Canadian tide turns as residents return home

Experts say an improving climate for physicians in Canada and an increasingly hostile one in the United States are driving the change.

By Myrle Croasdale, AMNews staff. Oct. 24/31, 2005.

John Warner, MD, returned to his native Canada in 1991 after completing medical training in the United States. That was unusual then, but now, with prospects in Canada getting more attractive to its native physicians and prospects in the United States comparatively less so, such a move is becoming more common.

For the first time in 30 years, Canada is seeing more physicians return than leave, according to the Canadian Institute for Health Information. In 2004, 202 physicians left the United States for Canada, while 162 Canadian doctors moved south.

A net gain of 40 physicians might seem small, but for much of the 1980s and 1990s, Canada lost hundreds of doctors per year to the United States, peaking with a net loss of 443 doctors in 1994, as 583 left and 140 returned.

Deepening administrative burdens from managed care insurers and rising medical liability rates are some of the reasons more of Dr. Warner's Canadian colleagues are returning home after training or practicing in the United States.

The shift also is attributed to the Canadian government's efforts to reinvest in upgrades, such as new operating rooms, under the single-payer system. In some provinces, physicians are being offered higher reimbursements. All of this is to stem a growing shortage of doctors and increase access to quality care. Such stability follows deep cutbacks in Canada's reimbursement and health care infrastructure during the 1980s and 1990s.

Dr. Warner, a urologist in Toronto, did a fellowship at the Memorial Sloan-Kettering Cancer Center in New York City before returning to Canada in 1991. A visit this summer by a urology colleague from New York gave the two time to compare their practice environments.