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.