One in nine trained-in-Canada doctors is practising medicine in the United States, says a study published in Tuesday's issue of the Canadian Medical Association Journal.

If Canadian-educated doctors who were born in the U.S. are excluded, the number is one in 12, and the study suggests that luring back some of these Canadian physicians would go a long way toward solving the country's doctor shortage.

'I must admit that I was sort of knocked over by the numbers. They were a lot bigger than I'd anticipated.'—Dr. Walter Rosser, Queen's University

While they admit the exodus has abated a bit in the past couple of years, the authors say the impact is as if two average-sized medical schools in Canada were doing nothing but training doctors for the United States.

There are only 17 medical schools in this country.

"I must admit that I was sort of knocked over by the numbers. They were a lot bigger than I'd anticipated," said one of the authors, Dr. Walter Rosser, chief of the department of family medicine at Queen's University in Kingston, Ont.

There were 8,162 Canadian-educated doctors providing direct patient care in the U.S. in 2006, the study said.

Nearly half of the Canadian-educated physicians in the U.S. graduated from three medical schools — McGill University (24.7 per cent), the University of Toronto (15.2 per cent) and the University of Manitoba (eight per cent).

Canadian-educated specialists practising in the U.S. in 2006 represented nearly 20 per cent of the Canadian specialist workforce.

Of the Canadian doctors working in the United States, 1,023 were in rural practices. Many parts of rural Canada are in dire need of doctors and finding a way to draw some of those people back home would be a major bonus, the study suggested.

Quebec bleeds doctors

The doctor exodus is hitting Quebec hardest, where every year countless doctors leave the province seeking greener pastures.  But the phenomenon is no surprise to Dr. Richard Levin, dean of medicine at McGill University, who said there are many reasons for young doctors to leave Quebec.

"The working condition issue I think needs particular attention," he said Tuesday. "The salary differentials that exist across provinces, and that affect us in Quebec in particular, the hospitals, which need renewal, and all the legislative decisions have negatively impacted this situation."

Martin Girard, a McGill graduate and anesthesiology resident, has watched many classmates leave Quebec in search of better paid opportunities south of the border. He's convinced the trend will continue, as long as Quebec doesn't make significant changes to the province's doctor culture.

Young doctors are turned off by Quebec's billing restrictions for new physicians, which prevent most from setting up practice in urban centres, Girard said. 

"If we simply turn a blind eye to it, we'll wake up one morning with much worse problems than we currently have," he said.

Alberta woos doctors

According to the study, seven per cent of doctors trained at the University of Alberta move to the United States once they graduate.

But Alberta's efforts to stem the tide have produced promising results, according to Edmonton's Capital Health.

The city has enjoyed a 22 per cent increase in physicians in four years, a "stunning" staff turnaround compared to five years ago, said spokesman Steve Buick.

He credits efforts to increase funding and resources at Edmonton's medical research centres in order to attract more physicians.

Dr. Darcie Kiddoo is one doctor who came back to Alberta after a training stint in the United States.

Although she found specialized training in pediatric urology south of the border, the American medical system and its labyrinth of insurance companies ultimately pushed her home.

"It's become so complicated that for one physician, you need to hire about seven office staff," she said.

Now living in Edmonton, Kiddoo teaches at the University of Alberta, where she watches fresh crops of students being courted by aggressive U.S. recruiters.

The trouble, as she sees it, is the Canadian pitch, or lack thereof.

"I think a lot more graduates will probably stick around if they feel wanted, and offered jobs," she said.

Luring doctors home

"I still believe that there's a lot of opportunity to get some of these folks back," said Rosser, who noted he's recently recruited a husband-and-wife team of Canadian doctors from Ohio, where they have been practising.

"Generally, they're very unhappy," he said of Canadians in family practice in the U.S. "In fact, they're much more unhappy than family doctors here.

"And so it seems to me they're ripe for the picking."

And luring back Canadian doctors home from the U.S. doesn't pose the ethical quandaries associated with recruiting doctors from developing countries, a form of medical "poaching" that has been widely criticized but is still widely done by developed countries.

The president of the Association of Faculties of Medicine of Canada said political authorities have to figure out what's behind the exodus to the U.S., and do their best to stem the tide.

"We need to further understand the reasons for this ongoing loss and find ways to encourage these physicians to practise in Canada," Nick Busing said in a guest editorial in the journal.

Rosser and his co-authors suggested provincial governments ought to consider offering incentives to attract Canadian-educated doctors back to the country.

Rosser, former head of the division of family medicine at the University of Toronto, Rosser become tired in the 1990s of watching his students head south of the border. In 1997, he recalled, all eight family medicine graduates in one program went to the United States to practise.

It was a time when governments were talking about restricting where new doctors could set up shop, and doctors were feeling disenchanted and underappreciated, he said.

In talking with some colleagues in the U.S., Rosser realized with their help he could tap into the American Medical Association's physician masterfile, which lists all doctors living in the U.S. From the data set, they could tell which medical school each doctor graduated from as well as the doctor's nationality.

Looking at patterns from 1995 onward, they could see that the return migration of Canadian doctors outnumbered those leaving for the first time in 2004 — 262 left and 317 returned.

Rosser believes the tide has turned, though he acknowledges Canada will always lose some doctors, in particular specialists looking to work in world-renowned centres of excellence elsewhere. But changes in policies at the provincial level have made practising in Canada more attractive, he said.

"I think we're in a much better position and I think we're going to find the doctor shortage is going to reverse fairly quickly, within three or four years, hopefully."