For years, an exodus of doctors to the United States helped fuel Canada's growing shortage of medical staff, and gave emotional ammunition to opponents of Canadian-style health-care reform in the States.
But medical recruiters and migration statistics suggest a surprising new trend has emerged over the past few years: a net movement of physicians from the United States to Canada.
The reasons they are coming are equally unexpected: pay that is reportedly much better in some specialties; more freedom in their practices; and uncertainty about the impact of health reform in the United States.
"Canada is the number one spot in the world for doctors to come and work, live and play," said John Philpott, CEO of CanAM Physician Recruiting in Halifax. "Talking to physicians in the United States, they're shocked how much more money they can make in Canada."
The flip side of the equation seems to be true as well, with fewer Canadian doctors answering the call to practice in the States, once seen as a Mecca of better remuneration and more comfortable work environments.
"I have calls from American companies on a regular basis asking me to find them Canadian doctors, and I have to say 'that ship has sailed,' " said Susan Craig of Toronto-based Susan Craig Associates, which recruits doctors for both American and Canadian employers.
"We used to place an ad and we'd be flooded with doctors. That's not the case now."
Statistics released annually by the Canadian Institute for Health Information first suggested five years ago that the number of doctors returning to Canada after departing the country for other places was greater than the number leaving, ending a net out-migration that had lasted for more than a decade.
The impression remained, however, that Canadian doctors were still flocking to the United States. During the recent debate over the U.S. health-care reform proposals, opponents frequently cited Canada's system as an example to be avoided, and pointed to the supposed exodus of doctors southward as evidence that it was broken.
More detailed CIHI statistics reveal a different picture, however. The number of doctors returning to Canada from the U.S. specifically after working here previously has exceeded those going in the opposite direction every year since 2004.
On top of that, the number of American-trained doctors who came here for the first time jumped to 52 in 2008 from a low of nine in 1995. Neither set of statistics includes doctors trained in other countries who were working in the U.S. and left for Canada recently.
HealthForce Ontario, the provincial agency that recruits doctors and other medical workers, has lured an increasing cadre of MDs from the U.S. since it launched three years ago. The number jumped to 87 last year from 10 in 2007, and has already reached 66 by this July.
Health Match BC, a similar agency, attracted 19 U.S. doctors in 2008, 20 in 2009 and expects to top 30 this year, said CEO John Mabbott.
No one suggests, though, the numbers match the flight south of Canadian physicians during the 1990s.
At that time, provincial governments, worried about escalating health costs, concluded there was a surplus of doctors. Medical school enrollments were slashed, pay caps instituted and physicians discouraged from working in "over-serviced" areas.
The result by 2006 was that 12,000 Canadian-trained doctors — more than 10% of the total — were working in the States, noted a 2007 paper in the Canadian Medical Association Journal.
The ensuing doctor shortage in Canada prompted legislators to approve higher fees, increase enrollment and take other measures to improve doctors' lot.
"The situation here has improved radically and physicians here are treated with much more respect and care than they were previously," said Ms. Craig.
Private and public-sector recruiters say they are luring American-born doctors, Canadians who had long ago moved to the States, and physicians from other countries who trained and got licensed in the U.S., only to decide to work in Canada.
Comparing physician incomes in the two countries is not easy, given the different ways doctors are paid in various jurisdictions. Undisputedly some surgical and other specialities are still much better compensated in the States.
Some recruiters, though, say family doctors, pediatricians, emergency physicians and psychiatrists can make more for similar work in Canada — as much as $50,000 to $100,000 more, according to Mr. Philpott. He said he relocated one doctor from Wisconsin to Newfoundland, doubling her income in the process.
Psychiatrists can end up "significantly ahead" in Canada, echoed Ms. Craig, noting "the whole money thing has changed." Mr. Mabbott said some physicians from the States tell him, also, that they make more in B.C.
Money is not the only draw, however.
Many U.S. physicians are also fed up with a system in which private insurance companies fund most medical care, meaning they must deal with as many as 40 different firms to get paid. One study suggested that U.S. physicians spend 140 hours and $60,000 a year dealing with insurers, said Lynn Bury, recruitment director for HealthForce Ontario.
Some also see the Canadian system as allowing them to practise more freely, unfettered by private hospitals, insurance companies and HMOs, said Ms. Bury.
Mr. Mabbott said he is worried about the impact of U.S. health-care reform, designed to provide health coverage to 40 million uninsured Americans, and potentially create a demand for thousands more physicians.
Other recruiters, though, say the reform plan Congress approved this year has so far left some doctors fretting about the future and viewing Canada as a welcome escape.
Said Mr. Philpott: "Obama's health plan is scaring the life out of all the doctors in the United States."
