Foreign-trained doctors practising in Canada declining substantially

CANADIAN INSTITUTE FOR HEALTH INFORMATIONAug 21 2009

Since the 1970s, the percentage of foreign-trained doctors practising in Canada has declined considerably. A new report released by the Canadian Institute for Health Information (CIHI) shows the number of international medical graduates (IMGs), as a proportion of the physician workforce in Canada, decreased from 33% in the 1970s to 22% in 2007.

The decline was seen in all provinces and in the territories and may be largely due to the aging and retirement of the wave of British- and Irish-trained physicians who began practising in earlier decades, as well as smaller proportions of new foreign-trained doctors setting up practice in Canada. The report also found that more than one-quarter (27%) of Canada's foreign-trained doctors actually grew up in Canada but studied overseas.

"The findings of the study were revealing," says Geoff Ballinger, Manager of Health Human Resources at CIHI. "Canada has been known to attract doctors from other countries; however, the proportion of these doctors has been declining since 1975."

The study found that the number of foreign-trained doctors varies between provinces, as well as between urban and rural areas. In 2007, Quebec (10.7%) and Prince Edward Island (13.8%) had the smallest proportion of foreign-trained doctors in their physician workforces, while Saskatchewan (48.8%) and Newfoundland and Labrador (35.2%) had the largest. The study also found that foreign-trained doctors who began to practise in the 1990s were significantly more likely to change province or territory over the next 10 years than those who began in the 1970s.

In all provinces, except Ontario and Quebec, doctors in rural areas were more likely to be foreign trained as opposed to doctors in urban settings. IMGs make up more than half (52.8%) of new physicians starting practices in rural or remote areas and represent approximately one-quarter (25.6%) of all doctors in rural or remote areas.

In the years following World War II, Canada's medical schools were challenged to keep pace with the expanding needs of the post-war population. Canada was viewed as an attractive place to live and relatively large numbers of foreign-trained doctors chose to emigrate here. As such, between the late 1960s and the early 1970s, Canada licensed more internationally trained doctors than it graduated domestically, and most of Canada's foreign-trained doctors came from Britain and Ireland.

From 2003 to 2007, the majority of new doctors (69.0%) practising in Canada were trained in Canadian medical schools. This time period also experienced a shift in the main providers of Canada's IMGs to South Africa (13.9% of all new IMGs), India (8.6%) and Egypt (6.3%).

The numbers of new IMGs entering Canada to practise medicine from member countries of the Organisation for Economic Co-operation and Development (OECD) have shown declines. In contrast, other than India and Hong Kong, all non-OECD countries included in the study have shown increases.

"It is interesting to see that Ireland is no longer on the list of top 10 supplier countries and that 8 of the 14 countries included in the study are non-OECD members," says John David Stanway, Senior Analyst of Health Human Resources at CIHI and lead author of the report. "Foreign-trained doctors are a declining proportion of our physician workforce; however, those from developing countries are a growing share of that group."