The Dilemma of Physician Shortage and International Recruitment in Canada

Document Type : Policy Brief

Author

School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada

Abstract

The perception of physician shortage in Canada is widespread. Absolute shortages and relative discrepancies, both specialty-wise and in urban-rural distribution, have been a daunting policy challenge. International Medical Graduates (IMGs) have been at the core of mitigating this problem, especially as long as shortage of physicians in rural areas is concerned. Considering such recruitment as historical reality is naïve annotation, but when it is recommended per se, then the indication of interest overweighs the intent of ethically justified solution. Such a recommendation has not only invited policy debate and disagreement, but has also raised serious ethical concerns. Canadian healthcare policy-makers were put into a series of twisting puzzles—recruiting IMGs in mitigating physician shortage was questioned by lack of vision for Canada’s self-sufficiency. In-migration of IMGs was largely attributed to Canada’s point-based physician-friendly immigration system without much emphasizing on IMGs’ home countries’ unfavorable factors and ignoring their basic human rights and choice of livelihood. While policy-makers’ excellence in integrating the already-migrated IMGs into the Canadian healthcare is cautiously appraised, its logical consequence in passively drawing more IMGs is loudly criticised. Even the passive recruitment of IMGs raised the ethical concern of source countries’ (which are often developing countries with already-compromised healthcare system) vulnerability. The current paper offers critical insights juxtaposing all these seemingly conflicting ideas and interests within the scope of national and transnational instruments.

Keywords

Main Subjects


  1. Canadian Collaborative Centre for Physician Resources. Canadian Physician Resources – 2012 Basic Facts. Canadian Medical Association; 2012.
  2. Esmail N. Canada’s physician supply. Fraser Forum; 2008.
  3. Esmail N. Canada’s physician supply [internet]. Fraser Forum; 2011. Available from: http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/articles/canadas-physician-supply.pdf
  4. Statistics Canada. Access to a regular medical doctor, 2011 [internet]. 2011. Available from: http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11656-eng.htm
  5. Canadian Institute for Health Information (CIHI). International Medical Graduates in Canada: 1972 to 2007: Canadian Institute for Health Information; 2009 August 20.
  6. Phillips RL Jr, Petterson S, Fryer GE Jr, Rosser W. The Canadian contribution to the US physician workforce. CMAJ 2007; 176: 1083-7. doi: 10.1503/cmaj.060525
  7. Roos NP, Gaumont M, Horne JM. The impact of the physician surplus on the distribution of physicians across Canada. Can Public Policy 1976; 2: 169-91. doi: 10.2307/3549205
  8. Canadian Residency Matching Service. Canadian Students Studying Medicine Abroad 2010. Ottawa, ON: Canadian Residency Matching Service; 2010.
  9. Canadian Institute for Health Information (CIHI). Supply, Distribution and Migration of Canadian Physicians, 2010. Ottawa, Ontario, Canada: Canadian Institute for Health Information; 2011.
  10. McElroy R. Canada\'s shortage of physicians. Can Fam Physician 2004; 50: 349.
  11. Chan BTB. From perceived surplus to perceived shortage: what happened to Canada\'s physician workforce in the 1990s? Ontario: Canadian Institute for Health Information; 2002.
  12. Fooks C, Duvalko K, Baranek P, Lamothe L, Rondeau K. Health human resource planning in Canada: Physician and nursing work force issues: Commission on the Future of Health Care in Canada. Ottawa, ON: Canadian Policy Research Networks Inc.; 2002.
  13. Ethier J-L, Forté S. Canadian Medical Student Policy Statement on the Recruitment of International Medical Graduates by Canadian Provinces. Canadian Federation of Medical Students; 2008.
  14. Busing N. Managing physician shortages: We are not doing enough. CMAJ 2007; 176: 1057. doi: 10.1503/cmaj.070258
  15. College of Physicians and Surgeons of Ontario (CPSO). Tackling the Doctor Shortage: A Discussion Paper [internet]. College of Physicians and Surgeons of Ontario; 2004. Available from: http://www.cpso.on.ca/CPSO/media/uploadedfiles/policies/positions/resourceinitiative/Doctor-shortage.pdf
  16. Mullan F. The metrics of the physician brain drain. N Engl J Med 2005; 353: 1810-8. doi: 10.1056/nejmsa050004
  17. Bourgeault IL, Baumann A. Ethical Recruitment and Integration of Internationally Educated Health Professionals in Canada. 2011. Available from: http://rcpsc.medical.org/ publicpolicy/imwc/Canada_Theme_Ethical_Integration_of_IEHP_Canadian_Paper_Bourgeault_Baumann.pdf
  18. Wright D, Flis N, Gupta M. The \'Brain Drain\' of physicians: historical antecedents to an ethical debate, c. 1960-79. Philos Ethics Humanit Med 2008; 3: 24. doi: 10.1186/1747-5341-3-24
  19. McIntosh T, Torgerson R, Klassen N. The ethical recruitment of internationally educated health professionals: lessons from abroad and options for Canada. Ottawa: Canadian Policy Research Networks; 2007.
  20. Evans RG. Does Canada Have Too Many Doctors? Why Nobody Loves an Immigrant Physician. Can Public Policy 1976; 2: 147-60. doi: 10.2307/3549203
  21. Taylor AL, Dhillon IS. The WHO Global Code of Practice on the International Recruitment of Health Personnel: the evolution of global health diplomacy. Global Health Governance 2011; 5 1-24.
  22. Audas R, Ross A, Vardy D. The use of provisionally licensed international medical graduates in Canada. CMAJ 2005; 173: 1315-6. doi: 10.1503/cmaj.050675
  23. Watson DE, McGrail KM. More doctors or better care? Healthc Policy 2009; 5: 26. Doi: 10.12927/hcpol.2009.21000
  24. Frechette D, Hollenberg D, Shrichand A. What’s really behind Canada’s unemployed specialists? Too many, too few doctors? Findings from the Royal College’s employment study. Ottawa, Ontario: The Royal College of Physicians and Surgeons of Canada; 2013.
  25. Kapadia RK, McGrath BM. Medical school strategies to increase recruitment of rural-oriented physicians: the Canadian experience. Can J Rural Med 2011; 16: 13-9.
  26. UK Department of Health. Code of practice for NHS employers involved in the international recruitment of healthcare professionals. London: UK Department of Health; 2001.
  27. Sullivan P. Estimated 1500 Canadians studying medicine abroad. CMAJ 2007; 176: 1069-70. doi: 10.1503/cmaj.070328