Saturday, June 4, 2011

Meme-busting: Doctors are all leaving Canada to practice in the U.S.

I got such a great response to yesterday’s meme-busting post on tort reform and cost control that I decided to give you another.
Every time I talk about health care policy with physicians, one inevitably tells me of the doctor he or she knows who ran away from Canada to practice in the United States. Evidently, there’s a general perception that practicing in the United States is much more satisfying than in countries such as Canada.
If only that were so.
Let’s start with the underlying rationale. Satisfaction is measurable. The Commonwealth Fund measured it in its Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences:
Mail, phone, and e-mail survey of primary care physicians from February to July 2009 in Australia, Canada, France, Germany, Italy, Netherlands, New Zealand, Norway, Sweden, United Kingdom, and United States
Samples: 1,016 Australia, 1,401 Canada, 502 France, 715 Germany, 844 Italy, 614 Netherlands, 500 New Zealand, 774 Norway, 1,450 Sweden, 1,062 United Kingdom, and 1,442 United States
Here’s what they found:
Except for Austria and Germany, fewer doctors were satisfied practicing medicine in the United States in 2009 than in any other surveyed country. That includes Canada. And it was before health care reform, so you can’t blame any dissatisfaction on the PPACA.
 They also asked physicians what they thought about the health care system (again this was before the PPACA):

Except for Germany, more physicians in the United Sates felt that the system needed to be completely rebuilt than physicians in any other country.  The United States tied with Germany for last with an overwhelming 82% of physicians who thought the system needed fundamental changes or to be completely rebuilt.
 So let’s stop pretending that doctors in outer countries are miserable, and practicing in the Unites States is paradise.
 But the main outcome of interest here is doctors emigrating from Canada.  The meme is that physicians are leaving Canada in droves and moving here.  Is that true?
The Canadian Institute for Health Information has been tracking doctors' destinations only since 1992. Since then, between 60 and 70 percent of physicians who emigrate have headed south of the border. In the mid-1990s, the number leaving for the U.S. spiked at about 400 to 500 a year. However, in recent years, this number has declined, with only 169 physicians leaving for the States in 2003; 138 in 2004; and 122 in each of 2005 and 2006. These numbers represent less than half a percent of all doctors working in Canada.
So when emigration “spiked,” 400-500 doctors were leaving Canada for the United States.  There are more than 800,000 physicians in the U.S. right now, so I’m skeptical that every doctor knows one of those emigres. But I’d especially like you to pay attention to the yellow line, which is the net loss of doctors to Canada.
 In 2003, net emigration became net immigration. Let me say that again. More doctors were moving into Canada than were moving out.
 So there’s no part of this meme that’s true. Not only are physicians not more dissatisfied practicing in Canada than in the Unites States, but more doctors are also moving into Canada to practice than leaving.
 Aaron Carroll is a pediatrician, health services researcher, and Associate Professor of Pediatrics at Indiana University School of Medicine. He blogs at The Incidental Economist and tweets via@aaronecarroll .
By Aaron Carroll  |  08:46 AM ET, 06/03