HLTB03 Midterm Notes: Health, Illness, and Health Care in Canada
Chapter 5: On the Move: The Migration of Physicians and Nurses Into and Out of Canada
¾ Health care workers have long been nationally and internationally mobile, but this has increased more recently both
in terms of size and velocity.
¾ Concerns about the international migration of health care providers have become a more prominent and
controversial feature of health sector analysis in recent years in light of severe staff and skill shortages in health
systems of many countries.
¾ We are not just an exporter of health labour, but a significant importer as well.
¾ Canada has historically relied extensively on foreign health labour to help solve shortages in rural and remote under
serviced areas and in urban subspecialties.
¾ Today, immigrant doctors account for roughly one quarter of all physicians practicing in Canada; similarly, six to seven
percent of all nurses have been trained in other jurisdictions. By way of contrast, between 16 to 20 percent of
physicians emigrate from Canada, and although a smaller percentage of nurses emigrate, it has a critical impact on
the delivery of health care.
¾ Though we have moved in the direction of a nationally coordinated policy for health labour immigration, very little
exists that addresses the issue of health labour emigration.
¾ The absence of such coordinated policy in Canada is notable in light of the associated problems of lost labour and
potential solutions to human resource crises, and also because of the increasing salient ethical issues associated with
the international migration of health care providers.
¾ These ethical issues have moved to the forefront not just of health policy, but also of foreign policy agendas. In this
paper, the following will begin to be mapped out:
o The flow of physicians and nurses into and out of Canada through available datasets and published
o The policy, decision-making process, and regulatory environments that influence the flow of physicians and
nurses into and out of Canada.
The Demographic Context of Health Labour Migration in Canada
International Medical Graduates in the Canadian Health Care System
¾ Foreign medical labour is often referred to in the policy literature as international medical graduates (IMGs).
¾ Though often considered a homogenous group, IMGs are a varied group which include:
1. Canadians who pursue training elsewhere;
2. Visa physicians who are recruited into Canada to meet particular needs;
3. Graduates who enter Canada as refugees or who otherwise meet immigration requirements;
4. Visa trainees who enter Canada through postgraduate training positions.
¾ The probability of achieving full registration status with a provincial licensing authority varies dramatically across
these categories, and across provinces and territories.
¾ Throughout most of the 1970s roughly about one third of our physicians were IMGs but this has most recently
dropped to 23%.
¾ This downward trend reflects limits on the number of post-graduate training spaces available as well as a number of
¾ This was consistent with the recommendations of the National Committee on Physician Manpower who wanted to
focus on the goal of self-reliance for future physician needs. As a result, the number of immigrants claiming medicine
as their intended occupation fell dramatically subsequent to these decisions in 1975.
¾ More recently, according to the CMA, the number of IMGs recruited has increased quite dramatically from 388 in
supply of physicians services.
¾ The proliferation of temporary medical licenses to IMGs is just one indication, as argued by CMA representatives, of
the physician shortage in both family medicine and in particular specialities.
HLTB03 Midterm Notes: Health, Illness, and Health Care in Canada
¾ In terms of the sources of immigrant physicians who end up working within the health care system, they used to be
graduates primarily of medical schools in the U.K. or Ireland.
¾ Now, the majority of IMGs working within the health care system are from South Africa and India, with India being a
notable source of specialists, and South Africa of general/family practitioners.
¾ Demographically, IMGs tend to be older than Canadian-educated physicians (47% are age 55 or older, compared with
29% of all physicians) and a smaller proportion are female (22% versus 30%).
Internationally Educated Nurses in the Canadian Health Care System
¾ The overall percentage of internationally educated nurses (IENs) has remained relatively steady over the last five to
¾ There has, however, been a slight increase in the recruitment of foreign trained nurses in some provinces and
territories t notably British Columbia, Ontario, Saskatchewan and the Northwest Territories t in the face of
¾ The Philippines have been one of the primary sources for immigrant nursing labour in Canada, but from the U.K.
represent almost an equal proportion.
be the case for physicians.
¾ How long these new foreign trained applicants stay in the country is difficult to track.
¾ Demographically, it has been found that IENs in the current workforce are, on average, more than five years older
than Canadian nurses, particularly those of colour, occupy the lowest echelons of the profession if they do manage to
make it in.
¾ In sum, what is clear in undertaking this comparative analysis of the demographic data available on internationally
educated physicians and nurses is that:
o We can state with some certainty that internationally educated physicians and nurses are a crucial
component of Canadian health human resources.
o The source countries for internationally educated physicians and nurses have not only shifted over time, but
they also differ across these cases.
o What is also clear from these demographic trends is that various health care and health human policy have
and important influence.
¾ Across all professions, however, it seems that the primary destination for Canadians migrating out, is the neighbour
to the south t the United States t for a variety of reasons.
The Medical Brain Drain
¾ Most of the ink spilled on the health care brain drain has been regarding the out migration of physicians from
Canada; this drain was particularly heightened in the mid 1990s for reasons which will become clear.
¾ A study also found that the 1989 graduation cohort was diminished by 16%, the majority of which diminishment was
caused by migration to other countries.
¾ The trend continued with a peak in 1995 with 85% of health graduates moving to the United States. This peak is
widely attributed to the outflow of family physician graduates resulting from Ontario`s decision to introduce
geographic billing restriction legislation.
¾ Physicians left Canada at a rate about 10 times higher than all other Canadian emigrant workers.
¾ Earlier, McKendry et al. (1996) found that 22% of Canadian physicians said they were likely to move to the United
States whereas only 4% indicated the willingness to move back to Canada. (This was, however, was at the peak of the
migration of physicians way from Canada).
¾ In 2004, a dramatic shift was noted when more physicians returned to Canada than moved abroad.
Chapter 5: on the move: the migration of physicians and nurses into and out of canada. Health care workers have long been nationally and internationally mobile, but this has increased more recently both in terms of size and velocity. Concerns about the international migration of health care providers have become a more prominent and controversial feature of health sector analysis in recent years in light of severe staff and skill shortages in health systems of many countries. We are not just an exporter of health labour, but a significant importer as well. Canada has historically relied extensively on foreign health labour to help solve shortages in rural and remote under serviced areas and in urban subspecialties. Today, immigrant doctors account for roughly one quarter of all physicians practicing in canada; similarly, six to seven percent of all nurses have been trained in other jurisdictions.