Factors influencing the emigration of physicians from Canada to the United States
Robert J.R. McKendry, MD; George A. Wells, PhD; Paula Dale; Owen Adams;
Lynda Buske; Jill Strachan; Lourdes Flor
Canadian Medical Association Journal 1996; 154: 171-181
Dr. McKendry is professor of medicine, University of Ottawa, and director, Rheumatic Disease Unit, Ottawa General Hospital; Dr. Wells is associate professor, Department of Medicine, and associate director, Clinical Epidemiology Unit, University of Ottawa; Ms. Dale is research assistant, Rheumatic Disease Unit, Ottawa General Hospital; Mr. Adams is associate director, Physician Resources Information and Planning, Department of Health Policy and Economics, CMA; Ms. Buske is chief, Physician Resources Information and Planning, Department of Health Policy and Economics, CMA; Ms. Strachan is senior analyst, Health Human Resources, Health Information Division, Health Canada; and Ms. Flor is assistant director, Analytical Services, Health Information Division, Health Canada, Ottawa, Ont.
The opinions stated in this article are those of the authors and do not represent the views of their respective organizations or institutions.
Paper reprints of the full text may be obtained from: Dr. Robert J.R. McKendry, Director, Rheumatic Disease Unit, Ottawa General Hospital, Rm. LM-10, 501 Smyth Rd., Ottawa ON K1H 8L6; fax 613 737-8541
Objective: To determine whether location of postgraduate medical training and other factors are associated with the emigration of physicians from Canada to the United States.
Design: Case-control study; physicians were surveyed with the use of a questionnaire mailed in May 1994 (with a reminder sent in September 1994), responses to which were accepted until Dec. 31, 1994.
Participants: Physicians randomly selected from the CMA database, 4000 with addresses in Canada and 4000 with current addresses in the United States and previous addresses in Canada.
Outcome measures: Sex, age, location of undergraduate and postgraduate medical training, qualifications, practice location, opinions concerning residence decisions, current satisfaction and plans.
Results: The overall response rate was 49.6% (50.0% among physicians in the United States and 49.2% among those in Canada). Age and sex distributions were similar among the 8000 questionnaire recipients and the nearly 4000 respondents. Physicians living in the United States were more likely to be older (mean 53.2 v. 49.6 years of age), male (87% v. 75%) and specialists (79% v. 52%) than those practising in Canada. Postgraduate training in the United States was associated with subsequent emigration (odds ratio 9.2, 95% confidence interval 7.8 to 10.7). However, in rating the importance of nine factors in the decision to emigrate or remain in Canada, there was no significant difference between the two groups in the rating assigned to location of postgraduate training. Professional factors rated most important by most physicians in both groups were professional/clinical autonomy, availability of medical facilities and job availability. Remuneration was considered an equally important factor by those in Canada and in the United States. Six of seven personal/family factors were rated as more important to their choice of practice location by respondents in Canada than by those in the United States. Current satisfaction was significantly higher among respondents in the United States. Most physicians in each group planned to continue practising at their current location. Of Canadian respondents, 22% indicated that they were more likely to move to the United States than they were a year beforehand, whereas 4% of US respondents indicated that they were more likely to return to Canada.
Conclusions: Factors affecting the decision to move to the United States or remain in Canada can be categorized as "push" factors (e.g., government involvement) and "pull" factors (e.g., better geographic climate in the US). Factors can also be categorized by whether they are amenable to change (e.g., availability of medical facilities) or cannot be managed (e.g., proximity of relatives). An understanding of the reasons why physicians immigrate to the United States or remain in Canada is essential to planning physician resources nationally.
| CMAJ January 15, 1996 (vol 154, no 2) |