. 2011. 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… Available at: https://www.cma.ca/Assets/assets-ibrary/document/en/advocacy/Projections_paper-e.pdf. Cooper RA. By 2000, the number of CMGs in the US was lower than at any time since the 1970s. All authors read and approved the final manuscript. Andrew-Gee A. Ontario physicians decisively dismiss province’s new fee agreement. The AMA Masterfile is available for purchase and its use is governed by a User-Customer Agreement. In summary, fewer Canadian graduates are leaving for the US for postgraduate training and, of those that do, fewer are staying after completing training. Dr. Freeman was supported as a Visiting Scholar at The Robert Graham Center. Google Scholar. for 2000 and beyond. 2011;365(14):1340–5. N Engl J Med. Skinner BJ. Chan TB. 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. ‘Push’ and ‘pull’ factors may help explain these changes. On the other side of the border ‘pull’ factors are also changing. Accessed 17 Aug 2016. Accessed 25 Nov 2016. Haggie J. http://www.euro.who.int/en/about-us/partners/observatory. Canadian Medical Education Statistics 2014, Table 9. https://www.afmc.ca/sites/default/files/documents/en/Publications/CMES/Archives/CMES2014Vol36.pdf. 2013. When this happens, it is time to move to the United States! That rate has continued to decline, notes Freeman, who is also a professor at the Schulich School of Medicine and Dentistry in London, Ont. 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]. Google Scholar. By using this website, you agree to our There are limitations in measuring migration patterns, especially for non-respondents and in the years closest to graduation from residency training. 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. World Health Organization Global Code of Practice on the International Recruitment of Health Personnel. European Observatory on Health Policies. Barer ML, Stoddart GL. This analysis was undertaken to re-examine the issue of Canadian physician migration to the US. The difficulties encountered in attaining access to health care had measurable, negative effects on population health [14, 15]. MD Financial Management, Canadian Medical Association. Shifting tides in the emigration patterns of Canadian physicians to the United States: a cross-sectional secondary data analysis. 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. 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? Ottawa: Canadian Institute for Health Information; 2002. As well, physicians were allowed to form private professional corporations which help to alleviate income differentials with US counterparts. Torrey EF, Torrey BB. We examined trends in the number of Canadian medical school students who graduated from 1971 to 2011 and were located in the United States. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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. [17]. Physician migration across the Canada/US border is only one of them, but requires further understanding. These trends reveal that there has been a decline in the total number of Canadian graduates and IMGs moving to the US, including primary care physicians. Google Scholar. Push factors were reduced though efforts at health care reform including improved physician incomes and increased hospital funding to reduce surgical wait times. Canadian Resident Matching Service R1 Match Reports, 2003,2004,2005,2006,2007,2008,2009,2010,2011,2012. http://www.carms.ca/en/data-and-reports/. Family doctors saw the greatest pay increase: more than $1.5 billion collectively between 1992/93 and 2009/10. 2010;56(6):612. Others may emigrate seeking more career opportunities and higher remuneration. Training Programs. Iglehart JK. The information and opinions contained in research from The Graham Center do not necessarily reflect the views or the policy of The American Academy of Family Physicians. 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. [file:///C:/Users/tfreeman/Downloads/visa_report%20(2).pdf. This makes a move to America less attractive, a message the US has appeared to receive. Islam N. The dilemma of physician shortage and international recruitment in Canada. The primary care workforce: ethical and policy implications. Accessed 17 Aug 2016. Between 1999 and 2013 medical school enrolment in Canada increased by more than 80% [19]. 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. But it is not as simple as packing your bags and moving. Must be graduate of foreign medical school registered with WHO. Freeman, T.R., Petterson, S., Finnegan, S. et al. In Canada, the first decade of the 21st century saw increased medical school enrolment, more postgraduate residency positions and eased restrictions on IMG physicians entering the country. Ann Intern Med. Canadian health system reforms: lessons for Australia? Canadian Post-MD Education Registry (CAPER) Annual Census of Post-MD Trainees 1999–2000 and 2013–2014. These countries range from a high of Greece -- … Dilkens was working at the Canadian Consulate in Detroit on Sept. 11, 2001, when the United States unilaterally closed its northern border. Phillips Jr RL, Fryer Jr GE, Petterson S, Rosser W. The Canadian contribution to the US physician workforce. Getting Tested – Stage 1. The 1971 start date was chosen to capture physicians prior to their retirement. 3. This four decade retrospective found considerable variation in the migration pattern of CMGs to the US. The data used in this study were derived from publicly available sources. American citizens may study medicine in Canada, then return to the US for further training and to establish practice. Supply, distribution and migration of Canadian physicians. 2004;141(40):705–14. The circle game: understanding physician migration patterns within Canada. 2005;353:1810–18. It also prevents a clear picture of how migration has changed for three or more years. Washington Highlights: AAMC Applauds Reintroduction of GME Expansion Legislation. Gutkin C. The Yankees are coming! 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. Migration Policy Institute 2005. Though small, the population of Canadians in the United States is quite diverse, and includes students, highly skilled professionals on H-1B or NAFTA visas, family migrants, and retirees. Restrictions on IMG immigration were reduced and their proportion of the physician pool increased [12]. Mullan F. The metrics of the physician brain drain. We limited our analysis to physicians either in practice or in a residency program in the United States as of 2015. Ethical considerations for effective health human resources planning and management. 2013 Association of American Medical Colleges (ACMC); 2013. https://www.aamc.org/newsroom/newsreleases/335244/050213.html. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. These might include opportunities for further training, better living conditions, greater financial rewards, availability of practice positions and political and economic stability. Accessed 25 Nov 2016. CIHI. Our immigration team is here to help you through this sometimes complicated process. Health Aff. Petterson SM, Liaw WR, Phillips Jr RL, Rabin DC, Meyers DS, Bazemore AW. 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/. Article  CMGs are going to the US for post-graduate training in smaller numbers and, are less likely to remain than at any time since the 1970’s. 2009;115(15):3563–70. AAMC May 1, 2015. 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. However, the USA is on the number three position. SF contributed to the data collection and geospatial interpretation. Between 2002 and 2017, medical school enrolment will have increased by 30%. A physician in Canada is paid $260,924 ($339,000 Canadian) for clinical services by the government's Ministry of Health per year on average, according to a report from the Canadian … Google Scholar. 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]. SP contributed to the concept, data interpretation and written manuscript. 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]. 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. AB contributed to the concept, data interpretation and written manuscript. At the same time as the number of US medical graduates has increased, their interest in primary care specialties has declined as shown in Fig. Medical school enrolments have been increased on both sides of the border, yet there continues to be concerns about adequacy of physician human resources. Efforts at primary care reform were undertaken in most provinces and, though differing in detail, were aimed at improving primary care physician income and providing infrastructure funding. 2007. https://doi.org/10.1186/s12913-016-1908-2, DOI: https://doi.org/10.1186/s12913-016-1908-2. 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). Providing adequate numbers of physicians to deliver medical care for the Canadian and US population requires consideration of many variables [51]. Google Scholar. CMAJ. Those reasons include: Marriage. Canadian registration constraints. Thousands of Canadian citizens move to the United States each year for employment opportunities, business, family, or lifestyle. http://www.who.int/hrh/migration/code/WHO_global_code_of_practice_EN.pdf. Buske L. Projections of Physician Supply in Canada. 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. 2001 47(7):1404. 2015. Further analysis suggested that this outflow of physicians was only a minor factor in the shortage of physicians in Canada [18]. Canadian collaborative centre for physician resources, Organization for economic co-operation and development. 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. CAS  Reliability appears to be poorest for the 3 to 5 years immediately after completion of residency training. http://caper.ca/~assets/Papers%20and%20Presentations/pdf_2001_forum_canadian_exits.pdf. A specialist in the USA makes around $230,000 annually, whereas a general practitioner goes home with a $161,000 roughly. CAS  Because of the national and international implications of the emigration pattern of Canadian physicians we decided to re-examine what changes, if any, have taken place in these patterns in years subsequent to Phillips et al. 2013;26(2):65–7. https://www.acponline.org/system/files/documents/advocacy/where_we_stand/assets/ii4-national-health-care-workforce.pdf. Acad Med. There are measures before the US Congress to correct the mismatch between medical school enrolment and GME numbers [44–46], which may attract more Canadian medical graduates seeking postgraduate training to that country. Graduates of Canadian medical schools emigrated to the US at a fairly steady rate in the two decades beginning in 1970. In British Columbia (BC), the government releases a document each year called the Blue Book that shows the amount of money different specific types of physicians earn based on their specializations. 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. 2007;176(8):1083–7. The upper line shows all active physicians and the lower line primary care physicians only. 2012;20(4):303–12. volume 16, Article number: 678 (2016) 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]. They found that as of 2004, there were 8,162 Canadian educated physicians practicing in the US, 2,500 of them in primary care. Both countries have strong medical training systems and maintain harmonized medical education standards through the Liaison Committee for Medical Education (LCME). Accessed 17 Aug 2016. 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 There is evidence of some lag time in accounting for physicians who have migrated. 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. Decisions about health human resources are important and costly [1], yet are frequently made in the context of a lack of reliable data. The US distribution of physicians from lower income countries. 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