On Campus

Canada increasingly training its own doctors, finds report

When trained domestically, graduates are more likely to stay in the country

Canada is becoming more self-sufficient when it comes to its supply of doctors, a new report suggests.

Foreign-trained physicians practising in Canada make up a smaller proportion of the country’s doctors than they used to, says the report from the Canadian Institute for Health Information.

The number of internationally educated doctors grew between 1972 and the late 1980s, reaching a plateau of 13,500 that has held ever since.

Compared to the total physician workforce, however, there has been a decline, the report says: from a peak of 33.1 per cent in 1976 to 22.4 per cent in 2007.

The decline comes as physicians trained in the U.K. and Ireland in earlier decades age and retire, and as fewer new doctors who trained beyond Canadian borders begin practising here.

The percentage of foreign-trained doctors has dipped across all provinces and territories, though Newfoundland and Saskatchewan have the highest proportion and Prince Edward Island and Quebec the lowest.

“So what we’re seeing is that overall, Canada is training more people locally,” said Yvonne Rosehart, program lead in Health Human Resources at the institute’s Ottawa office.

Training physicians domestically is a good long-term strategy because graduates are more likely to stay in the country, she noted.

The report also says more than one-quarter – 27 per cent – of the country’s foreign-trained doctors actually grew up in Canada.

Doctors who were not raised in Canada and did not get their medical education here made up only 14 per cent (plus or minus 0.8 per cent) of the total number of doctors in Canada.

Regardless of national origin, doctors who studied abroad got their medical education from a wider array of countries than in the 1970s.

“We used to find that the majority of internationally trained physicians were from the U.K. and Ireland. Now, that’s not the case and they tend to be from more developing countries,” Rosehart said.

“We’re really seeing it go from OECD (Organization for Economic Co-operation and Development) or British-centric to more of a global recruitment.”

South Africa and India now contribute the most doctors to Canada’s supply. Ireland doesn’t even fall in the top 10 of contributing nations anymore, though Iran, Libya and Saudi Arabia do.

Of internationally trained physicians who started working between 2003 and 2007, 75 per cent studied in a developing country, Rosehart said.

Still, many of the countries in which Canadian doctors trained have historically shared a language with Canada or formerly belonged to British, American or French administrative systems.

These factors affect how Canada views credentials achieved elsewhere, as well as making it easier for the doctors to meet other licensing requirements, the report suggests.

The U.K., India, the U.S., Egypt, South Africa and France were in the top 10 supplying countries from 1972 to 1976 and again in the period from 2003 to 2007, more than three decades later.

The data also showed that physicians in rural areas were more likely than those in urban centres to have received their training out-of-country.

Especially when new, foreign-trained doctors begin practising in Canada, they frequently settle in rural or remote areas, making up more than half of new physicians and about a quarter of all doctors in these under-served regions. This trend holds true except in Ontario and Quebec.

International medical graduates are more likely to move within Canada than they once were, however.

“Back in the late ’70s, they were more likely to come to Canada, start a practice and stay there,” Rosehart said. “They’re slightly more mobile now than they used to be.”

Dr. Anne Doig, the new president of the Canadian Medical Association, said a multitude of factors determine physician mobility, including professional opportunity and satisfaction. In rural areas, for example, doctors have fewer colleagues on which they can rely for support and to help cover calls. “After five years, they’re tired out,” she said.

While Doig suspects Canada’s reliance on foreign-trained doctors will continue to go down as the country builds its own training capacity, she said it should never reach zero.

“We do believe there is a need for international exchange for knowledge reasons and for medical teaching, medical practice, medical research. The exchange of ideas requires that there be some in and out migration.”

She added the recruitment of doctors must be done ethically, however, in a way that doesn’t drain the resources of another jurisdiction.

The current reliance on doctors educated in Canada differs sharply from the situation after the Second World War. At that time, a growing population prompted Canada to issue more licences to foreign-trained doctors than to those trained within the country.

Researchers collected the data from two sources: Scott’s Medical Database at the Canadian Institute for Health Information and feedback from doctors who participated in the 2007 National Physician Survey.

The two sources aren’t completely comparable, Rosehart says, since one is a historical database the Canadian Institute for Health Information has maintained for decades while the other is a survey. Combined, however, they offer a lot of useful data about the supply of physicians in Canada.

The Institute works with each province to collect information about close to all doctors nationwide. The 2007 National Physician Survey questionnaire was sent to 60,811 doctors and 19,239 completed it, for a response rate of 31.64 per cent.

– The Canadian Press