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

By Aaron Carroll

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?

  No:

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

Canada – OECD Better Life Initiative-Part 2

A cohesive society is one where citizens have a high degree of confidence in their governmental institutions and public administration. 67% of people in Canada say they trust their political institutions, higher than the OECD average of 56%. High voter turnout is another measure of public trust in government and of citizens' participation in the political process. In the most recent elections for which data is available, voter turnout in Canada was 60%; this figure is lower than the OECD average of 72%.

Ensuring that government decision making is not compromised by conflicts of interest is key to maintaining trust in government. Transparency is therefore essential to hold government to account and to maintain confidence in public institutions.

Freedom of information laws (FOI) allows the possibility for individuals to access undisclosed information. For such policies to be successful, the public should have a clear understanding of their rights under the law, should be able to file requests with ease and should be protected against any possible retaliation. People in Canada can file a request for information either in writing or in person, but not yet online or by telephone. In addition, there are no provisions for anonymity or protection from retaliation.

Happiness can be measured in terms of life satisfaction, the presence of positive experiences and feelings, and the absence of negative experiences and feelings. Such measures, while subjective, are a useful complement to compare the quality of life across countries.

For Canada, like throughout much of the OECD, self-reported life satisfaction has been rising over the last decade. In recent polling, 78% were satisfied with their life and 85% believe that their life will be satisfying five years later. This makes Canada one of the highest-ranked countries in terms of life satisfaction in the OECD.

80% of people in Canada reported having more positive experiences in an average day (feelings of rest, pride in accomplishment, enjoyment, etc) than negative ones (pain, worry, sadness, boredom, etc). This figure is higher than the OECD average of 72%, and makes Canada one of the happiest countries in the OECD.

Personal security is a core element for the well-being of individuals, and largely reflects the risks of people being physically assaulted or falling victim to other types of crime. Across the OECD, victimisation rates for conventional crime (theft, robbery, assault) have declined in the new millennium. In Canada, only 1% of people reported falling victim to assault over the previous 12 months, much lower than the OECD average of 4%.17% of people feel unsafe on the street after dark, much lower than the OECD average of 26%.

The homicide rate (the number of murders per 100,000 inhabitants) is a more reliable measure of a country’s safety level because, unlike other crimes, murders are usually always reported to the police. According to the latest OECD data, Canada’s homicide rate is 1.7, lower than the OECD average.

Finding a suitable balance between work and life is a challenge for all workers, especially working parents. Some couples would like to have (more) children, but do not see how they could afford to stop working. Other parents are happy with the number of children in their family, but would like to work more. This is a challenge to governments because if parents cannot achieve their desired work/life balance, not only is their welfare lowered but so is development in the country.

Many parents manage to reconcile their work and care commitments adequately, although it remains a challenge for others. The female employment rate in Canada is high at 76% compared to the OECD average of 64%, and in two out of three two-parent families both parents work. 71% of mothers are employed after their children begin school; this figure is higher than the OECD average of 66% and suggests that mothers in Canada are able to successfully balance family and career.

Another important aspect of work-life balance is the amount of time a person spends at work. Evidence suggests that long work hours may impair personal health, jeopardize safety and increase stress. People in Canada work 1699 hours a year, lower than the OECD average of 1739 hours.

The more people work, the less time they have to spend on other activities, such as time with others or leisure. The amount and quality of leisure time is important for people’s overall well-being, and can bring additional physical and mental health benefits. People in Canada devote 62% of their day, or 15 hours, to personal care (eating, sleeping, etc.) and leisure(socializing with friends and family, hobbies, games, computer and television use, etc.) – close to the OECD average.

Better Policies for Better Lives

Childcare support could help vulnerable families

Canada performs well in a number of key family indicators: fertility rates (1.7 children per women), gender pay gaps (20% at median earnings) and child poverty (at almost 15%) are all close to the OECD average. Female employment is higher than most OECD countries and children’s educational achievement as measured by PISA reading literacy values is amongst the highest in the OECD. However,  childcare enrolment of children under age six, at 40%, lags behind OECD standards.

Canada is a federal country and each province has different policies in this area. Of the Provinces, Québec arguably has the most comprehensive mix of family-friendly policies, including childcare and out-of-school childcare support, in-work benefits for parents, and paternity leave. However, affordability and quality in childcare remains an issue across Canada.

Particularly vulnerable are sole parents, whose childcare costs are amongst the highest in the OECD. Providing greater investment in childcare would both reduce costs of childcare to parents and increase the quality of service, with positive effects on child development.