Medical students say the provincial government is offering them little incentive to stay and work in New Brunswick when they graduate.
They complain there are not enough residency positions; on-the-job-training for medical specialties.
As it stands, about a third of students will have to leave New Brunswick to complete their training, despite the millions the government pays to foster homegrown doctors.
"If New Brunswick is serious about attracting, keeping doctors, it needs to have these residencies available," said Matt Eagles, who will be attending Memorial University in Newfoundland this fall.
Fellow medical student Mike Craig, who will be attending Dalhousie Medical School at the University of New Brunswick, agrees.
"There will be many that will be placed in New Brunswick," said Craig. "But many will go either by choice or by necessity."
The New Brunswick government spends more than $6.5 million per Dalhousie Medical School graduating class, or $55,000 a year, per student. The numbers for the Université de Sherbrooke medical satellite institution in Moncton could not be obtained at the time of publication.
'People who train in an area are much more likely to practise in that area once they're done training.' —Dr. Andrew Warren, Dalhousie University
The overall government strategy is that doctors trained in the province will stay and practise here once they complete their studies.
It is in part to compensate for New Brunswick having, on average the third lowest-paid doctors in the country, only ahead of Quebec and P.E.I., according to the New Brunswick Medical Society.
But a lack of residency programs means that many students will still be leaving to complete their programs.
"People who train in an area are much more likely to practise in that area once they're done training," said Dr. Andrew Warren, the director of the medical residencies program at Dalhousie University. "There's actually research to support that."
Health Minister Ted Flemming declined to comment.
Residencies, which range between two to six years, take place at the tail end of a medical student’s studies — a critical period when many are deciding where they will practise, said Warren.
New Brunswick has 30 students attending the Dalhousie University medical satellite at the University of New Brunswick, but offers only 18 residencies in the province. Of those, 16 are family practice-oriented, the other two are in internal medicine.
The provincial government funds an additional nine residencies out of province, as per the agreement when building the satellite at the University of New Brunswick.
By comparison, Nova Scotia's Dalhousie University has 51 positions for its students.
"The actual residency placement across those 51 places actually varies from year to year, but Dalhousie offers all 51," said Warren.
Fee structure problematic
According to Warren, it takes doctors to make doctors, something that New Brunswick lacks when it comes to specializations.
"It's a matter of specialties available," he said. "Taking urology as an example, New Brunswick can't offer a urology residency because there aren't enough urologists to run a residency program."
Dalhousie is trying to increase its distributed medical education across all three Maritime provinces, but according to Warren a problem arises when it comes to compensating doctors.
Most doctors in New Brunswick, about 75 per cent, operate on a fee-for-service model, meaning they are paid according to the procedures performed on patients. Infant deliveries, for example, pay $550.
Taking on medical residents means doctors attend to fewer patients, which translates into doctors being paid less, said Warren.
"So physicians are perhaps understandably unwilling to take a financial disincentive," he said.
Warren suggests New Brunswick look at an alternative business model.
"Many physicians in Nova Scotia work under an alternate funding plan, which is basically a salary arrangement."