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There Is a Mountain of M.D.'s Over Thar!
(Silent Brain Drain)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 27 in the April 20, 2011 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

You probably have been reading about changes in the United States health care system by President Obama. After 40 years of observing the great Canadian social Medicare experiment, the Americans are getting the message that a nation's health can be measured by the universality of health care services.

The greatest attractiveness of the American health care system is restricted to those with financial resources. A thick wallet produces quick access and treatment with no wait.

In Canada, it doesn't matter whether you drink Timmy's or Starbucks, you're still in the same line. There are millions of Americans who would welcome the chance to stand in one of our free health care lines.

In Ontario, we have one large insurer called OHIP which is run by the government for all the people, and small private companies that fill in various gaps. The U.S. system is dotted with numerous private insurers who pick and choose (and more importantly decide) who and what your treatment options are. The bureaucracy is as tremendous as the bureaucrats are numerous. But Canadians still tend to be healthier than our American cousins. We silently accept an increasing shortage of physicians, tend to patiently wait for services, say please and occasionally thank you. Life threatening illnesses are routinely put to the front of the line with understanding by most. But the cracks are getting bigger.

With primary care reform, President Obama hopes to replace thousands of administrators and red tape workers with front line nurses and doctors. Now, consider some sobering thoughts. It is estimated that the U.S. system will need at least 20,000 extra doctors to accomplish this. If we tapped this silent brain drain of Canadians, it is estimated that we could have adequate medical manpower within five years. It would require no expensive infrastructure. Better yet, we could take the bull by the horn, and pay for our students to train in qualified schools with the provision that they practice in Canada. Just thinking outside the box could save billions and turn some of that 92% loss into a gain.

What future awaits a country that pays heavily to educate its citizens, then willingly and freely gives away this valuable resource?

We have done very little to build the required infrastructure to educate the generations of physicians we are short of in this country. The shortage has produced a largely hidden brain drain.

Our capacity to train physicians is limited and few politicians will invest in a traditional solution that will not see a return for a decade. We invest heavily in pre-medical education to produce 12 equally qualified candidates for every scarce medical school spot. That represents a whopping 92% loss on our investment.

Over the last few years, the Americans, British and Irish have ramped up their medical schools, maintained high standards and have taken our “losses”, convinced them to pay for their own medical education, and graduate them by the hundreds into their own systems. At last estimate, there are 4000 Canadian students in foreign medical schools. Instead of attracting these Canadian doctors back home to our shortage, we brand them as foreigners, and spend time arguing about which country is best to pilfer and re-train doctors from.

The American population is graying as fast as we are, and happily welcome our intellectual cast-offs, since Canadians look, speak and dress similar to Americans. To curb the loss of pre-medical students educated in Canada, partnership among our Universities, Government and Medical Regulators is required. Not only are we wasting a valuable national resource, it amounts to a national shame!

Related resources:

Too many Canadians studying medicine overseas by Mary C. Sheppard, CBC News. More medical schools opening but no residency positions. "The number of Canadians studying medicine outside of Canada has more than doubled in the last five years and a number of them may never get the opportunity to continue their training and to practice at home. In its first survey since 2006, the Canadian Resident Matching Service (CaRMS) identified approximately 80 schools in almost 30 countries as having Canadian students enrolled in medicine."

Shut out at home, Canadians flocking to Ireland's medical schools - and to an uncertain future by Patrick Sullivan, CMAJ's News and Features Editor.

Estimated 1500 Canadians studying medicine abroad by Patrick Sullivan, CMAJ.

How Bad Is the Brain Drain? by Charlotte Gray, Canadian Medical Association Journal (CMAJ) contributing editor. "The brain drain south was particularly dramatic in the mid-1990s ... In 1996, ... 731 physicians left Canada. Although another 218 doctors returned, the net loss was 513 physicians - a number roughly equivalent to 30% of the annual output from Canada's 16 medical schools."

China's Brain Drain Threatens Its Future. Chinese citizens, including many of the wealthy, are increasingly eyeing the exits in a new era of slower growth, by Nathaniel Taplin, Wall Street Journal, July 5, 2023.

Global medical ethics: Adding insult to injury: the healthcare brain drain by Dr C R Hooper, Philosophy Department, University College London, London, UK. Journal of Medical Ethics, 16 Jan. 2008.

Shifting tides in the emigration patterns of Canadian physicians to the United States: a cross-sectional secondary data analysis by Thomas R. Freeman, Stephen Petterson, Sean Finnegan & Andrew Bazemore. BMC Health Services Research volume 16, Article number: 678 (2016)

The Metrics of the Physician Brain Drain by Fitzhugh Mullan, M.D.

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