A traditional marker of Canadian pride, the public heath care system, has come under fire recently for its continuing use of foreign trained doctors to combat a growing physician shortage in Canada. The system designed to ensure all Canadians have reasonable access to insured health services has itself become one of the greatest impediments to accessing quick medical services. On a 2005 list that ranked OECD countries for their doctor-to-population ratio, Canada was demoted to the 24th position, with a mere 2.3 doctors for every 1000 patients.
While a recent Supreme Court decision in favor of private health care has enabled, in the words of the president of the Canadian Medical Association Dr. Brian Day, hundreds of thousands of patients in pain and on long waiting lists for medical treatment to pursue alternative options to the public health care system, the privatization approach has not squarely addressed the question of how best to cure the shortage of doctors. Private healthcare may be an option for some; but the bigger picture requires an imminent solution to safeguarding Canada’s healthcare system.
The problem it seems arose in the early 1990’s when, following a long period of high physician-to-population ratio, provincial governments became actively involved in the management of such ratios by implementing policies designed to restrict school enrollments and post graduate training programs and in turn, the growth rate of the physician-to-population ratio in order to maintain a level that is now below the current demand for physician services in Canada. At issue was the safeguarding of provincial resources.
Over time, this policy has single handedly resulted in doctor shortages. To make up for the shortage of Canadian born, raised and trained physicians, foreign-trained doctors and international medical graduates (IMG’s) were employed to fill the gap. Thus began an ethical debate: whether International Medical Graduates (IMG’s) are taking away the opportunities of able Canadian students to become physicians and practice in Canada, and whether the recruitment of highly skilled immigrants is creating a drain of such professionals in less developed countries?
On the first argument, if schools can recruit from the potential pool of Canadian students who are able and willing to pursue a medical career, then by all means, recruit away. Medical schools should accept more students if the teaching hospitals and the university departments will agree that larger class sizes will not affect the quality of education that medical students receive and if the admission standards are not compromised. It is unlikely that Canadians would be in favor of lowering the requirements for entry just so that “more Canadians” can become doctors. Quality, not quantity, should always remain the focus when it comes to our healthcare.
But the second argument leads Canadians into a two edged sword. Advocates of the once popular brain drain debate, which argues that the best and the brightest of a developing nation are being lured away by better opportunities abroad, often overlook the fact that in today’s global economy both the home and host countries are increasingly benefiting from the international migration of highly skilled professionals. While the host country surely benefits from the influx of highly skilled labour and the research and training that such professionals can generate, the role of remittances being sent home by these skilled professionals, as research studies confirms, generates opportunities for local communities and national economies which in turn serves as a very powerful lever to ensure their participation in the international financial community.
Consideration also needs to be given to other ‘push and pull’ factors that influence the professional’s decision to migrate; while some may argue that it is unethical to recruit from developing countries and contribute to their brain drain, one must give consideration to the working conditions and the professional environment available in the home country. Is talent being ‘wasted’ in an environment where basic infrastructures are lacking?
Additionally, we cannot ignore the reality that recruitment may also serve as a means for improving the basic skills of a workforce by enabling professionals to acquire better training techniques abroad that are otherwise not available at home and which are then shared with the professional community in which they work. As a case in point, the Philippines is currently pursuing the long-term improvement in the skills base of their nursing workforce, the largest of its kind in the world, by encouraging short-term outflow of health care professionals to other countries. To constrain the mobility of these nurses from an opportunity elsewhere would be equally unethical; we must never overlook the rights of the individual to make such choices.
And, it is not only doctors from abroad who are practicing in Canada. Increasingly, Canadian doctors are also pursuing training programs and practical opportunities as are Canadian patients themselves increasingly willing to go abroad for treatment. Medical tourism is on the rise for Canadians, as www.treatmentabroad.net notes how an increasing number of “desperate” Canadians are traveling as far as India for affordable surgeries without the long waiting times that are the norm in Canada.
Clearly a meaningful discussion of health care issues in Canada, necessitates that critics and related interest groups understand the ethical platforms they are promoting must take into consideration all components of the balance sheet.
