Last year an article appeared in Healthcare Quarterly attempting to analyze and understand reasons nurses emigrate from Canada to the United States, specifically North Carolina (Pink et al. 2004). An introduction to the article appeared unsympathetic to this situation (Pringle 2004). I recently came across the Spring issue of a Canadian-based publication whose mission, as printed in the publication, is "to provide healthcare professionals with job opportunities" among other things. Of the eight large glossy pages constituting the publication, almost two (25%) were devoted to advertisements attracting Canadian nurses to other countries. There were four ads (including one full-page) extolling the virtues of nursing in the United States and one attracting nurses to work in the United Kingdom. I e-mailed the publisher and the editor to gently challenge them on the ethics of doing this but received no response.

"Poaching" of healthcare professionals is an old but evergrowing problem, impeding the development of better healthcare in a number of societies, most notably in many developing countries. Singh et al. (2003) articulately analyzed the ethics of this practice in the nursing profession and denounced the practice of developed countries recruiting nurses from developing countries. They also argued that developing nations are not doing enough to address the factors that precipitate nurse migration (Singh et al. 2003). (Although Canada is not a developing country, we can fairly be accused of not doing enough to prevent our own nursing "brain drain.") Patel (2003) explored the problem, specifically focusing on the recruitment of doctors from India and other developing countries to the UK after they have completed fellowship training in the UK. He suggested some specific requirements for ethical recruitment of doctors from developing countries (Patel 2003). In some situations, leaders in developing countries have formally asked developed countries, including Canada, to recruit fewer of their healthcare professionals (Spurgeon 2001).

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.

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