Facts and Opinions: Abetting Emigration of Canada's Nurses and Doctors
The Canadian healthcare system is one of the last not-forprofit socialized, one-tiered systems in the world. We are all aware of its shortcomings, such as inappropriately long waits for diagnostic procedures such as magnetic resonance imaging, and for elective surgical procedures such as knee replacement. We are also all aware that, by and large, it is the most humane, fair and efficient system in the world. A recent full-length article in the New York Times Magazine, speculating on American healthcare reform, referred to the Canadian system a number of times, mostly favourably (Lowenstein 2005).
Canada and the US are both highly developed countries, so asymmetry in quality of healthcare is not a major issue in drawing healthcare providers from one country to the other. However, there is asymmetry in remuneration, in that nurses attracted to the US from Canada can expect bigger signing bonuses and higher salaries. Additionally, there is often an improvement in personal lifestyle such as weather, improved educational opportunities (as many American hospitals support nurses' pursuit of advanced education) and other factors (Pink et al. 2004; Pringle 2004). The differential between incomes of Canadian and American doctors, especially specialists, is even more substantial than the differential in nurses' salaries. Therefore, arguably the main incentive that attracts healthcare providers from Canada to the US is similar to (though scaleddown from) the strong incentive that draws healthcare providers from developing to developed countries.
Many of these factors cannot be changed overnight. In spite of that, many Canadians would still prefer to live and work in Canada. Therefore, the brain drain from Canada to the US continues at a steady but limited rate, which does not cripple our universities and hospitals, for example, but it certainly poses ongoing challenges to these and other institutions within our society, which has only one-tenth the human resources to draw on compared to the US. This challenge is arguably greater within the nursing profession than with any other identifiable group of professionals in our country.
Canada is a land of opportunity, and no one would ever stand in the way of people seeking a better or more fulfilling life, even if that takes them away from Canada. But my simple question is this: Should Canadians be so tolerant, unworried and even smug about Canada's future that we actually facilitate this brain drain? Instead of making it ridiculously simple for nurses and doctors to leave, why don't we make it easier for them to stay? Various half-hearted strategies have been employed to do this over the years, and these initiatives have been incompletely and/or only intermittently successful. Maybe if we try harder we can do better at keeping our valued healthcare professionals within the best healthcare system in the world, and in a country where most of them would likely prefer to remain. This message is directed squarely at government, hospital administrators and others in a position to make the material changes needed to stop the brain drain of nurses and doctors to the US. A financial commitment to secure the future of our healthcare system seems like an investment with positive and crucial benefit to this particular warrior in the healthcare trenches.
About the Author(s)
Mark Bernstein MD, MHSc, FRCSC is a Professor in the Department of Surgery, University of Toronto Division of Neurosurgery based at the Toronto Western Hospital site of the University Health Network.
Lowenstein, R. 2005, March 13. "The Quality Cure?" New York Times Magazine pp. 46-51.
Patel, V. 2003. "Recruiting Doctors from Poor Countries: The Great Brain Robbery?" British Medical Journal 327: 926-28.
Pink, G.H., L.M. Hall and P. Leatt. 2004. "Canadian-Trained Nurses in North Carolina." Healthcare Quarterly 7: Suppl. 2-11.
Pringle, D. 2004. Guest Adversaria. Healthcare Quarterly 7: Suppl. 1.
Singh, J.A., B. Nkala, E. Amuah, N. Mehta and A. Ahmad. 2003. "The Ethics of Nurse Poaching from the Developing World." Nursing Ethics 10: 667-71.
Spurgeon, D. 2001. "Canada Asked to Recruit Fewer South African Doctors." British Medical Journal 322: 189.
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