• Phantoms in the snow – ctd.

    Longtime reader of the blog, Steve, reminds me of another pervasive myth of border-crossing medicine.  It’s the idea that docs are flocking from Canada in order to work in more hospitable climates.  Like here.  The idea is that doctors are so fed up in Canada, they are leaving in droves.  You can’t imagine how many people I’ve talked to who claim to know such a doctor.

    It is true that years ago there was a net influx of docs into the US from Canada.  But it was never in the numbers that you would think.  As always, with these kinds of things, actual data can be found.  In fact, the Canadian Institute for Health Information was measuring movement of doctors across the border:

    In the mid-1990s, the number leaving for the U.S. spiked at about 400 to 500 a year. However, in recent years, this number has declined, with only 169 physicians leaving for the States in 2003; 138 in 2004; and 122 in each of 2005 and 2006. These numbers represent less than half a percent of all doctors working in Canada.

    It gets better.  Check out this chart:

    The important line to watch is the yellow one, which is the net loss of docs to Canada.  Even in the worst year, fewer than 500 more docs moved out of Canada than moved in.  But, since 2003, there has been a net movement of docs into Canada.

    Docs are not fed up with Canada and moving away.  If anything, it’s the opposite.

    • Has there been a decline of Canadian natives wanting to be a doctor? In other words, did the decline of doctors coming to the US stem from a decline of new doctors in Canada? People could have been fed up with the system and not become doctors in the first place, causing a decline of people who could come to the US and lead to a need to import doctors.

      I have no idea if this is true at all, just something I thought of when reading this post.

    • Warren,

      This is from the same source I linked to above:

      The data also disprove claims that the brain drain is responsible for Canada’s doctor shortage. In 2006, there were 62,307 active physicians in Canada – the highest number ever, largely attributable to a more than five percent increase in Canadian-trained physicians over the last five years. The 2006 data also show a five percent increase in physicians between 2002 and 2006, which is just over parity with population growth over the same time.

      So short answer, no.

    • Sorry, right after I posted my comment I wondered if the issue was addressed in the link and there it is.

    • I live in Northern California. Pediatricians who work full-time in hospitals make about $100k to start here. In Manitoba, the salary is considerably higher despite a cost of living that’s about 50% lower. People don’t move to another country to take a lower-paying job.

    • So the real story is that, if we exclude doctors trained in Canada who decide at the start of their careers that they’d prefer to practice in the US, there’s a significant net movement of doctors from Canada to the US, but there’s also a movement of doctors from non-US jurisdictions to Canada. I’m not sure why that should be considered a debunking of a myth. It just fits the story into a larger pattern–doctors are moving to more hospitable (read: lucrative) places. (That’s why we don’t see significant movement from the US to Canada.)

    • @Thomas- Significant if you think that less than 1/2% is significant. This data also does not account for docs who leave for non-economic reasons. I work with one Canadian trained surgeon. He told me he left because he married an American woman and they wanted to be close to her family. So, we have a very small percentage moving. We also do not know al of the reasons for moving. Heck, the weather alone would make me want to leave.


    • Small quibble, you conclude “But, since 2003, there has been a net movement of docs into Canada.” That is not shown in the graph nor is it asserted in the paper. Since 2003, *less* doctors have been leaving Canada. To quote the paper, “However, in recent years, this number has declined, with only 169 physicians leaving for the States in 2003; 138 in 2004; and 122 in each of 2005 and 2006.” So, a net number of doctors are still leaving Canada, just fewer than before.

      I don’t think this materially effects the point of your post. It’s just that errors like this really annoy me.

    • @Thomas M. Hermann

      I’m sorry you’re annoyed, but it shouldn’t be at me.

      The yellow line shows the net loss of doctors to Canada. You can see the net loss is negative in recent years, meaning that there is a net gain.

      Those numbers you quote are the number of doctors leaving for the US from Canada. Doctors also move to Canada. You are ignoring those numbers. Those numbers (red line) are greater than the number leaving Canada (dark line) in recent years, resulting in a net gain.

    • The chart says doctors *returning* to Canada – presumably meaning ones who were trained in Canada, left for a while, and came back. Which suggests that the number of doctors moving to Canada is much greater than what shows up on the chart.